The clinical impact of longitudinal measures of cardiac and pulmonary vascular morphology in smokers

项目概要/摘要： 在美国，COPD影响多达2400万人，据估计，这些患者中的30%至70% 有临床意义的肺血管疾病（PVD）。虽然观察到的平均肺动脉压增加 动脉压往往是轻度或中度，他们已被证明是独立的预测保健 利用率和死亡率。尽管PVD合并继发性肺动脉高压是肺动脉高压的晚期表现， 慢性烟草烟雾暴露和有一个连续的变化，肺血管和心脏 反映了疾病的演变。吸烟者的实质中最早可观察到的变化之一是 肺血管重构这些变化已在肺功能正常的受试者中描述， 被认为是肺实质气肿性破坏的前兆。后续进展 肺气肿和过度充气会导致心脏功能受损。左心室舒张容积 减少和右心室扩张，理论上这两者都是由于隐匿性肺血管 疾病和肺血管阻力升高。我们对这些过程的了解有限， 它是基于不同的临床研究的聚合，采用了一系列的调查技术， 如心导管插入术、组织病理学、超声心动图和心脏磁共振成像。这些 工具在很大程度上不能区分血流动力学显著形态学变化的贡献， 吸烟者的肺，如实质过度膨胀区域的血管伸长，远端 小血管和肺气肿区域广泛缺乏血管床。我们先前已经 在第一轮COPDGene CT扫描中对这些特征进行了详细的研究， 对于R 01 HL 0144624的申请，我们建议检查其随时间的进展，对双心室的影响， 形态学以及与临床相关结果的相关性。 我们建议对肺血管的临床相关性进行纵向研究， 在COPDGene研究中招募的6000名受试者的心脏形态学。为此，我们已经收集了一个 由肺病学家、计算机科学家、流行病学家、放射学家和统计学家组成的多学科团队。我们 我们将使用4D对比增强心脏CT扫描和配对的 心脏门控CT扫描和心脏超声心动图。然后，我们将部署这些工具以及 我们的血管分割算法在所有第1轮，第2轮和第3轮COPDGene CT扫描收集 在10年的观察期内，以标准化的时间间隔。

Project Summary/Abstract: COPD affects up to 24 million people in the United States and it is estimated that 30 to 70% of these patients have clinically significant pulmonary vascular disease (PVD). While the observed increases in mean pulmonary arterial pressure tend to be mild or moderate, they have been shown to be independent predictors of health care utilization and mortality. PVD with secondary pulmonary hypertension, though, is a late stage manifestation of chronic tobacco smoke exposure and there is a continuum of changes to the pulmonary vasculature and heart that reflect the evolution of disease. One of the earliest observable changes in the parenchyma of smokers is pulmonary vascular remodeling. These changes have been described in subjects with normal lung function and are thought to be the precursor to emphysematous destruction of the parenchyma. The subsequent progression of emphysema and hyperinflation then leads to impaired cardiac function. Diastolic volumes of the left ventricle decrease and right ventricle dilates, both of which have been theorized to be due to occult pulmonary vascular disease and elevations in pulmonary vascular resistance. Our knowledge of these processes is limited because it is based upon an aggregation of disparate clinical studies employing an array of investigative techniques such as cardiac catheterization, histopathology, echocardiography, and cardiac magnetic resonance imaging. These tools are largely unable to discriminate the contributions of hemodynamically significant morphologic changes in the lungs of smokers such as vessel elongation in hyperinflated regions of the parenchyma, pruning of the distal small vessels, and widespread absence of a vascular bed due in regions of emphysema. We have previously performed a detailed investigation of these features in the Round 1 COPDGene CT scans and with this renewal application for R01 HL0144624, we are proposing to examine their progression over time, effect on biventricular morphology, and association with clinically relevant outcomes. We are proposing to perform a longitudinal investigation of the clinical relevance of pulmonary vascular and cardiac morphology in 6000 subjects enrolled in the COPDGene Study. To do this we have assembled a multidisciplinary team of pulmonologists, computer scientists, epidemiologists, radiologists, and statisticians. We will refine our surface fitting model of the heart using both 4D contrast enhanced cardiac CT scans and paired cardiac gated CT scans and echocardiograms in the CARDIA Study. We will then deploy these tools as well as our vascular segmentation algorithms in all the Round 1, Round 2 and Round 3 COPDGene CT scans collected at standardized intervals over a 10 year period of observation.