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The presence of pulmonary vasculopathy in QIAs and its role in the QIA\u2013outcome relationship is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify radiographic pulmonary vasculopathy in QIAs and determine whether this vasculopathy mediates the QIA\u2013outcome relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ever-smokers with QIAs, outcomes, and pulmonary vascular mediator data were identified from the Genetic Epidemiology of COPD (COPDGene) study cohort. CT-based vascular mediators were right ventricle\u2013to\u2013left ventricle ratio, pulmonary artery\u2013to\u2013aorta ratio, and preacinar intraparenchymal arterial dilation (pulmonary artery volume, 5\u201320 mm2in cross-sectional area, normalized to total arterial volume). Outcomes were 6-minute walk distance and a modified Medical Council Research Council Dyspnea Scale score of 2 or higher. Adjusted causal mediation analyses were used to determine whether the pulmonary vasculature mediated the QIA effect on outcomes. Associations of preacinar arterial dilation with select plasma biomarkers of pulmonary vascular dysfunction were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among 8,200 participants, QIA burden correlated positively with vascular damage measures, including preacinar arterial dilation. Preacinar arterial dilation mediated 79.6% of the detrimental impact of QIA on 6-minute walk distance (56.2\u2013100%; P\u2009&amp;lt;\u20090.001). Pulmonary artery\u2013to\u2013aorta ratio was a weak mediator, and right ventricle\u2013to\u2013left ventricle ratio was a suppressor. Similar results were observed in the relationship between QIA and modified Medical Council Research Council dyspnea score. Preacinar arterial dilation correlated with increased pulmonary vascular dysfunction biomarker levels, including angiopoietin-2 and N-terminal brain natriuretic peptide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Parenchymal QIAs deleteriously impact outcomes primarily through pulmonary vasculopathy. Preacinar arterial dilation may be a novel marker of pulmonary vasculopathy in QIAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202312-2342oc","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T13:33:43Z","timestamp":1717162423000},"page":"1132-1142","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":7,"title":["Preacinar Arterial Dilation Mediates Outcomes of Quantitative Interstitial Abnormalities in the COPDGene Study"],"prefix":"10.1093","volume":"210","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1085-6024","authenticated-orcid":false,"given":"Eileen M.","family":"Harder","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care 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