High attenuation areas on chest computed tomography in community-dwelling adults: the MESA study.
Evidence suggests that lung injury, inflammation and extracellular matrix remodelling precede lung fibrosis in interstitial lung disease (ILD). We examined whether a quantitative measure of increased lung attenuation on computed tomography (CT) detects lung injury, inflammation and extracellular matrix remodelling in community-dwelling adults sampled without regard to respiratory symptoms or smoking.We measured high attenuation areas (HAA; percentage of lung voxels between -600 and -250 Hounsfield Units) on cardiac CT scans of adults enrolled in the Multi-Ethnic Study of Atherosclerosis.HAA was associated with higher serum matrix metalloproteinase-7 (mean adjusted difference 6.3% per HAA doubling, 95% CI 1.3-11.5), higher interleukin-6 (mean adjusted difference 8.8%, 95% CI 4.8-13.0), lower forced vital capacity (FVC) (mean adjusted difference -82 mL, 95% CI -119--44), lower 6-min walk distance (mean adjusted difference -40 m, 95% CI -1--80), higher odds of interstitial lung abnormalities at 9.5 years (adjusted OR 1.95, 95% CI 1.43-2.65), and higher all cause-mortality rate over 12.2 years (HR 1.58, 95% CI 1.39-1.79).High attenuation areas are associated with biomarkers of inflammation and extracellular matrix remodelling, reduced lung function, interstitial lung abnormalities, and a higher risk of death among community-dwelling adults.
Podolanczuk, AJ; Oelsner, EC; Barr, RG; Hoffman, EA; Armstrong, HF; Austin, JHM; Basner, RC; Bartels, MN; Christie, JD; Enright, PL; Gochuico, BR; Hinckley Stukovsky, K; Kaufman, JD; Hrudaya Nath, P; Newell, JD; Palmer, SM; Rabinowitz, D; Raghu, G; Sell, JL; Sieren, J; Sonavane, SK; Tracy, RP; Watts, JR; Williams, K; Kawut, SM; Lederer, DJ
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