Higher pulmonary artery and vein volumes are associated with disease severity and mortality in smokers with and without COPD

Aim: In chronic obstructive pulmonary disease (COPD), emphysema can lead to microscopic artery loss and pulmonary hypertension. Left heart dysfunction can lead to enlargement of distal pulmonary veins. Aims: To evaluate pulmonary artery/vein volume on CT and associate this with clinical parameters and mortality. Methods: The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). For this analysis we quantified large artery volume (diameter ≥2mm, AVX_LA) and small vein volume (diameter <2mm, AVX_SV) in participants in the COPDGene study, normalized for body height. Normal AVX_LA and AVX_SV volumes were determined using never smokers (95^th percentile). Baseline characteristics were compared between normal and abnormal groups using independent T-tests. Results: 7980 subjects included 77 never smokers. AVX_SV>97.5 mm³/cm and AVX_LA>263.9 mm³/cm were defined as abnormal. Subjects with increased AVX_SV or AVX_LA had higher 10y mortality compared to subjects with normal AVX_SV and AVX_LA (41.4% and 39.4% vs. 28.0%). Results on clinical parameters are shown in the table. *p<.001 as compared to normal group **Overlap in 536 subjects Conclusions: High AVX_SV and AVX_LA in subjects with COPD are associated with male gender, more emphysema, higher CAC scores and higher mortality. This may reflect left heart dysfunction and pulmonary artery hypertension.