The clinical impact of pulmonary vascular remodeling in smokers

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子。以往的研究和观察表明，吸烟者可能有几种病理性肺血管重构。这些症状包括进行性管腔闭塞引起的炎症性重塑，恶性膨胀区血管异常延伸，严重肺气肿破坏区血管完全丧失。虽然现有的工具可用于研究这些过程的综合效应，如右心导管、超声心动图和一氧化碳弥散能力（DLCO）的测量，但没有一种工具可以区分血管重构/变形的类型及其对临床损害的相对贡献。本研究的目的是提高对吸烟者肺血管重构的临床影响和流行病学相关性的认识。我们将对所有参加COPDGene研究的受试者进行基于CT的纵隔（Aim 1）和实质内血管（Aim 2）定量测量，然后用超声心动图、心脏MRI和DLCO测量（Aim 3）对这些测量进行临床验证。在目标3的最后步骤中，我们将检查肺部和心血管疾病（包括临床诊断的心血管疾病和冠状动脉和胸主动脉钙化）之间的重叠和关联，以及肺血管形态与运动能力、COPD急性加重、症状和死亡率之间的关系。我们相信，这将导致对慢性阻塞性肺病病理生理学的更好理解，并可能最终改善慢性阻塞性肺病患者的护理。

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.