Pulmonary Artery Enlargement is Associated with Exacerbations and Mortality in Ever-Smokers with Preserved Ratio Impaired Spirometry (PRISm)

Preserved ratio impaired spirometry: clinical, imaging and artificial intelligence perspective

Preserved ratio impaired spirometry (PRISm) is a pulmonary function pattern characterized by a forced expiratory volume in one second (FEV1) to forced vital capacity ratio greater than 0.70, with an FEV1 that is below 80% of the predicted value, even after the use of bronchodilators. PRISm is considered a form of "Pre-Chronic Obstructive Pulmonary Disease (Pre-COPD)" within the broader scope of COPD. Clinically, it presents with respiratory symptoms and is more commonly observed in individuals with high body mass index, females, and those who are current smokers. Additionally, it is frequently associated with metabolic disorders and cardiovascular diseases. Regarding prognosis, PRISm shows considerable variation, ranging from improvement in lung function to the development of COPD. In this article, we review the epidemiology, comorbidities, and clinical outcomes of PRISm, with a particular emphasis on the crucial role of imaging assessments, especially computed tomography scans and magnetic resonance imaging (MRI) technology, in diagnosing, evaluating, and predicting the prognosis of PRISm. Comprehensive imaging provides a quantitative evaluation of lung volume, density, airways, and vasculature, while MRI technology can directly quantify ventilation function and pulmonary blood flow. We also emphasize the future potential of X-ray technology in this field. Moreover, the article discusses the application of artificial intelligence, including its role in predicting PRISm subtypes and modeling ventilation function.

Associations Between Physical Activity and Preserved Ratio Impaired Spirometry: A Cross-Sectional NHANES Study

Background

Preserved ratio impaired spirometry (PRISm) is considered to be one of the early chronic obstructive pulmonary disease states, and there are few studies on PRISm prevention. We aimed to evaluate the relationship between physical activity and the risk of PRISm.

Methods

A cross-sectional study was conducted using data from US adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012. We examined the association between physical activity and PRISm using multivariable logistic regression models and a restricted cubic spline (RCS) model.

Results

Compared to the normal and chronic obstructive pulmonary disease (COPD) groups, the PRISm group had lower levels of physical activity (3537.2 MET-min/week in the normal group vs 3452.1 MET-min/week in the COPD group vs 2841.5 MET-min/week in the PRISm group). Adjusted multivariable regression models revealed that greater physical activity dose (more than 4800 MET-min/week) was associated with lower odds of PRISm (adjusted odds ratio [aOR] = 0.77, 95% confidence interval [95% CI] = 0.61-0.98; P = 0.031). The RCS curve revealed that there was a significant nonlinear negative dose-response relationship between the level of physical activity and the risk of PRISm (P non-linearity <0.05). In the population with a body mass index (BMI) ≥25 kg/m2, the higher physical activity dose was associated with a significantly lower risk of PRISm (OR = 0.51, 95% CI: 0.46-0.82).

Conclusion

A greater total physical activity level was associated with a lower risk of PRISm in US adults, especially in populations with a BMI ≥ 25 kg/m2. These findings emphasize that a physically active lifestyle may be a potential precaution against PRISm.

Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: a computed tomography analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry

Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship with nontuberculous mycobacteria (NTM) is unknown. The Bronchiectasis and NTM Research Registry is a multicenter registry created to foster research in non-cystic fibrosis (CF) bronchiectasis and NTM lung disease. The majority of patients with non-CF bronchiectasis at Oregon Health & Science University have NTM infections. To determine the prevalence of PA dilation in these patients and its association with supplemental oxygen use, severity of bronchiectasis, tobacco use, and NTM in the sputum culture, we evaluated the chest computed tomography (CT) scans from 321 patients in a cross-sectional analysis. We measured the severity of bronchiectasis by applying modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio >0.9. In our cohort, the mean age was 67.3 years and 83.2% were female. The mean modified Reiff score was 7.1, indicating moderate disease severity. Forty-two patients (13.1%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (P<0.001), but there was no association between PA dilation and NTM infection.

Preserved Ratio Impaired Spirometry and Risks of Macrovascular, Microvascular Complications and Mortality Among Individuals With Type 2 Diabetes

BACKGROUND

The prospective associations of preserved ratio impaired spirometry (PRISm) with new-onset macrovascular and microvascular complications and mortality among individuals with type 2 diabetes (T2D) and whether PRISm enhances the prediction ability of an established office-based risk score remain to be elucidated.

RESEARCH QUESTION

Can PRISm be used as a predictor of poor prognosis in individuals with T2D?

STUDY DESIGN AND METHODS

We included 20,047 study participants with T2D and complete data on spirometry at recruitment from the UK Biobank cohort. Multivariable Cox proportional hazards models were used to assess the associations of baseline PRISm (FEV1 to FVC ratio, ≥ 0.70; FEV1, < 80% predicted) with subsequent risks of incident stroke (any type), ischemic stroke, myocardial infarction, unstable angina, coronary heart disease, diabetic retinopathy, diabetic kidney disease, all-cause mortality, cardiovascular mortality, and respiratory mortality.

RESULTS

For this cohort analysis, 4,521 patients (22.55% of participants with T2D) showed comorbid PRISm at baseline. Over a median follow-up of 11.52 to 11.87 years, patients with T2D with PRISm at baseline showed higher risks than those with normal spirometry findings of various T2D complications developing and mortality; the adjusted hazard ratios for PRISm were 1.413 (95% CI, 1.187-1.681) for stroke (any type), 1.382 (95% CI, 1.129-1.690) for ischemic stroke, 1.253 (95% CI, 1.045-1.503) for myocardial infarction, 1.206 (95% CI, 1.086-1.339) for coronary heart disease, 1.311 (95% CI, 1.141-1.506) for diabetic retinopathy, 1.384 (95% CI, 1.190-1.610) for diabetic kidney disease, 1.337 (95% CI, 1.213-1.474) for all-cause mortality, 1.597 (95% CI, 1.296-1.967) for cardiovascular mortality, and 1.559 (95% CI, 1.189-2.044) for respiratory mortality, respectively. The addition of PRISm significantly improved the reclassification ability, based on the net reclassification index, of an office-based risk score by 15.53% (95% CI, 10.14%-19.63%) to 33.60% (95% CI, 20.90%-45.79%).

INTERPRETATION

Individuals with T2D with comorbid PRISm, accounting for a considerable proportion of the population with T2D, showed significantly increased risks of adverse macrovascular and microvascular complications and mortality.

Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: A CT analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry

Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship to nontuberculous mycobacteria (NTM) is unknown. To determine the prevalence of PA dilation in patients with NTM-predominant non-CF bronchiectasis, we evaluated the chest computed tomography (CT) scans from 321 patient in the United States based Bronchiectasis and NTM Research Registry. The majority of our cohort had NTM infection. We measured the severity of bronchiectasis using modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio > 0.9. Forty-two patients (13%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (p < 0.001), but there was no association between PA dilation and NTM infection.

Prognostic Significance of Pulmonary Artery to Aorta Ratio and Other CT Markers in Pulmonary Fibrosis With and Without Emphysema

Pulmonary hypertension (PH) is associated with decreased survival in patients with pulmonary fibrosis and combined pulmonary fibrosis and emphysema. Main pulmonary artery (PA) diameter and PA diameter/ascending aortic diameter (PA/AA) ratio, as measured on CT, have recently emerged as specific markers for PH. Our single-center retrospective study found that PA/AA ratio > 1 is associated with decreased survival in individuals with pulmonary fibrosis, with or without emphysema. Our study also describes markers of cardiac remodeling, and the echocardiographic diagnosis of PH in this patient population.