Computed tomography derived vascular injury marker correlates with forced expiratory volume in one second (FEV 1) loss in World Trade Center exposed fire fighters

Details

• Personal Author:
  Cho S ; Nolan A ; Prezant DJ ; Rom, William N. ; Schenck E ; Weiden MD
• Description:
  Rationale: An increased ratio of pulmonary artery to aorta (PA/A) diameter, as a marker of vascular injury, measured by computed tomography (CT) predicts future exacerbations in patients with chronic obstructive pulmonary disease (COPD) Wells et. al. NEJM. World Trade Center (WTC) exposed fire fighters have developed respiratory symptoms and a subset had a decline in pulmonary function. Our group has previously shown that systemic biomarkers of inflammation and cardiovascular disease predict this decline. We hypothesize that a PA/A ratio >/= to 1 will be associated with a decline in FEV1. Methods: From a baseline cohort of never smokers with normal spirometry pre 9/11, cases and controls were selected. Cases had FEV1 fall to less than the lower limit of normal (< LLN), and controls had preserved lung function. Spirometry was performed according to ATS/ERS guidelines. Inspiratory series CT images, collected contemporaneously with spirometry, were retrospectively assessed using iSite PACS, (Philips iSite Enterprise, Version 3.6.114; www.healthcare.philips.com). The diameter of the main PA at the level of its bifurcation and the diameter of the ascending aorta in its maximum dimension were recorded using the same image. ES, who was blinded to group assignment, made all measurements. Statistics and data management were performed using SPSS. Results: CT images were available for 91 patients in the case/control cohort. Body mass index (BMI), age, exposure and pulmonary function data are shown in Table 1. Exposure intensity, age at exposure, time from 9/11 to spirometry and to CT were similar. BMI was increased in cases compared to controls. The mean PA diameter and PA/A ratio were increased in cases (p=0.05, 0.09), the mean A diameter was similar. Using binary logistic regression the odds ratio of having an FEV1< LLN if the PA/A ratio was >/= 1 was 3.6 (p=0.047), when corrected for exposure, age at 9/11 and BMI. Conclusions: In this preliminary study a PA/A ratio >/= 1 was associated with WTC related decline in FEV1. There are several potential confounders. Data on the presence of congestive heart failure, sleep apnea and other comorbidities are presenting lacking. Additionally, patient effort and respiratory system compliance may influence inspiratory measurements of the PA. In future studies, we plan to analyze expiratory CT images and correlate with other markers of heart disease. Increased PA/A represents another potentially useful non-invasive tool to assess for obstructive lung dysfunction and warrants further study. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Biological Assay Biomarkers Body Weight Cardiovascular System Computers Diagnosis Dust Emergency Responders Firefighters Immune System Lung Lung Diseases Methacholine Compounds Occupational Exposure Occupational Health Particulate Matter Radiography Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety

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• Keywords:
  Airborne-dusts Airborne-particles Airway-obstruction Bioassays Biopsy Body-weight Cardiovascular-function Chest-X-rays Clinical-diagnosis Emergency-responders Employee-exposure Fire-fighters Heart Immune-reaction Lung-disorders Lung-function Methacholines Particulate-dust Particulates Proteins Pulmonary-function Pulmonary-function-tests Pulmonary-system-disorders Rescue-workers Respiratory-system-disorders Scanning-techniques Serology Spirometry Vital-capacity X-ray-equipment

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• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Grant
• Genre:
  Abstract or Summary
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  187
• NIOSHTIC Number:
  nn:20044752
• Citation:
  Am J Respir Crit Care Med 2013 May; 187(Meeting Abstracts):A2375
• Contact Point Address:
  E. Schenck, New York University School of Medicine, New York, NY
• Email:
  edward.schenck@nyumc.org
• Federal Fiscal Year:
  2013
• Performing Organization:
  New York City Fire Department
• Peer Reviewed:
  False
• Start Date:
  20040701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Meeting Abstracts
• End Date:
  20110630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:cc3c38b7378ae50133bc5bdde60fc5c7b95e0c0bbc442fb7d4c79fa4214282fa0193f16ad846ae3bb6b299656b22b7031bcb3574c3a15618c48be0219e015a3b
• Download URL:
  https://stacks.cdc.gov/view/cdc/200388/cdc_200388_DS1.pdf
• File Type:
  [PDF - 55.38 KB ]