The clinical impact of pulmonary vascular remodeling in smokers

吸烟者肺血管重塑的临床影响

基本信息

批准号：
8793809
负责人：
Raul San Jose Estepar
金额：
$ 46.29万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-02-01 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8793809
关键词：
Acute Age Algorithmic Software Algorithms Aorta Arteries Atherosclerosis Back Blood Vessels Blood Volume Caliber Carbon Monoxide Cardiac Cardiac Catheterization Procedures Cardiovascular Diseases Chest Chronic Obstructive Airway Disease Clinical Cohort Studies Coronary Coronary artery Data Diffuse Diffusion Disease Distal Dropout Drops Echocardiography Enrollment Epidemiology Exercise Functional disorder Impairment Inflammation Inflammatory Investigation Label Lead Length Lung Lung diseases Magnetic Resonance Imaging Measurement Measures Mechanics Mediastinal Methods Morbidity - disease rate Morphology Nature Obstruction Outcome Pathologic Patient Care Patients Phenotype Process Pulmonary Emphysema Pulmonary artery structure Pulmonary veins Relative (related person)Research Research Personnel Respiratory physiology Scanning Severities Smoker Smoking Symptoms Testing Vascular Diseases Vascular remodeling Veins base calcification clinical Diagnosis clinically significant cohort epidemiologic data functional disability health care service utilization heart function image processing improved insight lung lobe mortality pressure public health relevance sex software development tool

项目摘要

DESCRIPTION (provided by investigator): Smoking related pulmonary vascular disease has been demonstrated to be an independent predictor of morbidity and mortality in patients with COPD. Previous investigation and observation suggests that there are several types of pathologic pulmonary vascular remodeling possible in smokers. These range from inflammatory remodeling with progressive luminal occlusion, aberrant vessel elongation in regions of hyperinflation, and outright loss of vasculature in regions of severe emphysematous destruction. While there are existing tools that may be used to investigate the aggregate effect of these processes such as right heart catheterization, echocardiography, and measurements of diffusing capacity for carbon monoxide (DLCO), none can differentiate the types of vascular remodeling/deformation present nor their relative contribution to clinical impairment. The purpose of this investigation is to improve understanding of the clinical impact and epidemiologic associations of pulmonary vascular remodeling in smokers. We will do this by performing CT based quantitative measures of the mediastinal (Aim 1) and intra-parenchymal vasculature (Aim 2) in all subjects enrolled in the COPDGene Study and then clinically validating these measures with echocardiography, cardiac MRI and measures of DLCO (Aim 3). In the final steps of Aim 3 we will examine the overlap and associations between pulmonary and cardiovascular disease (both clinical diagnosed CVD and both coronary and thoracic aortic calcification) and the relationship between pulmonary vascular morphology and exercise capacity, acute exacerbations of COPD, symptoms, and mortality. We believe that this will lead to improved understanding of the pathophysiology of COPD and may ultimately improve the care of patients with COPD.

描述（研究人员提供）：与吸烟相关的肺血管疾病已被证明是COPD患者发病率和死亡率的独立预测指标。先前的研究和观察表明，吸烟者可能有几种类型的病理肺血管重塑。这些范围从炎症重塑，进行性腔内闭塞，过度充电区域的异常血管伸长以及严重强质性破坏区域的脉管系统的彻底丧失。尽管有一些现有工具可用于研究这些过程的总体效应，例如右心导管插入术，超声心动图和一氧化碳散射能力的测量值（DLCO），但没有一个可以区分血管重塑/变形的类型，它们的类型和对临床受损的相对贡献也表现出相对的贡献。这项研究的目的是提高对吸烟者肺血管重塑的临床影响和流行病学关联的了解。我们将通过对COPDGENE研究入学的所有受试者中的纵隔（AIM 1）和副作用脉管系统（AIM 2）进行基于CT的定量度量（AIM 2）来做到这一点，然后通过超声心动图，心脏MRI和DLCO的测量（AIM 3）对这些措施进行临床验证。在目标3的最后一步中，我们将检查肺和心血管疾病之间的重叠和关联（临床诊断的CVD以及冠状动脉和胸部主动脉钙化）以及肺血管形态和运动能力之间的关系，COPD的急性恶化，COPD，症状和死亡率。我们认为，这将导致人们对COPD的病理生理学的了解，并最终可能改善COPD患者的护理。