Pulmonary Vascular

Disease in COPD: What

CT can teach us
George Washko M.D.
Applied Chest Imaging Laboratory
Brigham and Women’s Hospital
May 2010
 Pulmonary Arterial Hypertension
• Defined by mean pulmonary artery pressure
 > 25 mm Hg at rest, or

 > 30 mm Hg during exercise

• Measured by non invasive echocardiogram but fraught with error

 COPD and PVD
 Estimated prevalence of disease 26–
90%1,2

 Presence associated with

• Increased health care utilization3
• Increased mortality4

1. NEJM 1972;286:912-8
2. AJRCCM 2002;166:314-22
3. AJRCCM 1999;159:158-64
4. Am Rev Resp Dis 1979;119:895-902
BOLD Study – Burden of
Obstructive Lung Disease

Buist. Proc Am Thorac Soc. 2008; 5:796-799

Three Key Players in Vascular
Related Smoking Pathology

• Vessel Remodeling
• Inflammation
• Endothelial dysfunction

Changes are seen in “healthy” heavy

smokers NOT just those with
quantifiable airways obstruction
Slide provided by Philippe Grenier
Slide provided by Philippe Grenier
Normal

Emphysema
Cross Sectional Area (CSA)

CSA:
•Cross sectional area of
“dots”
•CSA < 5mm2
•CSA 5-10mm2
•%CSA<5mm2 =
ΣCSA<5mm2
Total Axial Area
NLST Cohort (n=191)
Age (years) 62 ± 5

Pack Years 52 ± 29

FEV1 % 74.2 ± 20.5

Predicted

FEV1 / FVC 0.63 ± 0.13

NLST
 NETT (n=79)
　 　 Mean SD

Age (y) 65 7

Gender, % female (%) 41.8

BMI 25.3 4.3

FEV1 (% predicted) 28.0 6.5

TLC (% predicted) 125.6 12.2

RV (% predicted) 220.4 45.6

DLCO (% predicted) 27.2 8.2

PaO2 64.5 9.9

%LAA-950 　 26.1 11.7

NETT
NETT
 LTRC (n=51)
Demographics, pulmonary function, and CT measurements

　 Mean SD Range
Age (y) 66 9 47 - 82
Gender, % female (%) 42.8
BMI 26.3 4.6 16.5 - 41.8
Pack-Years 48.0 30.8 1 - 128
FEV1% predicted (%) 50.4 23.7 16.0 - 93.0
FEV1/FVC 0.46 0.15 0.23 - 0.69
DLco% predicted (%) 54.4 21.9 22.0 - 98.0
%CSA<5 (%) 0.63 0.15 0.38 - 1.02
%LAA-950 (%) 20.9 15.1 0.4 – 47.9
LTRC
 What can CT teach us?
 Burden of disease exists as a continuum
 Potential for widespread identification of
disease
 Facilitate population based research in
disease mechanisms

 How to apply the two in clinical

investigation and ultimately clinical care?
Questions?