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Association Between Emphysema-like Lung on Cardiac Computed Tomography and Mortality in Persons Without Airflow Obstruction

Year: 2014
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Low lung function is known to predict mortality in the general population, but the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease (COPD) is uncertain. OBJECTIVE: To determine whether greater emphysema-like lung on CT is associated with all-cause mortality among persons in the general population without airflow obstruction or COPD. DESIGN: Prospective cohort study. SETTING: Population-based, multiethnic sample from 6 U.S. communities. PARTICIPANTS: 2965 participants aged 45 to 84 years without airflow obstruction on spirometry. MEASUREMENTS: Emphysema-like lung was defined as the number of lung voxels with attenuation less than -950 Hounsfield units on cardiac CT and was adjusted for the number of total imaged lung voxels. RESULTS: Among 2965 participants, 50.9% of whom had never smoked, there were 186 deaths over a median of 6.2 years. Greater emphysema-like lung was independently associated with increased mortality (adjusted hazard ratio per one-half interquartile range, 1.14 [95% CI, 1.04 to 1.24]; P=0.004) after adjustment for potential confounders, including cardiovascular risk factors and FEV1. Generalized additive models supported a linear association between emphysema-like lung and mortality without evidence for a threshold. The association was of greatest magnitude among smokers, although multiplicative interaction terms did not support effect modification by smoking status. LIMITATIONS: Cardiac CT scans did not include lung apices. The number of deaths was limited among subgroup analyses. CONCLUSION: Emphysema-like lung on CT was associated with all-cause mortality among persons without airflow obstruction or COPD in a general population sample, particularly among smokers. Recognition of the independent prognostic significance of emphysema on CT among patients without COPD on spirometry is warranted. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute.
DOI: 10.7326/m13-2570
Authors: Elizabeth C. Oelsner, Eric A. Hoffman, Aaron R. Folsom, J. Jeffrey Carr, Paul L. Enright, Steven M. Kawut, Richard Kronmal, David Lederer, Joao A.C. Lima, Gina S. Lovasi, Steven Shea, R. Graham Barr
Institutions: University of Iowa, University of Minnesota, University of Arizona, Johns Hopkins University, University of Washington, Wake Forest University, Columbia University, University of Pennsylvania
Language: English
Field: Medicine
Open Access status: green
Awards: G1261793039, MESA, G1276754516, G1409423729, G1640378483, G2144938473, G22458031, MESA, Clinical and Translational Science Award, Institute for Clinical and Translational Research (UL1), MESA, G2837638605, G290884426, G291913881, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--EBCT READING, Subclinical Interstitial Lung Disease in MESA and FAR-ILD, G3647016462, MESA, TITLE: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA), G4851387139, OPTION 3. 4/1/2014 - 3/31/2015. MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) - READING CENTER, NHLBI, MESA, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-ULTRASOUND, Multi-center Structural & Functional Quantitative CT Pulmonary Phenotyping, Mentored Patient-Oriented Research in Pulmonary Arterial Hypertension, Genome-wide and Linkage Study of Quantitative Emphysema Phenotypes, MESA, G66341962, G6710751198, MESA, G78770644, Combined Cardiopulmonary Failure in COPD: SPIROMICS HF, Precision phenotyping of emphysema in the elderly: the MESA Lung Study, Center for Environmental Health in Northern Manhattan, G991334795
OpenAlex ID: W2068990840
FWCI: 6.42
Cites: 69
Cited by: 93
Related to: 10