Increased volume of pulmonary veins on CT associates independently with higher mortality in smokers with and without COPD

Aims: Subclinical heart failure may lead to congestion in the pulmonary veins and increased mortality. Aim: To determine the association of pulmonary vein volume with all-cause mortality in smokers with and without COPD. Methods: The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). AVX quantified total volume of small (diameter <2mm; AVX_SV) and large (≥2mm; AVX_LV) pulmonary veins on CT in 7903 participants of the COPDGene study, normalized for body height. Cox regression analysis was used to analyze associations between AVX_SV and AVX_LV scores and mortality. Corrections were made for age, sex, BMI, FEV1%predicted, mMRC, 6MWT, smoking status, emphysema, airway wall thickness, coronary artery calcium score, severe exacerbations, and scanner model. Results: Mean age was 60.1±9.0 years; 3594 (45.5%) subjects had COPD. AVX_SV was 82.3±13.3 mm3/cm; AVX_LV 178.2±53.1 mm3/cm. Higher AVX_SV and AVX_LV were both associated with higher mortality, HR 1.57 (CI 1.31-1.88) and HR 1.07 (CI 1.01-1.13) per 50 mm3/cm, respectively. Conclusions: Increased pulmonary venous volume is associated with a higher mortality in smokers with and without COPD, independent of emphysema and coronary artery calcium score, and may be a marker of volume redistribution as a result of heart failure.