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Regional distribution of high-attenuation areas on chest computed tomography in the Multi-Ethnic Study of Atherosclerosis

Bina Choi, Steven M. Kawut, Ganesh Raghu, Eric Hoffman, Russell Tracy, Purnema Madahar, Elana J. Bernstein, R. Graham Barr, David J. Lederer, Anna Podolanczuk
ERJ Open Research 2020 6: 00115-2019; DOI: 10.1183/23120541.00115-2019
Bina Choi
1Columbia University Medical Center, New York, NY, USA
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Steven M. Kawut
2University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Ganesh Raghu
3University of Washington Medical Center, Seattle, WA, USA
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Eric Hoffman
4University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Russell Tracy
5University of Vermont, Burlington, VT, USA
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Purnema Madahar
1Columbia University Medical Center, New York, NY, USA
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Elana J. Bernstein
1Columbia University Medical Center, New York, NY, USA
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  • ORCID record for Elana J. Bernstein
R. Graham Barr
1Columbia University Medical Center, New York, NY, USA
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David J. Lederer
1Columbia University Medical Center, New York, NY, USA
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Anna Podolanczuk
1Columbia University Medical Center, New York, NY, USA
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  • For correspondence: ajp2158@cumc.columbia.edu
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  • FIGURE 1
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    FIGURE 1

    Multi-Ethnic Study of Atherosclerosis (MESA) cardiac computed tomography scan with superimposed lines to delineate examined lung regions. In this representative scan, the basilar region includes sections E, F, K, L. The non-basilar region includes sections A, B, C, D, G, H, I, J. The peel includes sections A, C, E, H, I, K. The core includes sections B, D, F, G, J, L. The basilar peel includes sections E, K. The basilar core includes sections F, L.

  • FIGURE 2
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    FIGURE 2

    Baseline regional high-attenuation areas (HAA).

  • FIGURE 3
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    FIGURE 3

    Odds ratios (OR; with 95% confidence intervals) of interstitial lung abnormalities (ILA) per doubling of high-attenuation areas (HAA).

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    FIGURE 4

    Hazard ratios (with 95% confidence intervals) of all-cause mortality per doubling of high-attenuation areas (HAA).

Tables

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  • TABLE 1

    Baseline characteristics of Multi-Ethnic Study of Atherosclerosis (MESA) participants

    Age years62±10
    Female3600 (53)
    Race/ethnicity
     White2622 (39)
     African American1892 (28)
     Hispanic1494 (22)
     Chinese American804 (12)
    BMI kg·m−228±5
     <2529%
     25–3039%
     >3032%
    Height cm166±10
    Waist circumference cm98±14
    Glomerular filtration rate81±18
    Smoking
     Never smoker50%
     Former smoker37%
     Current smoker13%

    Data are presented as mean±sd or n (%), unless otherwise stated. All parameters collected at MESA baseline visit in years 2000–2002. BMI: body mass index.

    • TABLE 2

      Associations of biomarkers, forced vital capacity, ILA, and all-cause and ILD-specific mortality with HAA in examined lung regions

      BasilarNon-basilarPeelCoreBasilar peelBasilar core
      Change per doubling HAA %p-valueChange per doubling HAA %p-valueChange per doubling HAA %p-valueChange per doubling HAA %p-valueChange per doubling HAA %p-valueChange per doubling HAA %p-value
      MMP-76.6 (2.6–10.8)0.0016.4 (2.5–10.4)0.0015.9 (2.2–9.8)0.00210.3 (4.7–16.3)<0.0015.8 (2.2–9.6)0.0023.8 (0.8–7.0)0.01
      IL-64.9 (1.5–8.4)0.00510.3 (6.5–14.2)<0.0017.3 (4.0–10.6)<0.0019.1 (4.0–14.4)<0.0015.5 (2.4–8.6)<0.0011.5 (−0.9–4.0)0.220
      SP-A4.9 (−1.1–11.3)0.1132.7 (−3.0–8.8)0.3625.2 (−0.5–11.1)0.0738.7 (0.2–17.8)0.044.2 (−1.3–10.0)0.140−0.1 (−4.7–4.8)0.973
      Change per doubling HAA mLp-valueChange per doubling HAA mLp-valueChange per doubling HAA mLp-valueChange per doubling HAA mLp-valueChange per doubling HAA mLp-valueChange per doubling HAA mLp-value
      FVC−28 (−57–0)0.051−113 (−151–−75)<0.001−26 (−58–5)0.099−186 (−226–−145)<0.001−15 (−42–12)0.226−115 (−142–−88)<0.001
      OR per doubling HAAp-valueOR per doubling HAAp-valueOR per doubling HAAp-valueOR per doubling HAAp-valueOR per doubling HAAp-valueOR per doubling HAAp-value
      ILA2.20 (1.66–2.90)<0.0011.54 (1.17–2.02)0.0021.79 (1.40–2.30)<0.0011.52 (1.04–2.24)0.031.87 (1.45–2.39)<0.0011.42 (1.14–1.76)0.001
      Hazard ratio per doubling HAAp ValueHazard ratio per doubling HAAp ValueHazard ratio per doubling HAAp ValueHazard ratio per doubling HAAp ValueHazard ratio per doubling HAAp ValueHazard ratio per doubling HAAp Value
      All-cause mortality1.25 (1.10–1.42)<0.0011.47 (1.29–1.66)<0.0011.41 (1.26–1.58)<0.0011.35 (1.13–1.62)0.0011.21 (1.08–1.36)0.0011.20 (1.09–1.32)<0.001
      ILD mortality#3.98 (2.10–7.55)<0.0013.44 (2.13–5.56)<0.0013.94 (2.36–6.56)<0.0013.30 (1.83–5.93)<0.0013.89 (2.08–7.29)<0.0011.83 (0.97–3.46)0.061

      Data are presented as mean (95% CI). All analyses adjusted for age, sex, race/ethnicity, body mass index (BMI), waist circumference, smoking status, pack–years, educational attainment, renal function, total volume of imaged lung (not in FVC analysis), percentage emphysema, mA dose and study site. HAA: high attenuation areas; MMP-7: matrix metalloproteinase-7; IL-6: interleukin-6; SP-A: surfactant protein-A; FVC: forced vital capacity; ILA: interstitial lung abnormalities. #: Adjusted for generalised propensity score, which includes age, sex, race/ethnicity, BMI, waist circumference, smoking status, pack-years, educational attainment, renal function, total volume of imaged lung, percentage emphysema, mA dose, study site, alcohol use, total intentional exercise (metabolic equivalent min·wk−1), coronary artery calcium, diabetes medication use, insulin use, fasting glucose, hypertension, antihypertensive medication use, systolic and diastolic blood pressures, cholesterol medication use, total and high-density lipoprotein cholesterol levels, C-reactive protein, d-dimer and cancer history.

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      Regional distribution of high-attenuation areas on chest computed tomography in the Multi-Ethnic Study of Atherosclerosis
      Bina Choi, Steven M. Kawut, Ganesh Raghu, Eric Hoffman, Russell Tracy, Purnema Madahar, Elana J. Bernstein, R. Graham Barr, David J. Lederer, Anna Podolanczuk
      ERJ Open Research Jan 2020, 6 (1) 00115-2019; DOI: 10.1183/23120541.00115-2019

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      Regional distribution of high-attenuation areas on chest computed tomography in the Multi-Ethnic Study of Atherosclerosis
      Bina Choi, Steven M. Kawut, Ganesh Raghu, Eric Hoffman, Russell Tracy, Purnema Madahar, Elana J. Bernstein, R. Graham Barr, David J. Lederer, Anna Podolanczuk
      ERJ Open Research Jan 2020, 6 (1) 00115-2019; DOI: 10.1183/23120541.00115-2019
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