The clinical impact of pulmonary vascular remodeling in smokers

吸烟者肺血管重塑的临床影响

• 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
• 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

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（由研究者提供）：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因素。先前的调查和观察表明，吸烟者可能存在几种类型的病理性肺血管重塑。这些范围包括进行性管腔闭塞的炎症重塑、过度充气区域的异常血管伸长以及严重肺气肿破坏区域的脉管系统彻底丧失。虽然现有的工具可用于研究这些过程的综合效应，例如右心导管插入术、超声心动图和一氧化碳扩散能力 (DLCO) 的测量，但没有一个工具可以区分存在的血管重塑/变形的类型及其产生的影响。对临床损伤的相对贡献。本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。我们将通过对参加 COPDGene 研究的所有受试者进行基于 CT 的纵隔（目标 1）和实质内脉管系统（目标 2）定量测量，然后通过超声心动图、心脏 MRI 和 DLCO 测量对这些测量进行临床验证（目标3）。在目标 3 的最后步骤中，我们将检查肺部和心血管疾病（临床诊断的 CVD 以及冠状动脉和胸主动脉钙化）之间的重叠和关联，以及肺血管形态和运动能力、COPD 急性加重、症状、和死亡率。我们相信，这将提高对慢性阻塞性肺病病理生理学的了解，并可能最终改善慢性阻塞性肺病患者的护理。