Pulmonary microvascular blood flow in mild chronic obstructive pulmonary disease and emphysema: The MESA COPD study

Katja Hueper, Jens Vogel-Claussen, Megha A. Parikh, John H.M. Austin, David A. Bluemke, James Carr, Jiwoong Choi, Thomas A. Goldstein, Antoinette S. Gomes, Eric A. Hoffman, Steven M. Kawut, Joao Lima, Erin D. Michos, Wendy S. Post, Ming Jack Po, Martin R. Prince, Kiang Liu, Dan Rabinowitz, Jan Skrok, Ben M. SmithKarol Watson, Youbing Yin, Alan M. Zambeli-Ljepovic, R. Graham Barr*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Rationale: Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, andbrain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. Objectives: To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. Methods: PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below 2950 Hounsfield units (2950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. Measurements and Main Results: Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52%insevereCOPD(all P < 0.01 vs. control subjects). PMBF was reduced with greater percentage emphysema2950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. Conclusions: PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.

Original languageEnglish (US)
Pages (from-to)570-580
Number of pages11
JournalAmerican journal of respiratory and critical care medicine
Issue number5
StatePublished - Sep 1 2015


  • Chronic obstructive pulmonary disease (COPD)
  • Gadolinium-enhanced MRI
  • Lung emphysema
  • Pulmonary microvascular blood flow (PMBF)
  • Small airway disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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