101
|
Elbehairy AF, Parraga G, Webb KA, Neder JA, O’Donnell DE. Mild chronic obstructive pulmonary disease: why spirometry is not sufficient! Expert Rev Respir Med 2017; 11:549-563. [DOI: 10.1080/17476348.2017.1334553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amany F. Elbehairy
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Grace Parraga
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, Canada
| | - Katherine A. Webb
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E. O’Donnell
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| |
Collapse
|
102
|
Aaron CP, Hoffman EA, Lima JAC, Kawut SM, Bertoni AG, Vogel-Claussen J, Habibi M, Hueper K, Jacobs DR, Kalhan R, Michos ED, Post WS, Prince MR, Smith BM, Ambale-Venkatesh B, Liu CY, Zemrak F, Watson KE, Budoff M, Bluemke DA, Barr RG. Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study. PLoS One 2017; 12:e0176180. [PMID: 28426728 PMCID: PMC5398710 DOI: 10.1371/journal.pone.0176180] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 04/06/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evaluation of impaired left ventricular (LV) filling has focused on intrinsic causes of LV dysfunction; however, pulmonary vascular changes may contribute to reduced LV filling and dyspnea. We hypothesized that lower total pulmonary vascular volume (TPVV) on computed tomography (CT) would be associated with dyspnea and decrements in LV end-diastolic volume, particularly among ever-smokers. METHODS The Multi-Ethnic Study of Atherosclerosis recruited adults without clinical cardiovascular disease in 2000-02. In 2010-12, TPVV was ascertained as the volume of arteries and veins in the lungs detectable on non-contrast chest CT (vessels ≥1 mm diameter). Cardiac measures were assessed by magnetic resonance imaging (MRI). Dyspnea was self-reported. RESULTS Of 2303 participants, 53% had ever smoked cigarettes. Among ever-smokers, a lower TPVV was associated with a lower LV end-diastolic volume (6.9 mL per SD TPVV), stroke volume, and cardiac output and with dyspnea (all P-values <0.001). Findings were similar among those without lung disease and those with 0-10 pack-years but were mostly non-significant among never-smokers. TPVV was associated smaller left atrial volume but not with LV ejection fraction or MRI measures of impaired LV relaxation. In a second sample of ever-smokers, a lower pulmonary microvascular blood volume on contrast-enhanced MRI was also associated with a lower LV end-diastolic volume (P-value = 0.008). CONCLUSION Reductions in pulmonary vascular volume were associated with lower LV filling and dyspnea among ever-smokers, including those without lung disease, suggesting that smoking-related pulmonary vascular changes may contribute to symptoms and impair cardiac filling and function without evidence of impaired LV relaxation.
Collapse
Affiliation(s)
- Carrie P. Aaron
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States of America
| | - Joao A. C. Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Steven M. Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Alain G. Bertoni
- Departments of Medicine and Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Mohammadali Habibi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Katja Hueper
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Erin D. Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Wendy S. Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Martin R. Prince
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Bharath Ambale-Venkatesh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Chia-Ying Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Filip Zemrak
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Karol E. Watson
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - Matthew Budoff
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| |
Collapse
|
103
|
Elbehairy AF, Faisal A, Guenette JA, Jensen D, Webb KA, Ahmed R, Neder JA, O'Donnell DE. Resting Physiological Correlates of Reduced Exercise Capacity in Smokers with Mild Airway Obstruction. COPD 2017; 14:267-275. [DOI: 10.1080/15412555.2017.1281901] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amany F. Elbehairy
- Department of Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azmy Faisal
- Faculty of Physical Education for Men, Alexandria University, Alexandria, Egypt
- School of Health Sport and Bioscience, University of East London, United Kingdom
| | - Jordan A. Guenette
- Department of Physical Therapy and UBC Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Dennis Jensen
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC, Canada
| | - Katherine A. Webb
- Department of Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Rashid Ahmed
- College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, North Dakota, United States
| | - J. Alberto Neder
- Department of Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E. O'Donnell
- Department of Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | | |
Collapse
|
104
|
Hoffman EA, Newell JD. Lung Mass as the Complement to Lung Air Content in Quantitative CT of the COPD Lung. Acad Radiol 2017; 24:383-385. [PMID: 28262202 DOI: 10.1016/j.acra.2017.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Eric A Hoffman
- Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52240; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa.
| | - John D Newell
- Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52240; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| |
Collapse
|
105
|
Crossley D, Turner A, Subramanian D. Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques. World J Respirol 2017; 7:1-16. [DOI: 10.5320/wjr.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
The pathophysiology of chronic obstructive pulmonary disease (COPD) and Alpha one antitrypsin deficiency is increasingly recognised as complex such that lung function alone is insufficient for early detection, clinical categorisation and dictating management. Quantitative imaging techniques can detect disease earlier and more accurately, and provide an objective tool to help phenotype patients into predominant airways disease or emphysema. Computed tomography provides detailed information relating to structural and anatomical changes seen in COPD, and magnetic resonance imaging/nuclear imaging gives functional and regional information with regards to ventilation and perfusion. It is likely imaging will become part of routine clinical practice, and an understanding of the implications of the data is essential. This review discusses technical and clinical aspects of quantitative imaging in obstructive airways disease.
Collapse
|
106
|
Neder JA, Berton DC, Arbex FF, Alencar MC, Rocha A, Sperandio PA, Palange P, O'Donnell DE. Physiological and clinical relevance of exercise ventilatory efficiency in COPD. Eur Respir J 2017; 49:49/3/1602036. [PMID: 28275174 DOI: 10.1183/13993003.02036-2016] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
Exercise ventilation (V'E) relative to carbon dioxide output (V'CO2 ) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). High V'E-V'CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an association between high V'E-V'CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV1 impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase V'E-V'CO2 In fact, a high V'E-V'CO2 has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high V'E-V'CO2 has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the V'E-V'CO2 relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.
Collapse
Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Danilo C Berton
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada.,Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Clara Alencar
- Division of Cardiology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paolo Palange
- Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Denis E O'Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| |
Collapse
|
107
|
Walter Barbosa G, Neder JA, Utida K, O'Donnell DE, de Tarso Müller P. Impaired exercise ventilatory efficiency in smokers with low transfer factor but normal spirometry. Eur Respir J 2017; 49:49/3/1602511. [PMID: 28275177 DOI: 10.1183/13993003.02511-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/11/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Gisele Walter Barbosa
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Dept of Medicine Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Karina Utida
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Dept of Medicine Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Dept of Medicine Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| |
Collapse
|
108
|
Schivo M, Albertson TE, Haczku A, Kenyon NJ, Zeki AA, Kuhn BT, Louie S, Avdalovic MV. Paradigms in chronic obstructive pulmonary disease: phenotypes, immunobiology, and therapy with a focus on vascular disease. J Investig Med 2017; 65:953-963. [PMID: 28258130 DOI: 10.1136/jim-2016-000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous syndrome that represents a major global health burden. COPD phenotypes have recently emerged based on large cohort studies addressing the need to better characterize the syndrome. Though comprehensive phenotyping is still at an early stage, factors such as ethnicity and radiographic, serum, and exhaled breath biomarkers have shown promise. COPD is also an immunological disease where innate and adaptive immune responses to the environment and tobacco smoke are altered. The frequent overlap between COPD and other systemic diseases, such as cardiovascular disease, has influenced COPD therapy, and treatments for both conditions may lead to improved patient outcomes. Here, we discuss current paradigms that center on improving the definition of COPD, understanding the immunological overlap between COPD and vascular inflammation, and the treatment of COPD-with a focus on comorbid cardiovascular disease.
Collapse
Affiliation(s)
- Michael Schivo
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Timothy E Albertson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
| | - Angela Haczku
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Nicholas J Kenyon
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Amir A Zeki
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Brooks T Kuhn
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Mark V Avdalovic
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
| |
Collapse
|
109
|
Martinez CH, Freeman CM, Nelson JD, Murray S, Wang X, Budoff MJ, Dransfield MT, Hokanson JE, Kazerooni EA, Kinney GL, Regan EA, Wells JM, Martinez FJ, Han MK, Curtis JL. GDF-15 plasma levels in chronic obstructive pulmonary disease are associated with subclinical coronary artery disease. Respir Res 2017; 18:42. [PMID: 28245821 PMCID: PMC5331711 DOI: 10.1186/s12931-017-0521-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/13/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15), a cytokine associated with cardiovascular mortality, increases during chronic obstructive pulmonary disease (COPD) exacerbations, but any role in stable COPD is unknown. We tested associations between GDF-15 and subclinical coronary atherosclerosis, assessed by coronary artery calcium (CAC) score, in COPD subjects free of clinical cardiovascular disease (CVD). METHODS Cross-sectional analysis of COPD participants (GOLD stages 2-4) in the COPDGene cohort without CVD at enrollment, using baseline CAC (from non-EKG-gated chest computed tomography) and plasma GDF-15 (by custom ELISA). We used multinomial logistic modeling of GDF-15 associations with CAC, adjusting for demographics, baseline risk (calculated using the HEART: Personal Heart Early Assessment Risk Tool (Budoff et al. 114:1761-1791, 2006) score), smoking history, measures of airflow obstruction, emphysema and airway disease severity. RESULTS Among 694 participants with COPD (47% women, mean age 63.6 years) mean GDF-15 was 1,304 pg/mL, and mean CAC score was 198. Relative to the lower GDF-15 tertile, higher tertiles showed bivariate association with increasing CAC score (mid tertile odds ratio [OR] 1.80, 95% confidence interval [CI] 1.29, 2.51; higher tertile OR 2.86, CI 2.04, 4.02). This association was maintained after additionally adjusting for baseline CVD risk, for co-morbidities and descriptors of COPD severity and impact, markers of cardiac stress (N-terminal pro-B-type natriuretic peptide, troponin T) and of inflammation (Interleukin-6), and in subgroup analysis excluding men, diabetics, current smokers or those with limited ambulation. CONCLUSIONS In ever-smokers with COPD free of clinical CVD, GDF-15 contributes independently to subclinical coronary atherosclerosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT00608764 . Registered 28 January 2008.
Collapse
Affiliation(s)
- Carlos H Martinez
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Christine M Freeman
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA.,Research Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Joshua D Nelson
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Xin Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mark T Dransfield
- The Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Medical Service, Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - John E Hokanson
- School of Public Health, University of Colorado, Aurora, CO, USA
| | - Ella A Kazerooni
- Radiology Department, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gregory L Kinney
- School of Public Health, University of Colorado, Aurora, CO, USA
| | - Elizabeth A Regan
- National Jewish Health & Research Center, Denver, CO, USA.,Pulmonary & Critical Care Medicine Division, Department of Medicine, University of Colorado, Denver, CO, USA
| | - J Michael Wells
- The Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Medical Service, Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - Fernando J Martinez
- Pulmonary & Critical Care Medicine Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - MeiLan K Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Jeffrey L Curtis
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA. .,Graduate Program in Immunology, University of Michigan, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA. .,Medical Service, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA.
| | | |
Collapse
|
110
|
Takayanagi S, Kawata N, Tada Y, Ikari J, Matsuura Y, Matsuoka S, Matsushita S, Yanagawa N, Kasahara Y, Tatsumi K. Longitudinal changes in structural abnormalities using MDCT in COPD: do the CT measurements of airway wall thickness and small pulmonary vessels change in parallel with emphysematous progression? Int J Chron Obstruct Pulmon Dis 2017; 12:551-560. [PMID: 28243075 PMCID: PMC5315203 DOI: 10.2147/copd.s121405] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recent advances in multidetector computed tomography (MDCT) facilitate acquiring important clinical information for managing patients with COPD. MDCT can detect the loss of lung tissue associated with emphysema as a low-attenuation area (LAA) and the thickness of airways as the wall area percentage (WA%). The percentage of small pulmonary vessels <5 mm2 (% cross-sectional area [CSA] <5) has been recently recognized as a parameter for expressing pulmonary perfusion. We aimed to analyze the longitudinal changes in structural abnormalities using these CT parameters and analyze the effect of exacerbation and smoking cessation on structural changes in COPD patients. Methods We performed pulmonary function tests (PFTs), an MDCT, and a COPD assessment test (CAT) in 58 patients with COPD at the time of their enrollment at the hospital and 2 years later. We analyzed the change in clinical parameters including CT indices and examined the effect of exacerbations and smoking cessation on the structural changes. Results The CAT score and forced expiratory volume in 1 second (FEV1) did not significantly change during the follow-up period. The parameters of emphysematous changes significantly increased. On the other hand, the WA% at the distal airways significantly decreased or tended to decrease, and the %CSA <5 slightly but significantly increased over the same period, especially in ex-smokers. The parameters of emphysematous change were greater in patients with exacerbations and continued to progress even after smoking cessation. In contrast, the WA% and %CSA <5 did not change in proportion to emphysema progression. Conclusion The WA% at the distal bronchi and the %CSA <5 did not change in parallel with parameters of LAA over the same period. We propose that airway disease and vascular remodeling may be reversible to some extent by smoking cessation and appropriate treatment. Optimal management may have a greater effect on pulmonary vascularity and airway disease than parenchymal deconstruction in the early stage of COPD.
Collapse
Affiliation(s)
- Shin Takayanagi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Noriyuki Yanagawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yasunori Kasahara
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| |
Collapse
|
111
|
Awano N, Inomata M, Ikushima S, Yamada D, Hotta M, Tsukuda S, Kumasaka T, Takemura T, Eishi Y. Histological analysis of vasculopathy associated with pulmonary hypertension in combined pulmonary fibrosis and emphysema: comparison with idiopathic pulmonary fibrosis or emphysema alone. Histopathology 2017; 70:896-905. [PMID: 27992963 DOI: 10.1111/his.13153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate pulmonary vasculopathy in an autopsy series of patients with combined pulmonary fibrosis and emphysema (CPFE), and compare these findings with those of patients with idiopathic pulmonary fibrosis (IPF) alone and emphysema alone. METHODS AND RESULTS We retrospectively analysed the clinical, radiological and pathological features of 26 patients with CPFE, 11 with IPF, and 23 with emphysema. We evaluated pulmonary vascular, venous-venular and arteriolar tissue changes in the fibrotic, emphysematous and relatively unaffected (preserved) areas by using the Heath-Edwards scoring system. We found moderate-to-severe vasculopathy in the CPFE group, but no significant differences in the fibrotic and emphysematous areas among the three groups. However, in the preserved area, the grading was significantly different among the three groups (P < 0.001), and vasculopathy in the CPFE group was the most severe. Although venous-venular and arteriolar changes in almost all fibrotic and emphysematous areas in the three groups showed no significant differences, there were significant differences in venous-venular (P = 0.004) and arteriolar (P < 0.001) changes in the preserved area among the three groups, which were most prevalent in the CPFE group. In the CPFE group, venous-venular changes and vasculopathy by Heath-Edwards grading were highest in the fibrotic area and lowest in the preserved area. CONCLUSIONS These results imply that pulmonary vasculopathy in patients with CPFE could occur in the whole lung tissue. This may explain the tendency for it to lead to the development of pulmonary hypertension in CPFE cases.
Collapse
Affiliation(s)
- Nobuyasu Awano
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.,Department of Respiratory Medicine, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Soichiro Ikushima
- Department of Respiratory Medicine, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Daisuke Yamada
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Masatoshi Hotta
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Shunji Tsukuda
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| |
Collapse
|
112
|
Dournes G, Macey J, Blanchard E, Berger P, Laurent F. [MRI of the pulmonary parenchyma: Towards clinical applicability?]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:40-49. [PMID: 28159433 DOI: 10.1016/j.pneumo.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Abstract
Lung parenchyma has long been considered out of the scope of magnetic resonance imaging (MRI) clinical applicability. However, technological advances have emerged to soluce the technical difficulties and thus, applications in clinical practice have become realistic. Nevertheless, various approaches have been proposed and there is a need to synthetize the most recent literature data in order to envision a rationale to build lung MR protocols for clinical use. In addition, these technological innovations may modify the usual paradigms of lung MRI, which are still not consensual. Thus, lung MR protocols appear to be heterogeneous across expert centers in the current context. In this literature review, we ought to describe a rationale on the need to get an alternative to ionizing imaging modalities, in particular in the follow-up of patients with chronic lung diseases. We will describe the most recent technical advances regarding both morphological and functional MRI. Finally, we will conclude on the clinical applicability of MRI of the pulmonary parenchyma, as a routine or research tool.
Collapse
Affiliation(s)
- G Dournes
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France.
| | - J Macey
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - E Blanchard
- Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - P Berger
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - F Laurent
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| |
Collapse
|
113
|
Green CE, Turner AM. The role of the endothelium in asthma and chronic obstructive pulmonary disease (COPD). Respir Res 2017; 18:20. [PMID: 28100233 PMCID: PMC5241996 DOI: 10.1186/s12931-017-0505-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/13/2017] [Indexed: 01/05/2023] Open
Abstract
COPD and asthma are important chronic inflammatory disorders with a high associated morbidity. Much research has concentrated on the role of inflammatory cells, such as the neutrophil, in these diseases, but relatively little focus has been given to the endothelial tissue, through which inflammatory cells must transmigrate to reach the lung parenchyma and cause damage. There is evidence that there is an abnormal amount of endothelial tissue in COPD and asthma and that this tissue and its’ progenitor cells behave in a dysfunctional manner. This article reviews the evidence of the involvement of pulmonary endothelium in COPD and asthma and potential treatment options for this.
Collapse
Affiliation(s)
- Clara E Green
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK.
| | - Alice M Turner
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
114
|
Jones JH, Zelt JT, Hirai DM, Diniz CV, Zaza A, O'Donnell DE, Neder JA. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD. COPD 2016; 14:210-218. [PMID: 27997255 DOI: 10.1080/15412555.2016.1253670] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO2 output ([Formula: see text]CO2) nadir. Pulmonary blood flow (PBF) in a submaximal test was calculated by inert gas rebreathing. Emphysema was quantified as % of attenuation areas below 950 HU. Patients typically presented with centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/total lung ratio = 0.82 ± 0.04). They had lower peak oxygen uptake ([Formula: see text]O2), higher [Formula: see text]E/[Formula: see text]CO2 nadir, and greater dyspnea scores than controls (p < 0.05). Lower peak [Formula: see text]O2 and worse dyspnea were found in patients with higher [Formula: see text]E/[Formula: see text]CO2 nadirs (≥30). Patients had blunted increases in PBF from rest to iso-[Formula: see text]O2 exercise (p < 0.05). Higher [Formula: see text]E/[Formula: see text]CO2 nadir in COPD was associated with emphysema severity (r = 0.63) which, in turn, was related to reduced lung diffusing capacity (r = -0.72) and blunted changes in PBF from rest to exercise (r = -0.69) (p < 0.01). Ventilation "wasted" in emphysematous areas is associated with impaired exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (DLCO) to a key clinical outcome (poor exercise tolerance) in COPD patients with only modest spirometric abnormalities.
Collapse
Affiliation(s)
- Joshua H Jones
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Joel T Zelt
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Daniel M Hirai
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Camilla V Diniz
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Aida Zaza
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Denis E O'Donnell
- b Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - J Alberto Neder
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| |
Collapse
|
115
|
Lo Cascio CM, Quante M, Hoffman EA, Bertoni AG, Aaron CP, Schwartz JE, Avdalovic MV, Fan VS, Lovasi GS, Kawut SM, Austin JHM, Redline S, Barr RG. Percent Emphysema and Daily Motor Activity Levels in the General Population: Multi-Ethnic Study of Atherosclerosis. Chest 2016; 151:1039-1050. [PMID: 27940190 DOI: 10.1016/j.chest.2016.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/14/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND COPD is associated with reduced physical capacity. However, it is unclear whether pulmonary emphysema, which can occur without COPD, is associated with reduced physical activity in daily life, particularly among people without COPD and never smokers. We hypothesized that greater percentage of emphysema-like lung on CT scan is associated with reduced physical activity assessed by actigraphy and self-report. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants free of clinical cardiovascular disease from the general population. Percent emphysema was defined as percentage of voxels < -950 Hounsfield units on full-lung CT scans. Physical activity was measured by wrist actigraphy over 7 days and a questionnaire. Multivariable linear regression was used to adjust for age, sex, race/ethnicity, height, weight, education, smoking, pack-years, and lung function. RESULTS Among 1,435 participants with actigraphy and lung measures, 47% had never smoked, and 8% had COPD. Percent emphysema was associated with lower activity levels on actigraphy (P = .001), corresponding to 1.5 hour less per week of moderately paced walking for the average participant in quintile 2 vs 4 of percent emphysema. This association was significant among participants without COPD (P = .004) and among ever (P = .01) and never smokers (P = .03). It was also independent of coronary artery calcium and left ventricular ejection fraction. There was no evidence that percent emphysema was associated with self-reported activity levels. CONCLUSIONS Percent emphysema was associated with decreased physical activity in daily life objectively assessed by actigraphy in the general population, among participants without COPD, and nonsmokers.
Collapse
Affiliation(s)
| | - Mirja Quante
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eric A Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC
| | - Carrie P Aaron
- Department of Medicine, Columbia University, New York, NY
| | - Joseph E Schwartz
- Department of Medicine, Columbia University, New York, NY; Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY
| | - Mark V Avdalovic
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA
| | - Vincent S Fan
- VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Gina S Lovasi
- Department of Medicine, Columbia University, New York, NY
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY.
| |
Collapse
|
116
|
Yu H, Wang L, Wu Z, Yang Z. Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema. Biosci Trends 2016; 10:344-356. [PMID: 27594047 DOI: 10.5582/bst.2016.01113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for severe emphysema, providing treatment options for patients who are unable to undergo lung volume reduction surgery (LVRS) or lung transplantation. Current BLVR techniques include bronchoscopic volume reduction with valve implants, use of a lung volume reduction coil (LVRC), bronchoscopic thermal vapor ablation (BTVA), biological lung volume reduction (BioLVR), and use of airway bypass stents (ABS). To date, several randomized controlled trials of these bronchoscopic therapies have been conducted in patients with emphysema, and bronchoscopic volume reduction with valve implants remains the best approach thus far. Recent studies indicate that BLVR may be of great value in improving lung function, exercise capacity, and quality of life and that BLVR has the potential to replace conventional surgery for patients with severe emphysema. Optimal patient selection and the proper selection of the BLVR technique in accordance with patient characteristics are crucial to the success of BLVR. More multicenter, prospective, randomized controlled trials need to be conducted in the future to optimize the current selection strategy and evaluate the safety, efficiency, and long-term benefit of BLVR techniques.
Collapse
Affiliation(s)
- Hang Yu
- Department of Respiratory Medicine, Chinese PLA General Hospital
| | | | | | | |
Collapse
|
117
|
Iyer KS, Newell JD, Jin D, Fuld MK, Saha PK, Hansdottir S, Hoffman EA. Quantitative Dual-Energy Computed Tomography Supports a Vascular Etiology of Smoking-induced Inflammatory Lung Disease. Am J Respir Crit Care Med 2016; 193:652-61. [PMID: 26569033 DOI: 10.1164/rccm.201506-1196oc] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Endothelial dysfunction is of interest in relation to smoking-associated emphysema, a component of chronic obstructive pulmonary disease (COPD). We previously demonstrated that computed tomography (CT)-derived pulmonary blood flow (PBF) heterogeneity is greater in smokers with normal pulmonary function tests (PFTs) but who have visual evidence of centriacinar emphysema (CAE) on CT. OBJECTIVES We introduced dual-energy CT (DECT) perfused blood volume (PBV) as a PBF surrogate to evaluate whether the CAE-associated increased PBF heterogeneity is reversible with sildenafil. METHODS Seventeen PFT-normal current smokers were divided into CAE-susceptible (SS; n = 10) and nonsusceptible (NS; n = 7) smokers, based on the presence or absence of CT-detected CAE. DECT-PBV images were acquired before and 1 hour after administration of 20 mg oral sildenafil. Regional PBV and PBV coefficients of variation (CV), a measure of spatial blood flow heterogeneity, were determined, followed by quantitative assessment of the central arterial tree. MEASUREMENTS AND MAIN RESULTS After sildenafil administration, regional PBV-CV decreased in SS subjects but did not decrease in NS subjects (P < 0.05), after adjusting for age and pack-years. Quantitative evaluation of the central pulmonary arteries revealed higher arterial volume and greater cross-sectional area (CSA) in the lower lobes of SS smokers, which suggested arterial enlargement in response to increased peripheral resistance. After sildenafil, arterial CSA decreased in SS smokers but did not decrease in NS smokers (P < 0.01). CONCLUSIONS These results demonstrate that sildenafil restores peripheral perfusion and reduces central arterial enlargement in normal SS subjects with little effect in NS subjects, highlighting DECT-PBV as a biomarker of reversible endothelial dysfunction in smokers with CAE.
Collapse
Affiliation(s)
| | - John D Newell
- 1 Department of Biomedical Engineering.,2 Department of Radiology
| | - Dakai Jin
- 3 Department of Electrical Engineering, and
| | | | - Punam K Saha
- 2 Department of Radiology.,3 Department of Electrical Engineering, and
| | - Sif Hansdottir
- 5 Division of Pulmonary Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; and
| | - Eric A Hoffman
- 1 Department of Biomedical Engineering.,2 Department of Radiology.,5 Division of Pulmonary Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; and
| |
Collapse
|
118
|
Yoshimura K, Suzuki Y, Uto T, Sato J, Imokawa S, Suda T. Morphological changes in small pulmonary vessels are associated with severe acute exacerbation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:1435-45. [PMID: 27418816 PMCID: PMC4934566 DOI: 10.2147/copd.s107424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pulmonary vascular remodeling is essential for understanding the pathogenesis of chronic obstructive pulmonary disease (COPD). The total cross-sectional area (CSA) of small pulmonary vessels has been reported to correlate with the pulmonary artery pressure, and this technique has enabled the assessment of pulmonary vascular involvements. We investigated the contribution of morphological alterations in the pulmonary vessels to severe acute exacerbation of COPD (AE-COPD). METHODS This study enrolled 81 patients with COPD and 28 non-COPD subjects as control and assessed the percentage of CSA (%CSA) less than 5 mm(2) (%CSA<5) and %CSA in the range of 5-10 mm(2) (%CSA5-10) on high-resolution computed tomography images. RESULTS Compared with the non-COPD subjects, the COPD patients had lower %CSA<5. %CSA<5 was positively correlated with airflow limitation and negatively correlated with the extent of emphysema. COPD patients with lower %CSA<5 showed significantly increased incidences of severe AE-COPD (Gray's test; P=0.011). Furthermore, lower %CSA<5 was significantly associated with severe AE-COPD (hazard ratio, 2.668; 95% confidence interval, 1.225-5.636; P=0.010). CONCLUSION %CSA<5 was associated with an increased risk of severe AE-COPD. The distal pruning of the small pulmonary vessels is a part of the risk associated with AE-COPD, and %CSA<5 might be a surrogate marker for predicting AE-COPD.
Collapse
Affiliation(s)
- Katsuhiro Yoshimura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Tomohiro Uto
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Jun Sato
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
119
|
Imaging in vascular diseases of the lung. Curr Opin Pulm Med 2016; 22:522-6. [PMID: 27270181 DOI: 10.1097/mcp.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The present review focuses on the recent developments in the field of pulmonary angiography and perfusion by means of computed tomography and magnetic resonance imaging. RECENT FINDINGS Computed tomography allows for a detailed analysis of large and small pulmonary vascular pathologies and simultaneously allows for evaluation of the lung parenchyma. Magnetic resonance imaging allows for large and small vessel evaluation as well as noninvasive pressure assessment. Furthermore, recently non-breath-hold contrast-enhanced and noncontrast-enhanced techniques have been developed making magnetic resonance imaging an ideal tool for comprehensive thoracic imaging, even in challenging patients. SUMMARY Noninvasive imaging using computed tomography and magnetic resonance imaging further increases their value in daily clinical practice when it comes to assessment of large and small pulmonary artery disease. As computed tomography is more easy to use and widely available, it remains the diagnostic modality of choice. However, magnetic resonance imaging is the modality of choice when a comprehensive angiographic and functional assessment is deemed necessary.
Collapse
|
120
|
Thomsen C, Theilig D, Herzog D, Poellinger A, Doellinger F, Schreiter N, Schreiter V, Schürmann D, Temmesfeld-Wollbrueck B, Hippenstiel S, Suttorp N, Hubner RH. Lung perfusion and emphysema distribution affect the outcome of endobronchial valve therapy. Int J Chron Obstruct Pulmon Dis 2016; 11:1245-59. [PMID: 27354783 PMCID: PMC4907487 DOI: 10.2147/copd.s101003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The exclusion of collateral ventilation (CV) and other factors affect the clinical success of endoscopic lung volume reduction (ELVR). However, despite its benefits, the outcome of ELVR remains difficult to predict. We investigated whether clinical success could be predicted by emphysema distribution assessed by computed tomography scan and baseline perfusion assessed by perfusion scintigraphy. Data from 57 patients with no CV in the target lobe (TL) were retrospectively analyzed after ELVR with valves. Pulmonary function tests (PFT), St George's Respiratory Questionnaire (SGRQ), and 6-minute walk tests (6MWT) were performed on patients at baseline. The sample was grouped into high and low levels at the median of TL perfusion, ipsilateral nontarget lobe (INL) perfusion, and heterogeneity index (HI). These groups were analyzed for association with changes in outcome parameters from baseline to 3 months follow-up. Compared to baseline, patients showed significant improvements in PFT, SGRQ, and 6MWT (all P≤0.001). TL perfusion was not associated with changes in the outcome. High INL perfusion was significantly associated with increases in 6MWT (P=0.014), and high HI was associated with increases in forced expiratory volume in 1 second (FEV1), (P=0.012). Likewise, there were significant correlations for INL perfusion and improvement of 6MWT (r=0.35, P=0.03) and for HI and improvement in FEV1 (r=0.45, P=0.001). This study reveals new attributes that associate with positive outcomes for patient selection prior to ELVR. Patients with high perfusions in INL demonstrated greater improvements in 6MWT, while patients with high HI were more likely to respond in FEV1.
Collapse
Affiliation(s)
- Christian Thomsen
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| | - Dorothea Theilig
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Herzog
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| | | | - Felix Doellinger
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Schreiter
- Institute of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vera Schreiter
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Schürmann
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| | | | - Stefan Hippenstiel
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| | - Norbert Suttorp
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| | - Ralf-Harto Hubner
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine
| |
Collapse
|
121
|
Ostridge K, Wilkinson TMA. Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J 2016; 48:216-28. [PMID: 27230448 DOI: 10.1183/13993003.00041-2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
Computed tomography (CT) is the modality of choice for imaging the thorax and lung structure. In chronic obstructive pulmonary disease (COPD), it used to recognise the key morphological features of emphysema, bronchial wall thickening and gas trapping. Despite this, its place in the investigation and management of COPD is yet to be determined, and it is not routinely recommended. However, lung CT already has important clinical applications where it can be used to diagnose concomitant pathology and determine which patients with severe emphysema are appropriate for lung volume reduction procedures. Furthermore, novel quantitative analysis techniques permit objective measurements of pulmonary and extrapulmonary manifestations of the disease. These techniques can give important insights into COPD, and help explore the heterogeneity and underlying mechanisms of the condition. In time, it is hoped that these techniques can be used in clinical trials to help develop disease-specific therapy and, ultimately, as a clinical tool in identifying patients who would benefit most from new and existing treatments. This review discusses the current clinical applications for CT imaging in COPD and quantification techniques, and its potential future role in stratifying disease for optimal outcome.
Collapse
Affiliation(s)
- Kristoffer Ostridge
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| |
Collapse
|
122
|
Marchetti N, Criner GJ. Update in Chronic Obstructive Pulmonary Disease 2015. Am J Respir Crit Care Med 2016; 193:1092-100. [DOI: 10.1164/rccm.201602-0213up] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
123
|
Functional and Prognostic Implications of the Main Pulmonary Artery Diameter to Aorta Diameter Ratio from Chest Computed Tomography in Korean COPD Patients. PLoS One 2016; 11:e0154584. [PMID: 27152915 PMCID: PMC4859521 DOI: 10.1371/journal.pone.0154584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/17/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The ratio of the diameter of the main pulmonary artery (mPA) to the diameter of the aorta (Ao) on chest computed tomography is associated with diverse clinical conditions. Herein, we determined the functional and prognostic implications of the mPA/Ao ratio in Korean chronic obstructive pulmonary disease (COPD) patients. METHODS The study population comprised 226 chronic obstructive pulmonary disease patients from the Korean Obstructive Lung Disease cohort who underwent chest computed tomography. We analyzed the relationships between the clinical characteristics, including pulmonary function, echocardiography findings, St. George's Respiratory Questionnaire, 6-minute walking (6MW) distance, and exacerbation with the mPA, Ao, and mPA/Ao ratio. RESULTS The mean age was 65.8 years, and 219 (96.9%) patients were male. The mean FEV1% predicted and FEV1/FVC ratio were 61.2% and 47.3%, respectively. The mean mPA and Ao were 23.7 and 36.4 mm, respectively, and the mPA/Ao ratio was 0.66. The mPA/Ao ratio correlated negatively with the 6MW distance (G = -0.133, P = 0.025) and positively with the right ventricular pressure (G = 0.323, P = 0.001). After adjustment for potential confounders, the mPA/Ao ratio was significantly associated with 6MW distance (β = -107.7, P = 0.017). Moreover, an mPA/Ao ratio >0.8 was a significant predictor of exacerbation at the 1-year (odds ratio 2.12, 95% confidence interval 1.27-3.52) and 3-year follow-ups (odds ratio 2.04, 95% confidence interval 1.42-2.90). CONCLUSIONS The mPA/Ao ratio is an independent predictor of exercise capacity and an mPA/Ao ratio >0.8 is a significant risk factor of COPD exacerbation.
Collapse
|
124
|
Neder JA, Alharbi A, Berton DC, Alencar MCN, Arbex FF, Hirai DM, Webb KA, O'Donnell DE. Exercise Ventilatory Inefficiency Adds to Lung Function in Predicting Mortality in COPD. COPD 2016; 13:416-24. [DOI: 10.3109/15412555.2016.1158801] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
125
|
Wielpütz MO, Kauczor HU. Imaging cystic fibrosis lung disease with MRI. IMAGING 2016. [DOI: 10.1183/2312508x.10002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|