ArticleCirculation2026
Association of Pulmonary Vascular Remodeling With Cardiac Structure and Function, Pulmonary Pressure, and Heart Failure in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study.
Aditya Dewanjee, Victoria Lamberson, Yimin Yang, Fernando R Giugni, Brian L Claggett, Kunihiro Matsushita, Michael J Blaha, George Washko, Rubén San José Estépar, Pietro Nardelli and 2 more
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In one paragraphArticle in Circulation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Aditya DewanjeeDivision of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (A.D., V.L., F.R.G.).ORCID 0000-0003-0172-7589 Victoria LambersonDivision of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (A.D., V.L., F.R.G.).ORCID 0000-0003-2760-5053 Yimin YangDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (Y.Y., B.L.C.).ORCID 0009-0002-6711-6123 Fernando R GiugniDivision of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (A.D., V.L., F.R.G.).ORCID 0000-0001-9268-286X Brian L ClaggettDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (Y.Y., B.L.C.).ORCID 0009-0009-1748-4340 Kunihiro MatsushitaDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.).ORCID 0000-0002-7179-718X George WashkoDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (G.W., Rubén S.J.E., P.N., Raúl S.P.E.).ORCID 0009-0004-1906-3244 Rubén San José EstéparDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (G.W., Rubén S.J.E., P.N., Raúl S.P.E.).ORCID 0000-0002-7095-2432 Pietro NardelliDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (G.W., Rubén S.J.E., P.N., Raúl S.P.E.).ORCID 0000-0003-4280-558X Raúl San José EstéparDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (G.W., Rubén S.J.E., P.N., Raúl S.P.E.).ORCID 0000-0002-3677-1996 Funding
THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY - COORDINATING CENTER - TASK AREA B.2 AND B.375N92022D00001 · NHLBI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI COUPER, DAVID · 2022 to 2025
$13.7MMapping the Progression to HFpEF in the Elderly through Longitudinal Changes in Cardiac FunctionR01HL135008 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI Amil M Shah · 2017 to 2026
$11.5MTHE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY - FIELD CENTER - TASK ORDER 01, TASK AREA A75N92022D00003 · NHLBI · UNIVERSITY OF MINNESOTA · PI LUTSEY, PAMELA L. · 2022 to 2025
$5.1MTHE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY - FIELD CENTER - TASK ORDER 01, TASK AREA A75N92022D00005 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI WAGENKNECHT, LYNNE E · 2022 to 2025
$5.0MTHE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY - FIELD CENTER - TASK ORDER 01, TASK AREA A75N92022D00004 · NHLBI · UNIVERSITY OF MISSISSIPPI MED CTR · PI WINDHAM, BEVERLY GWEN · 2022 to 2025
$4.8MTHE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY - FIELD CENTER - TASK ORDER 01, TASK AREA A75N92022D00002 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI CORESH, JOSEF · 2022 to 2025
$4.7MEarly Detection of Transthyretin Cardiac Amyloidosis: Defining a Novel Target for HFpEF Treatment and Prevention in Late LifeR01HL150342 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI DORBALA, SHARMILA, SHAH, AMIL M · 2020 to 2023
$4.1MQuantifying cardiac structure and function to define the progression to hear failure in African AmericansR01HL143224 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI SHAH, AMIL M · 2018 to 2021
$3.4MProteomic signatures to identifypathways underlying the progression toheart failureR01HL148218 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI SHAH, AMIL M, YU, BING · 2020 to 2023
$3.4MContributions of pulmonary arterial and venous remodeling to HFpEF in the elderlyR01HL160025 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI SAN JOSE ESTEPAR, RAUL, SHAH, AMIL M · 2022 to 2025
$3.0MMentoring patient-oriented research in deep phenotyping of cardiac function for heart failure preventionK24HL152008 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI SHAH, AMIL M · 2020 to 2024
$608kNHLBI NIH HHS 75N92022D00001NHLBI NIH HHS 75N92022D00002NHLBI NIH HHS 75N92022D00003NHLBI NIH HHS 75N92022D00004NHLBI NIH HHS 75N92022D00005NHLBI NIH HHS K24 HL152008NHLBI NIH HHS R01 HL135008NHLBI NIH HHS R01 HL143224NHLBI NIH HHS R01 HL148218NHLBI NIH HHS R01 HL150342NHLBI NIH HHS R01 HL160025
6 · The paper itselfAbstract
backgroundAging is associated with increases in pulmonary pressure related to concomitant age-associated left ventricular remodeling, diastolic dysfunction, and declines in pulmonary function. Little is known regarding morphological changes in the pulmonary arterial vasculature underlying these associations. Our aim was to determine the associations between pulmonary vascular arterial remodeling, reflected in distal pruning and proximal dilation, and cardiac structure and function, pulmonary pressure, and functional outcomes.
methodsAmong 2275 participants in the community-based Atherosclerosis Risk in Communities study (ARIC) who underwent echocardiography and noncontrast cardiac computed tomography at study visit 7 (2018-2019), we quantified the fraction of total pulmonary vascular area comprised of arterial vessels with cross-sectional area <5 mm
resultsMean age was 80±4 years, 61% were women, 22% reported Black race, and mean left ventricular ejection fraction was 64±7%. Mean aBV5/aTBV was 0.30±0.08, and aBVg10/aTBV was 0.45±0.09. Lower aBV5/aTBV, reflecting greater distal pruning, and higher aBVg10/aTBV, reflecting greater proximal dilation, were both associated with greater left ventricular remodeling, worse diastolic function, and worse systolic function. Lower aBV5/aTBV and higher aBVg10/aTBV demonstrated nonlinear associations with greater pulmonary artery systolic pressure. Both lower aBV5/aTBV and higher aBVg10/aTBV were associated with higher circulating NT-proBNP and greater odds of moderate to severe dyspnea. Higher aBVg10/aTBV, in particular, was associated with greater risk of incident heart failure over a 4-year follow-up with a hazard ratio of 1.25 (95% CI, 1.03-1.51) per one SD in aBVg10/TBV.
conclusionsAmong older adults, pulmonary vascular arterial remodeling is associated with greater left ventricular remodeling, worse diastolic and systolic dysfunction, greater pulmonary artery systolic pressure, greater odds of significant dyspnea, and greater risk of heart failure development. Our findings clarify the morphologic changes in the pulmonary vasculature that link cardiac dysfunction to higher pulmonary pressure in late life and may appear before symptomatology.
Indexed as
AtherosclerosisHeart FailurePulmonary ArteryVascular RemodelingAgedEchocardiographyFemaleHumansMalePeptide FragmentsRisk FactorsVentricular RemodelingPeptide Fragmentscohort studiesechocardiographyhypertension, pulmonaryvascular remodeling
Identifiers
PMID42478373
PMCPMC13390777
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