# The clinical impact of longitudinal measures of cardiac and pulmonary vascular morphology in smokers

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $676,308

## Abstract

Project Summary/Abstract:
COPD affects up to 24 million people in the United States and it is estimated that 30 to 70% of these patients
have clinically significant pulmonary vascular disease (PVD). While the observed increases in mean pulmonary
arterial pressure tend to be mild or moderate, they have been shown to be independent predictors of health care
utilization and mortality. PVD with secondary pulmonary hypertension, though, is a late stage manifestation of
chronic tobacco smoke exposure and there is a continuum of changes to the pulmonary vasculature and heart
that reflect the evolution of disease. One of the earliest observable changes in the parenchyma of smokers is
pulmonary vascular remodeling. These changes have been described in subjects with normal lung function and
are thought to be the precursor to emphysematous destruction of the parenchyma. The subsequent progression
of emphysema and hyperinflation then leads to impaired cardiac function. Diastolic volumes of the left ventricle
decrease and right ventricle dilates, both of which have been theorized to be due to occult pulmonary vascular
disease and elevations in pulmonary vascular resistance. Our knowledge of these processes is limited because
it is based upon an aggregation of disparate clinical studies employing an array of investigative techniques such
as cardiac catheterization, histopathology, echocardiography, and cardiac magnetic resonance imaging. These
tools are largely unable to discriminate the contributions of hemodynamically significant morphologic changes in
the lungs of smokers such as vessel elongation in hyperinflated regions of the parenchyma, pruning of the distal
small vessels, and widespread absence of a vascular bed due in regions of emphysema. We have previously
performed a detailed investigation of these features in the Round 1 COPDGene CT scans and with this renewal
application for R01 HL0144624, we are proposing to examine their progression over time, effect on biventricular
morphology, and association with clinically relevant outcomes.
We are proposing to perform a longitudinal investigation of the clinical relevance of pulmonary vascular and
cardiac morphology in 6000 subjects enrolled in the COPDGene Study. To do this we have assembled a
multidisciplinary team of pulmonologists, computer scientists, epidemiologists, radiologists, and statisticians. We
will refine our surface fitting model of the heart using both 4D contrast enhanced cardiac CT scans and paired
cardiac gated CT scans and echocardiograms in the CARDIA Study. We will then deploy these tools as well as
our vascular segmentation algorithms in all the Round 1, Round 2 and Round 3 COPDGene CT scans collected
at standardized intervals over a 10 year period of observation.

## Key facts

- **NIH application ID:** 9982372
- **Project number:** 5R01HL116473-08
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Raul San Jose Estepar
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $676,308
- **Award type:** 5
- **Project period:** 2013-02-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982372

## Citation

> US National Institutes of Health, RePORTER application 9982372, The clinical impact of longitudinal measures of cardiac and pulmonary vascular morphology in smokers (5R01HL116473-08). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9982372. Licensed CC0.

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