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. 2018 Nov 23;4(4):00044-2018.
doi: 10.1183/23120541.00044-2018. eCollection 2018 Oct.

Pulmonary vascular pruning in smokers with bronchiectasis

Alejandro A Diaz  1 , Diego J Maselli  2 , Farbod Rahaghi  1 , Carolyn E Come  1 , Andrew Yen  3 , Erick S Maclean  1 , Yuka Okajima  1 , Carlos H Martinez  4 , Tsuneo Yamashiro  5 , David A Lynch  6 , Wei Wang  7 , Gregory L Kinney  8 , George R Washko  1 , Raúl San José Estépar  9
Affiliations

Pulmonary vascular pruning in smokers with bronchiectasis

Alejandro A Diaz et al. ERJ Open Res. .

Abstract

There are few studies looking at the pulmonary circulation in subjects with bronchiectasis. We aimed to evaluate the intraparenchymal pulmonary vascular structure, using noncontrast chest computed tomography (CT), and its clinical implications in smokers with radiographic bronchiectasis. Visual bronchiectasis scoring and quantitative assessment of the intraparenchymal pulmonary vasculature were performed on CT scans from 486 smokers. Clinical, lung function and 6-min walk test (6MWT) data were also collected. The ratio of blood vessel volume in vessels <5 mm2 in cross-section (BV5) to total blood vessel volume (TBV) was used as measure of vascular pruning, with lower values indicating more pruning. Whole-lung and lobar BV5/TBV values were determined, and regression analyses were used to assess the differences in BV5/TBV between subjects with and without bronchiectasis. 155 (31.9%) smokers had bronchiectasis, which was, on average, mild in severity. Compared to subjects without bronchiectasis, those with lower-lobe bronchiectasis had greater vascular pruning in adjusted models. Among subjects with bronchiectasis, those with vascular pruning had lower forced expiratory volume in 1 s and 6MWT distance compared to those without vascular pruning. Smokers with mild radiographic bronchiectasis appear to have pruning of the distal pulmonary vasculature and this pruning is associated with measures of disease severity.

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Conflict of interest statement

Conflict of interest: A.A. Diaz received research grants from the NIH and Brigham and Women's Hospital, and speaker fees from Novartis Inc. outside of the submitted work. Conflict of interest: D.J. Maselli has nothing to disclose. Conflict of interest: F. Rahaghi has nothing to disclose. Conflict of interest: C.E. Come received NIH/NHLBI grant K23HL114735 during the conduct of the study. Conflict of interest: A. Yen reports receiving salary support from the NIH under COPDGene R01-HL089897 during the conduct of the study. Conflict of interest: E.S. Maclean has nothing to disclose. Conflict of interest: Y. Okajima reports receiving grants from Canon Medical Systems, grants from Ziosoft, outside the submitted work. Conflict of interest: C.H. Martinez has nothing to disclose. Conflict of interest: T. Yamashiro has nothing to disclose. Conflict of interest: D.A. Lynch reports receiving grants from the NHLBI, research supports from Parexel and Veracyte, and personal fees from Boehringer Ingelheim and Genentech/Roche, outside the submitted work. Conflict of interest: W. Wang has nothing to disclose. Conflict of interest: G.L. Kinney has nothing to disclose. Conflict of interest: G.R. Washko reports receiving grants from the NIH, grants and other support from Boehringer Ingelheim, and other support from Genentech, Quantitative Imaging Solutions and PulmonX, during the conduct of the study. G.R. Washko's spouse works for Biogen, which is focused on developing therapies for fibrotic lung disease. Conflict of interest: R. San José Estépar reports receiving grants from the NHLBI during the conduct of the study. He is founder and co-owner of Quantitative Imaging Solutions, which is a company that provides image-based consulting and develops software to enable data sharing.

Figures

FIGURE 1
FIGURE 1
Illustration of intraparenchymal pulmonary vascular pruning in bronchiectasis. Axial computed tomography images of the right lower lobe (RLL) from subjects a) without and b) with bronchiectasis. c and d) Three-dimensional reconstructions of the intraparenchymal pulmonary vascular tree of the right lung from the same subjects. Note the lack of pulmonary vessels in the RLL from the subject with bronchiectasis (d). e) Plot of RLL blood vessel volume to the vessel size for both subjects. Note a lower peak in blood vessel volume of small, distal pulmonary vessels in the RLL of bronchiectatic lung compared with nonbronchiectatic lung.
FIGURE 2
FIGURE 2
a) Forced expiratory volume in 1 s (FEV1) and b) 6-min walk test (6MWT) distance by bronchiectasis in any lobe/vascular pruning in the lower lobes groups (n=485). Group 0: bronchiectasis−/vascular pruning− (n=187); group 1: bronchiectasis+/vascular pruning− (n=82); group 2: bronchiectasis−/vascular pruning+ (n=143); group 3: bronchiectasis+/vascular pruning+ (n=73). Note that group 3 had lower FEV1 and 6MWT distance than group 1. p-values are from univariate models. See the main text for the results of the adjusted models. One subject was excluded from these analyses because of a missing right lower lobe ratio of blood vessel volume in vessels <5 mm2 in cross-section to total blood vessel volume, leaving a sample size of 485. The 6MWT distance measurement was missing in two additional subjects.
See this image and copyright information in PMC

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