The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive ...pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions.
The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers.
Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50
(DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk.
The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio OR=1.09, 95% confidence interval CI:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18).
Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.
MR imaging is widely used in the radiological diagnosis of oncology patients as it provides excellent soft tissue differentiation using routine anatomical MR imaging. A variety of MR acquisition ...sequences are available which can yield images of biophysical, physiological, metabolic, or functional properties of tissues. Imaging of response to oncological treatments has traditionally used single or multidirectional measurements of tumour dimensions following completion of therapy. Development of an MR imaging biomarker that would allow for early prediction of tumour response to therapeutic intervention would be a significant achievement as it could individualize clinical management of cancer patients in a timely fashion and improve outcome. This goal is very important as standard risk factors currently used in patient assessment cannot account for the variable and unpredictable treatment responses encountered by patients with similar risk profiles. This chapter will overview the use of diffusion-weighted MR imaging (DW-MRI) as a method of providing a potentially early surrogate marker of response to therapy in oncological imaging.
Individuals with chronic obstructive pulmonary disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions.
Examine the impact of ...depressive symptoms compared with FEV
% on COPD morbidity.
Using longitudinal data from individuals with COPD in the Subpopulations and Intermediate Outcome Measures in COPD Study, longitudinal growth analysis was performed to assess COPD morbidity by assessing differences in baseline 6-minute walk distance and patient reported outcomes (PROs) and their rate of change over time explained by depressive symptoms or lung function, as measured by Hospital Anxiety and Depression Scale or FEV
% respectively. PROs consisted of in-person completion of St. George's Respiratory Questionnaire, COPD Assessment Test, Functional Assessment of Chronic Illness Therapy Fatigue, and Modified Medical Research Council Dyspnea Scale measures.
Of the individuals analyzed (
= 1,830), 43% were female, 81% Caucasian with mean ± SD age of 65.1 ± 8.1, and 52.7 ± 27.5 pack-years smoking. Mean ± SD FEV
% was 60.9 ± 23.0% and 20% had clinically significant depressive symptoms. Adjusted models showed higher Hospital Anxiety and Depression Scale scores and lower FEV
% each were associated with worse PROs at baseline (
⩽ 0.001). Depression accounted for more baseline variance in St. George's Respiratory Questionnaire, COPD Assessment Test, and Functional Assessment of Chronic Illness Therapy Fatigue than FEV
%, explaining 30-67% of heterogeneity. FEV
% accounted for more baseline variance in Modified Medical Research Council Dyspnea Scale and 6-minute walk distance than depression, explaining 16-32% of heterogeneity. Depressive symptoms accounted for 3-17% variance in change over time in PROs. In contrast, FEV
% accounted for 1-4% variance over time in PROs.
Depression is more strongly associated with many PROs at baseline and their change over time compared with FEV
%. Recognizing and incorporating the impact of depressive symptoms into individualized care may improve COPD outcomes.
It has been suggested that patients with chronic obstructive pulmonary disease (COPD) experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and ...understand the implications of day-to-day symptom variability.
To compare standard deviation with other statistical measures of symptom variability and identify characteristics of individuals with higher symptom variability.
Individuals in the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained 4 weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during 4 follow-up weeks was explored.
Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week 4 was 0.32. Higher variability participants had higher St George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 versus 39.6 ± 21.5,
=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and health care resource utilization-defined exacerbations.
WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.
RationaleBronchiectasis is common among those with heavy smoking histories, but risk factors for bronchiectasis, including alpha-1 antitrypsin deficiency, and its implications for COPD severity are ...uncharacterized in such individuals.ObjectivesTo characterize the impact of bronchiectasis on COPD and explore alpha-1antitrypsin as a risk factor for bronchiectasis.MethodsSubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) participants (N=914; ages 40-80 years; ≥20-pack-year smoking) had high-resolution computed tomography (CT) scans interpreted visually for bronchiectasis, based on airway dilation without fibrosis or cicatrization. We performed regression-based models of bronchiectasis with clinical outcomes and quantitative CT measures. We deeply sequenced the gene encoding -alpha-1 antitrypsin, SERPINA1, in 835 participants to test for rare variants, focusing on the PiZ genotype (Glu366Lys, rs28929474).Measurements and Main ResultsWe identified bronchiectasis in 365 (40%) participants, more frequently in women (45% versus 36%, p=0.0045), older participants (mean age=66standard deviation (SD)=8.3 versus 64SD=9.1 years, p=0.0083), and those with lower lung function (forced expiratory volume in 1 second FEV1 percentage predicted=66%SD=27 versus 77%SD=25, p<0.0001; FEV1 to forced vital capacity FVC ratio=0.540.17 versus 0.63SD=0.16, p<0.0001). Participants with bronchiectasis had greater emphysema (%voxels ≤-950 Hounsfield units, 11%SD=12 versus 6.3%SD=9, p<0.0001) and parametric response mapping functional small airways disease (26SD=15 versus 19SD=15, p<0.0001). Bronchiectasis was more frequent in the combined PiZZ and PiMZ genotype groups compared to those without PiZ, PiS, or other rare pathogenic variants (N=21 of 40 52% versus N=283 of 70740%, odds ratio OR=1.97; 95% confidence interval CI=1.002, 3.90, p=0.049), an association attributed to White individuals (OR=1.98; 95%CI = 0.9956, 3.9; p=0.051).ConclusionsBronchiectasis was common in those with heavy smoking histories and was associated with detrimental clinical and radiographic outcomes. Our findings support alpha-1antitrypsin guideline recommendations to screen for alpha-1 antitrypsin deficiency in an appropriate bronchiectasis subgroup with a significant smoking history.
Various aneurysm animal models have been utilized to study the histological reaction post coil embolization. Our aim was to evaluate the imaging findings at day 14 of a rat external carotid artery ...side wall aneurysm treated with coil embolization using a gradient echo sequence on 7 T MRI and to correlate this with the histological findings.
Male Sprague Drawley rats were utilized to create a sidewall external carotid artery blind pouch aneurysm. A 5 mm segment of hydrocoil or bare platinum coil was inserted into the created aneurysm. Five sham operated rats were used as controls. The arterial construct was harvested on day 14. The block of tissue was evaluated with histopathology and immunohistochemistry. Prior to sacrifice, the animal underwent 7 T MRI. Statistical analysis was then performed to assess the correlation of signal abnormality with intra-aneurysmal thrombus formation on histology.
10 rats were used for the experiment. Five rats had implantation of hydrocoils and five of bare platinum coils. There was a statistically significant linear correlation between the intra-aneurysmal thrombus on histology and gradient echo 7 T MRI sequences. There was no correlation demonstrated in the hydrocoil implanted group. No thrombus or abnormal signal was seen in the sham group.
In our experiment, thrombus formation in aneurysms treated with bare platinum coils is well correlated with the presence of abnormal signal on 7 T MRI at 14 days. No correlation was appreciated in the hydrocoil implanted group due to the presence of intra-aneurysmal reactive tissue instead of thrombus.
