Supplementary Appendix

Transcription

1 Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Hunninghake GM, Hatabu H, Okajima Y, et al. MUC5B promoter polymorphism and interstitial lung abnormalities. N Engl J Med 2013;368: DOI: /NEJMoa

2 Data Supplement: This appendix has been provided by the authors to give readers additional information about their work. Supplement to: MUC5B promoter polymorphism and interstitial lung abnormalities Gary M. Hunninghake, M.D., M.P.H., 1 Hiroto Hatabu M.D., Ph.D., 2,3 Yuka Okajima, M.D., 2,3 Wei Gao, M.S., 4,5 Josée Dupuis, Ph.D., 4,5 Jeanne C. Latourelle, DSc., 6,7 Mizuki Nishino, M.D., 2,3 Tetsuro Araki, M.D., 2,3 Oscar E. Zazueta, M.D., 1 Sila Kurugol, Ph.D., 8 James C. Ross, M.S., 8,9 Raúl San José Estépar, Ph.D., 3,8 Elissa Murphy M.S., 10 Mark P. Steele, M.D., 11 James E. Loyd, M.D., 11 Marvin I. Schwarz, M.D., 10 Tasha E. Fingerlin, Ph.D., 12 Ivan O. Rosas, M.D., 1 George R. Washko, M.D., 1 George T. O Connor, M.D., 4,13 10 David A. Schwartz, M.D. 1 Pulmonary and Critical Care Division, Brigham and Women s Hospital, Harvard Medical School, Boston MA; 2 Center for Pulmonary Functional Imaging, Brigham and Women s Hospital, Boston MA; 3 Department of Radiology, Brigham and Women s Hospital, Boston, MA; 4 The National Heart, Lung, and Blood Institute s Framingham Heart Study, Framingham, Massachusetts; Boston MA; 5 Department of Biostatistics, Boston University School of Public Health, Boston, MA; 6 Department of Medicine, Boston University, Boston, MA.; 7 Department of Neurology, Boston University, Boston, 8 Surgical Planning Laboratory, Department of Radiology, Brigham and Women s Hospital, Boston MA; 9 Channing Laboratory, Brigham and Women s Hospital, Boston MA; Pulmonary Center, 10 Department of Medicine, University of Colorado, Denver, CO; 11 Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; 12 University of Colorado Denver, School of Public Health, Denver, CO; 13 Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA.

3 Appendix Table of Contents Methods: Visual CT Analysis 3 Figure: Figure S1.4 Table: Table S1.5 References.6 2

4 METHODS Visual HRCT Analysis All inspiratory volumetric thoracic CT images (chest CTs) were reviewed on AZE VirtualPlace Fujin Raijin workstations (AZE, Tokyo, Japan) using axial images with a window level of -700 HU and a window width of 1500 HU. The chest CTs were evaluated by three readers (including one pulmonologist and two chest radiologists) using a sequential reading method as previously described. 1 We divided the visual chest CTs analysis into two stages. In stage 1 of the visual chest CT analysis, chest CTs were scored as follows: no evidence of ILA, indeterminate, and ILA. For each block of 100 chest CT scans, reader 1 would review all of the 100 HRCT scans. Reader 2, who was blinded to the initial interpretation, would review all of the scans labeled as ILA, indeterminate, and 20% of the normal scans. Finally, reader 3, also blinded to the previous interpretations, provided majority opinion on those scans discordantly scored. Readers rotated positions after each block of 100 HRCT scans were evaluated. ILA were defined as changes affecting >5% of any lung zone including, nondependent ground-glass or reticular abnormalities, diffuse centrilobular nodularity, nonemphysematous cysts, honeycombing, or traction bronchiectasis. 1-3 Indeterminate scans were defined as focal or unilateral ground-glass attenuation, focal or unilateral reticulation, and patchy ground-glass abnormality (<5% of the lung). In stage 2 of the visual chest CT analysis, to further assess the association between MUC5B genotype and pulmonary fibrosis, we created an additional ILA subset further limited to those with architectural distortion highly suggestive of a fibrotic lung disease (Definite Fibrosis, 4 Figure 1C-D). All qualitative CT assessments, and ILA subtyping, was performed by a consensus of three readers blind to any additional participant specific information. 3

5 FIGURE: Figure S1: A and B represents a selected axial and coronal image of a subject with extensive calcified pleural plaques suggestive of asbestos exposure. 4

6 Table S1: Baseline characteristics of Framingham Heart Study participants with Interstitial Lung Abnormality (ILA) in Subsets Defined by Increasing Fibrotic Features Number (%) or Median (standard error) Variable* where appropriate Demographic Parameters Participants with ILA overall n=177 Participants with Definite fibrosis n=47 (27%) Age (years) 70 (12) 75 (9) Gender (female) 89 (50%) 19 (40%) Body Mass Index 28 (5) 28 (5) Former smoker 92 (53%) 24 (51%) Current Smoker 17 (10%) 4 (9%) Pack years of smoking (among ever smokers) 26 (20) 32 (26) Respiratory Symptoms Do you usually have a cough? (yes) 21 (12%) 6 (12%) Are you troubled by shortness of breath when hurrying on level ground or 31 (18%) 8 (17%) walking up a slight hill? (yes) Pulmonary Function Testing FEV 1 (% of predicted) 98% (17%) 97% (16%) FVC (% of predicted) 101% (15%) 98% (14%) FEV1/FVC ( % of predicted) 97% (9%) 98% (9%) FEV1/FVC, % 73% (7%) 73% (8%) Spirometric Restriction 6 (4%) 2 (5%) Air flow obstruction 10 (6%) 3 (8%) DLCO (% of predicted) 86% (14%) 82% (13%) Chest CT Parameters Total Lung Capacity (TLC: Liters) 4.6 (1.2) 4.6 (1.1) TLC % of predicted** 79% (17%) 77% (15%) TLC < 80% of predicted** 81 (54%) 24 (57%) * Data missing for current and former smoking status (n=2, 1%), spirometry (n=18, 10%), diffusion capacity of carbon monoxide (DLCO, n=32, 18%), and total lung capacity (n=29, 16%). Predicted values for FEV 1 and FVC are derived from Hankinson et al. 5 Spirometric restriction defined as FVC < 80% predicted with FEV1/FVC ratio > the lower limit of normal. 5 Airflow obstruction defined as FEV1 and FEV1/FVC ratio both < the lower limit of normal. 5 DLCO=Diffusion capacity of carbon monoxide, predicted values are derived from Miller et al. 6 ** Quantitative metrics of TLC were performed using Airway Inspector ( Percent of predicted total lung capacity based on ATS/ERS guidelines. 7 5

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