title: Enlarged pulmonary artery is predicted by vascular injury biomarkers and is associated with WTC-Lung Injury in exposed fire fighters: a case-control study.
abstract: OBJECTIVE
  We hypothesise that there is an association between an elevated pulmonary artery/aorta (PA/A) and World Trade Center-Lung Injury (WTC-LI). We assessed if serum vascular disease biomarkers were predictive of an elevated PA/A.
  
  
  METHODS
  Retrospective case-cohort analysis of thoracic CT scans of WTC-exposed firefighters who were symptomatic between 9/12/2001 and 3/10/2008. Quantification of vascular-associated biomarkers from serum collected within 200 days of exposure.
  
  
  METHODS
  Urban tertiary care centre and occupational healthcare centre.
  
  
  METHODS
  Male never-smoking firefighters with accurate pre-9/11 forced expiratory volume in 1 s (FEV1)≥75%, serum sampled ≤200 days of exposure was the baseline cohort (n=801). A subcohort (n=97) with available CT scans and serum biomarkers was identified. WTC-LI was defined as FEV1≤77% at the subspecialty pulmonary evaluation (n=34) and compared with controls (n=63) to determine the associated PA/A ratio. The subcohort was restratified based on PA/A≥0.92 (n=38) and PA/A<0.92(n=59) to determine serum vascular biomarkers that were predictive of this vasculopathy.
  
  
  METHODS
  The primary outcome of this study was to identify a PA/A ratio in a cohort of individuals exposed to WTC dust that was associated with WTC-LI. The secondary outcome was to identify serum biomarkers predictive of the PA/A ratio using logistic regression.
  
  
  RESULTS
  PA/A≥0.92 was associated with WTC-LI, OR of 4.02 (95% CI 1.21 to 13.41; p=0.023) when adjusted for exposure, body mass index and age at CT. Elevated macrophage derived chemokine and soluble endothelial selectin were predictive of PA/A≥0.92, (OR, 95% CI 2.08, 1.05 to 4.11, p=0.036; 1.33, 1.06 to 1.68, p=0.016, respectively), while the increased total plasminogen activator inhibitor 1 was predictive of not having PA/A≥0.92 (OR 0.88, 0.79 to 0.98; p=0.024).
  
  
  CONCLUSIONS
  Elevated PA/A was associated with WTC-LI. Development of an elevated PA/A was predicted by biomarkers of vascular disease found in serum drawn within 6 months of WTC exposure. Increased PA/A is a potentially useful non-invasive biomarker of WTC-LI and warrants further study.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Schenck
authors.affiliation: Department of Medicine, New York University, School of Medicine, New York, New York, USA División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ghislaine C
authors.initials: GC
authors.lastname: Echevarria
authors.affiliation: Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
authors.forename: Francis G
authors.initials: FG
authors.lastname: Girvin
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Kwon
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Comfort
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA Department of Environmental Medicine, New York University, School of Medicine, Tuxedo Park, New York, USA.
authors.forename: William N
authors.initials: WN
authors.lastname: Rom
authors.affiliation: Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA Department of Environmental Medicine, New York University, School of Medicine, Tuxedo Park, New York, USA Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA Department of Environmental Medicine, New York University, School of Medicine, Tuxedo Park, New York, USA Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D061388:Firefighters / Q000706:statistics & numerical data; D005541:Forced Expiratory Volume; D006801:Humans; D055370:Lung Injury / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D047851:September 11 Terrorist Attacks / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers