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Abstract
Background Pulmonary microvasculature alterations are implicated in emphysema pathogenesis, but the association between pulmonary microvascular blood volume (PMBV) and emphysema has not been directly assessed at scale, and prior studies have used non-specific measures of emphysema.
Methods The Multi-Ethnic Study of Atherosclerosis Lung Study invited participants recruited from the community without renal impairment to undergo contrast-enhanced dual-energy CT. Pulmonary blood volume was calculated by material decomposition; PMBV was defined as blood volume in the peripheral 2 cm of the lung. Non-contrast CT was acquired to assess per cent emphysema and novel CT emphysema subtypes, which include the diffuse emphysema subtype and small-airways-related combined bronchitic-apical emphysema subtype. Generalised linear regression models included age, sex, race/ethnicity, body size, smoking, total lung volume and small airway count.
Results Among 495 participants, 53% were never-smokers and the race/ethnic distribution was 35% white, 31% black, 15% Hispanic and 18% Asian. Mean PMBV was 352±120 mL; mean per cent emphysema was 4.95±4.75%. Lower PMBV was associated with greater per cent emphysema (−0.90% per 100 mL PMBV, 95% CI: −1.29 to –0.51). The association was of larger magnitude in participants with 10 or more pack-years smoking and airflow obstruction, but present among participants with no smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype (−1.48% per 100 mL PMBV, 95% CI: −2.31 to –0.55).
Conclusion In this community-based study, lower PMBV was associated with greater per cent emphysema, including in participants without a smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype.
- Emphysema
Data availability statement
Data are available upon reasonable request. The data sets supporting the conclusions of this article can be accessed by reasonable request to MESA Publication and Presentations (https://www.mesa-nhlbi.org) in compliance with MESA and NHLBI/NIH data privacy and sharing standard practices and policy.
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Data availability statement
Data are available upon reasonable request. The data sets supporting the conclusions of this article can be accessed by reasonable request to MESA Publication and Presentations (https://www.mesa-nhlbi.org) in compliance with MESA and NHLBI/NIH data privacy and sharing standard practices and policy.
Footnotes
X @DWKaczka, @ErinMichos
Contributors EAHe is responsible for the overall content of this manuscript as the guarantor. EAHe and RGB had full access to the study data and take responsibility for the integrity of the data and accuracy of the data analysis. EAHo, AM and YS made substantial contributions to the conception, design, analysis and interpretation of the data. EAHe, AM, EAHo, YS, NA, EDA, AGB, DAB, SEG, JG, DWK, AL, EM, PN, JSP, CSS, BS, KHS, KEW, AW and RGB drafted the submitted article or revised it critically for important intellectual content. EAHe, AM, EAHo, YS, NA, EDA, AGB, DAB, SEG, JG, DWK, AL, EM, PN, JSP, CSS, BS, KHS, KEW, AW and RGB provided final approval of the version to be published.
Funding This research was supported by grants R01-HL077612, R01-HL121270, R01-HL155816-02, R01-HL071759 and R01-HL093081 and contracts 75N92020D00002, 75N92020D00001, 75N92020D00005, 75N92020D00002, 75N92020D00003, 75N92020D00006, 75N92020D00004, 75N92020D00007, N01-HC-95159 through N01-HC-95169 from the National Heart, Lung and Blood Institute.
Competing interests EAHo is a founder and shareholder of VIDA Diagnostics, which makes the software used for secondary per cent emphysema measures in this article. YS and NA report receiving grants from the NIH. JG is a shareholder of VIDA Diagnostics and reports receiving grants from the NIH. DWK acknowledges grant support from the US Department of Defense and ZOLL Medical Corporation for work unrelated to this study, is a co-founder and shareholder of OscillaVent, and is listed as a co-inventor on US and European patents related to multi-frequency oscillatory ventilation. Unrelated to this work, EDM reports consulting fees paid by Amgen, AstraZeneca, Boehringer Ingelheim, Edwards Lifescience, Esperion, Medtronic, Merck, Novo Nordisk, Novartis, New Amsterdam and Pfizer. Unrelated to this work, PN reports receiving grant funding from GE Healthcare, consulting fees from Cannon, honoraria from the Society of Cardiovascular CT and American Society of Nuclear Cardiology, as well as owning stock in Moderna. BS reports receiving grants from the NIH, Canadian Institutes of Health Research, Fonds de la recherche en santé du Québec and the Research Institute of the McGill University Health Centre. RGB reports receiving grants from the COPD Foundation, the US Environmental Protection Agency, the American Lung Association and the NIH.
Provenance and peer review Not commissioned; externally peer reviewed.
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