1
|
Valentini A, Franchi P, Cicchetti G, Messana G, Chiffi G, Strappa C, Calandriello L, Del Ciello A, Farchione A, Preda L, Larici AR. Pulmonary Hypertension in Chronic Lung Diseases: What Role Do Radiologists Play? Diagnostics (Basel) 2023; 13:diagnostics13091607. [PMID: 37174998 PMCID: PMC10178805 DOI: 10.3390/diagnostics13091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Pulmonary hypertension (PH) is a pathophysiological disorder, defined by a mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest, as assessed by right heart catheterization (RHC). PH is not a specific disease, as it may be observed in multiple clinical conditions and may complicate a variety of thoracic diseases. Conditions associated with the risk of developing PH are categorized into five different groups, according to similar clinical presentations, pathological findings, hemodynamic characteristics, and treatment strategy. Most chronic lung diseases that may be complicated by PH belong to group 3 (interstitial lung diseases, chronic obstructive pulmonary disease, combined pulmonary fibrosis, and emphysema) and are associated with the lowest overall survival among all groups. However, some of the chronic pulmonary diseases may develop PH with unclear/multifactorial mechanisms and are included in group 5 PH (sarcoidosis, pulmonary Langerhans' cell histiocytosis, and neurofibromatosis type 1). This paper focuses on PH associated with chronic lung diseases, in which radiological imaging-particularly computed tomography (CT)-plays a crucial role in diagnosis and classification. Radiologists should become familiar with the hemodynamical, physiological, and radiological aspects of PH and chronic lung diseases in patients at risk of developing PH, whose prognosis and treatment depend on the underlying disease.
Collapse
Affiliation(s)
- Adele Valentini
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Franchi
- Department of Diagnostic Radiology, G. Mazzini Hospital, 64100 Teramo, Italy
| | - Giuseppe Cicchetti
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Gaia Messana
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Greta Chiffi
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Strappa
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucio Calandriello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Annemilia Del Ciello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Alessandra Farchione
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Lorenzo Preda
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Anna Rita Larici
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
2
|
Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
Collapse
Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW Pulmonary hypertension (PH) is a common complication of chronic obstructive lung disease (COPD), but clinical presentation is variable and not always 'proportional' to the severity of the obstructive disease. This review aims to analyze heterogeneity in clinical features of PH-COPD, providing a guide for diagnosis and management according to phenotypes. RECENT FINDINGS Recent works have focused on severe PH in COPD, providing insights into the characteristics of patients with predominantly vascular disease. The recently recognized 'pulmonary vascular phenotype', characterized by severe PH and mild airflow obstruction with severe hypoxemia, has markedly worse prognosis and may be a candidate for large trials with pulmonary vasodilators. In severe PH, which might be best described by a pulmonary vascular resistance threshold, there may also be a need to distinguish patients with mild COPD (pulmonary vascular phenotype) from those with severe COPD ('Severe COPD-Severe PH' phenotype). SUMMARY Correct phenotyping is key to appropriate management of PH associated with COPD. The lack of evidence regarding the use of pulmonary vasodilators in PH-COPD may be due to the existence of previously unrecognized phenotypes with different responses to therapy. This review offers the clinician caring for patients with COPD and PH a phenotype-focused approach to diagnosis and management, aimed at personalized care.
Collapse
Affiliation(s)
| | - Lucilla Piccari
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
| |
Collapse
|
4
|
Huaqiao C, Tingting S, Lu W, Lingzhi Y, Changchun H, Shanshan D, Huang W. Pulmonary Artery Enlargement Predicts Poor Survival in Patients with COPD: A Meta‐Analysis. Pulm Circ 2022; 12:e12099. [PMID: 35833098 PMCID: PMC9262316 DOI: 10.1002/pul2.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chen Huaqiao
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Shu Tingting
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Wang Lu
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yang Lingzhi
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Hu Changchun
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital Chongqing Medical University Chongqing China
| | - Du Shanshan
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Wei Huang
- Department of Cardiology the First Affiliated Hospital of Chongqing Medical University Chongqing China
| |
Collapse
|
5
|
Zell-Baran LM, Humphries SM, Moore CM, Lynch DA, Charbonnier JP, Oh AS, Rose CS. Quantitative imaging analysis detects subtle airway abnormalities in symptomatic military deployers. BMC Pulm Med 2022; 22:163. [PMID: 35477425 PMCID: PMC9047334 DOI: 10.1186/s12890-022-01960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Exposure to inhalational hazards during post-9/11 deployment to Southwest Asia and Afghanistan puts military personnel at risk for respiratory symptoms and disease. Pulmonary function and qualitative chest high resolution computed tomography (HRCT) are often normal in “deployers” with persistent respiratory symptoms. We explored the utility of quantitative HRCT imaging markers of large and small airways abnormalities, including airway wall thickness, emphysema, and air trapping, in symptomatic deployers with clinically-confirmed lung disease compared to controls. Methods Chest HRCT images from 45 healthy controls and 82 symptomatic deployers with asthma, distal lung disease or both were analyzed using Thirona Lung quantification software to calculate airway wall thickness (by Pi10), emphysema (by percentage of lung volume with attenuation < -950 Hounsfield units [LAA%-950]), and three parameters of air trapping (expiratory/inspiratory total lung volume and mean lung density ratios, and LAA%-856). SAS v.9.4 was used to compare demographic and clinical characteristics between deployers and controls using Chi-Square, Fisher Exact or t-tests. Linear regression was used to assess relationships between pulmonary function and quantitative imaging findings. Results Gender and smoking status were not statistically significantly different between groups, but deployers were significantly younger than controls (42 vs 58 years, p < 0.0001), had higher body mass index (31 vs 28 kg/m2, p = 0.01), and had fewer total smoking pack-years (8 vs. 26, p = 0.007). Spirometric measures were not statistically significantly different between groups. Pi10 and LAA%-950 were significantly elevated in deployers compared to controls in unadjusted analyses, with the emphysema measure remaining significantly higher in deployers after adjustment for age, sex, smoking, BMI, and expiratory total lung volume. Air trapping parameters were more common in control images, likely due to differences in age and smoking between groups. Among deployers, LAA%-950 and Pi10 were significantly correlated with spirometric markers of obstruction based on ratio of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and/or percent predicted FEV1. Conclusions Quantitative chest HRCT imaging analysis identifies emphysema in deployers with asthma and distal lung disease, and may be useful in detecting and monitoring deployment-related lung disease in a population where spirometry is typically normal.
Collapse
Affiliation(s)
- Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.
| | | | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.,Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| |
Collapse
|
6
|
Cao X, Gao X, Yu N, Shi M, Wei X, Huang X, Xu S, Pu J, Jin C, Guo Y. Potential Value of Expiratory CT in Quantitative Assessment of Pulmonary Vessels in COPD. Front Med (Lausanne) 2021; 8:761804. [PMID: 34722596 PMCID: PMC8551380 DOI: 10.3389/fmed.2021.761804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the associations between intrapulmonary vascular volume (IPVV) depicted on inspiratory and expiratory CT scans and disease severity in COPD patients, and to determine which CT parameters can be used to predict IPVV. Methods: We retrospectively collected 89 CT examinations acquired on COPD patients from an available database. All subjects underwent both inspiratory and expiratory CT scans. We quantified the IPVV, airway wall thickness (WT), the percentage of the airway wall area (WA%), and the extent of emphysema (LAA%−950) using an available pulmonary image analysis tool. The underlying relationship between IPVV and COPD severity, which was defined as mild COPD (GOLD stage I and II) and severe COPD (GOLD stage III and IV), was analyzed using the Student's t-test (or Mann-Whitney U-test). The correlations of IPVV with pulmonary function tests (PFTs), LAA%−950, and airway parameters for the third to sixth generation bronchus were analyzed using the Pearson or Spearman's rank correlation coefficients and multiple stepwise regression. Results: In the subgroup with only inspiratory examinations, the correlation coefficients between IPVV and PFT measures were −0.215 ~ −0.292 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.233 ~ 0.557 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.238 ~ 0.409 (p < 0.05). In the subgroup with only expiratory scan, the correlation coefficients between IPVV and PFT measures were −0.238 ~ −0.360 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.260 ~ 0.566 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.241 ~ 0.362 (p < 0.05). The multiple stepwise regression analyses demonstrated that WT were independently associated with IPVV (P < 0.05). Conclusion: The expiratory CT scans can provide a more accurate assessment of COPD than the inspiratory CT scans, and the airway wall thickness maybe an independent predictor of pulmonary vascular alteration in patients with COPD.
Collapse
Affiliation(s)
- Xianxian Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Medical Imaging Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Meijuan Shi
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xia Wei
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoqi Huang
- Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Shudi Xu
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
7
|
Kitazawa S, Wijesinghe AI, Maki N, Yanagihara T, Saeki Y, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Predicting Respiratory Complications Following Lobectomy Using Quantitative CT Measures of Emphysema. Int J Chron Obstruct Pulmon Dis 2021; 16:2523-2531. [PMID: 34511897 PMCID: PMC8428273 DOI: 10.2147/copd.s321541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/02/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose In performing surgery for lung cancer, emphysema is a risk factor related to postoperative respiratory complications (PRC). However, few studies have addressed the risk of radiological emphysematous volume affecting PRC. The aim of this study was to investigate the relationship between emphysematous volume as measured on 3-dimensional computed tomography and PRC. Patients and Methods We reviewed 342 lung cancer patients undergoing lobectomy between 2013 and 2018. The percentage of low attenuation area (LAA%) was defined as the percentage of the lung area showing attenuation of −950 Hounsfield units or lower. Preoperative factors including age, sex, body mass index, smoking index, respiratory function, tumour histology, and LAA% were evaluated. PRC included pneumonia, atelectasis, prolonged air leakage, empyema, hypoxia, ischemic bronchitis, bronchopleural fistula, and exacerbation of interstitial pneumonia. Uni- and multivariable analyses were performed to investigate the relationship between independent clinical variables and postoperative adverse events. Results Median LAA% was 5.0% (range, 0–40%) and PRC was observed in 50 patients (14.6%). Patients who presented with PRC showed significantly high LAA% compared to those without complications (median: 8.1% vs 3.8%; p < 0.001). Based on univariable analysis, age, sex, smoking index, percentage of forced expiratory volume in 1 s (FEV1.0%), histology, and LAA% were significant predictors for PRC. Multivariable analysis revealed higher LAA% as a significant risk factor for PRC (odds ratio = 1.040; 95% confidence interval, 1.001–1.080; p = 0.046). Conclusion In addition to respiratory function with spirometry, LAA% can be used as a predictor of PRC.
Collapse
Affiliation(s)
- Shinsuke Kitazawa
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ashoka Indranatha Wijesinghe
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naoki Maki
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Saeki
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
8
|
Waeijen-Smit K, Reynaert NL, Beijers RJHCG, Houben-Wilke S, Simons SO, Spruit MA, Franssen FME. Alterations in plasma hyaluronic acid in patients with clinically stable COPD versus (non)smoking controls. Sci Rep 2021; 11:15883. [PMID: 34354097 PMCID: PMC8342478 DOI: 10.1038/s41598-021-95030-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
Hyaluronic acid (HA) is a key component of the extracellular matrix. HA and its metabolism are suggested to be altered in the lungs of patients with chronic obstructive pulmonary disease (COPD). The present study explored systemic HA, and its metabolic regulators, in patients with clinically stable COPD and smoking and non-smoking controls. Furthermore, associations of HA with acute exacerbations (AECOPD), airway-related hospitalizations, systemic inflammation and cardiovascular risk were studied. In total, 192 patients with moderate to very severe COPD [aged 62.3 y (± SD 7.0)], 84 smoking controls [aged 61.8 y (± 5.7)], and 107 non-smoking controls [aged 60.1 y (± 7.0)] were included. Plasma HA was reduced in patients with COPD compared to non-smoking controls (p = 0.033), but was comparable after adjusting for age and sex. Expression of HAS-3 did not differ between groups, but was substantially less detectable in more patients with COPD than (non)smoking controls (p < 0.001). Expression of HYAL-2 was enhanced in patients with COPD versus smoking (p = 0.019) and non-smoking (p < 0.001) controls, also in the age- and sex- adjusted model (p < 0.001). Plasma HA was not associated with AECOPD, airway-related hospitalizations in the previous year, or systemic inflammation in COPD. Arterial pulse wave velocity explained some of the variance (< 10%) in plasma HA (p = 0.006). Overall, these results indicate that expression of HYAL-2, but not plasma HA nor HAS-3, is enhanced in patients with COPD compared to (non)smoking controls. Furthermore, HA was not associated with clinical outcomes, yet, cardiovascular risk might play a role in its systemic regulation in stable COPD.
Collapse
Affiliation(s)
- Kiki Waeijen-Smit
- Department of Research and Education, Ciro, Horn, The Netherlands. .,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Niki L Reynaert
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research and Education, Ciro, Horn, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
9
|
Zou C, Li F, Choi J, Haghighi B, Choi S, Rajaraman PK, Comellas AP, Newell JD, Lee CH, Barr RG, Bleecker E, Cooper CB, Couper D, Han M, Hansel NN, Kanner RE, Kazerooni EA, Kleerup EC, Martinez FJ, O’Neal W, Paine R, Rennard SI, Smith BM, Woodruff PG, Hoffman EA, Lin CL. Longitudinal Imaging-Based Clusters in Former Smokers of the COPD Cohort Associate with Clinical Characteristics: The SubPopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). Int J Chron Obstruct Pulmon Dis 2021; 16:1477-1496. [PMID: 34103907 PMCID: PMC8178702 DOI: 10.2147/copd.s301466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Quantitative computed tomography (qCT) imaging-based cluster analysis identified clinically meaningful COPD former-smoker subgroups (clusters) based on cross-sectional data. We aimed to identify progression clusters for former smokers using longitudinal data. PATIENTS AND METHODS We selected 472 former smokers from SPIROMICS with a baseline visit and a one-year follow-up visit. A total of 150 qCT imaging-based variables, comprising 75 variables at baseline and their corresponding progression rates, were derived from the respective inspiration and expiration scans of the two visits. The COPD progression clusters identified were then associated with subject demography, clinical variables and biomarkers. RESULTS COPD severities at baseline increased with increasing cluster number. Cluster 1 patients were an obese subgroup with rapid progression of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%). Cluster 2 exhibited a decrease of fSAD% and Emph%, an increase of tissue fraction at total lung capacity and airway narrowing over one year. Cluster 3 showed rapid expansion of Emph% and an attenuation of fSAD%. Cluster 4 demonstrated severe emphysema and fSAD and significant structural alterations at baseline with rapid progression of fSAD% over one year. Subjects with different progression patterns in the same cross-sectional cluster were identified by longitudinal clustering. CONCLUSION qCT imaging-based metrics at two visits for former smokers allow for the derivation of four statistically stable clusters associated with unique progression patterns and clinical characteristics. Use of baseline variables and their progression rates enables identification of longitudinal clusters, resulting in a refinement of cross-sectional clusters.
Collapse
Affiliation(s)
- Chunrui Zou
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
| | - Frank Li
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Jiwoong Choi
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Babak Haghighi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Prathish K Rajaraman
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
| | | | - John D Newell
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Chang Hyun Lee
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - R Graham Barr
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eugene Bleecker
- Department of Medicine, The University of Arizona, Tucson, AZ, USA
| | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Meilan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Wanda O’Neal
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Paine
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen I Rennard
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
| | - Prescott G Woodruff
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Eirc A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Ching-Long Lin
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
10
|
Benlala I, Dournes G, Girodet PO, Benkert T, Laurent F, Berger P. Evaluation of bronchial wall thickness in asthma using magnetic resonance imaging. Eur Respir J 2021; 59:13993003.00329-2021. [PMID: 34049945 DOI: 10.1183/13993003.00329-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchial thickening is a pathological feature of asthma that has been evaluated using computed tomography (CT), an ionised radiation technique. Magnetic Resonance Imaging (MRI) with Ultrashort Echo Time (UTE) pulse sequences could be an alternative to CT. OBJECTIVES To measure bronchial dimensions using MRI-UTE in asthmatic patients, by evaluating the accuracy and agreement with CT, by comparing severe and non-severe asthma and by correlating with pulmonary function tests. METHODS We assessed bronchial dimensions (wall area (WA), lumen area (LA), normalised wall area (WA%), and wall thickness (WT)) by MRI-UTE and CT in 15 non-severe and 15 age- and sex-matched severe asthmatic patients (NCT03089346). Accuracy and agreement between MRI and CT was evaluated by paired t-tests and Bland-Altman analysis. Reproducibility was assessed by intra-class correlation coefficient and Bland-Altman analysis. Comparison between non-severe and severe asthmatic parameters was performed by Student-t, Mann-Whitney or Fisher's Exact tests. Correlations were assessed by Pearson or Spearman coefficients. RESULTS LA, WA%, and WT were not significantly different between MRI-UTE and CT, with good correlations and concordance. Inter- and intra-observer reproducibility was moderate to good. WA% and WT were both higher in severe than in non-severe asthmatic patients. WA, WA% and WT were all negatively correlated with FEV1. CONCLUSION We demonstrated that MRI-UTE is an accurate and reliable radiation-free method to assess bronchial wall dimensions in asthma, with enough spatial resolution to differentiate severe from non-severe asthma.
Collapse
Affiliation(s)
- Ilyes Benlala
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU Bordeaux, Service de Radiologie et d'imagerie diagnostique et interventionnelle, CIC-P 1401, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France.,INSERM, Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Centre d'Investigation Clinique (CIC-P 1401), Bordeaux, France
| | - Gaël Dournes
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU Bordeaux, Service de Radiologie et d'imagerie diagnostique et interventionnelle, CIC-P 1401, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France.,INSERM, Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Centre d'Investigation Clinique (CIC-P 1401), Bordeaux, France
| | - Pierre-Olivier Girodet
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU Bordeaux, Service de Radiologie et d'imagerie diagnostique et interventionnelle, CIC-P 1401, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France.,INSERM, Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Centre d'Investigation Clinique (CIC-P 1401), Bordeaux, France
| | - Thomas Benkert
- MR application predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - François Laurent
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU Bordeaux, Service de Radiologie et d'imagerie diagnostique et interventionnelle, CIC-P 1401, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France.,INSERM, Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Centre d'Investigation Clinique (CIC-P 1401), Bordeaux, France
| | - Patrick Berger
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France .,CHU Bordeaux, Service de Radiologie et d'imagerie diagnostique et interventionnelle, CIC-P 1401, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France.,INSERM, Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Centre d'Investigation Clinique (CIC-P 1401), Bordeaux, France
| |
Collapse
|
11
|
Benlala I, Laurent F, Dournes G. Structural and functional changes in COPD: What we have learned from imaging. Respirology 2021; 26:731-741. [PMID: 33829593 DOI: 10.1111/resp.14047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. It is a heterogeneous disease involving different components of the lung to varying extents. Developments in medical imaging and image analysis techniques provide new insights in the assessment of the structural and functional changes of the disease. This article reviews the leading imaging techniques: CT and MRI of the lung in research settings and clinical routine. Both visual and quantitative methods are reviewed, emphasizing their relevance to patient phenotyping and outcome prediction.
Collapse
Affiliation(s)
- Ilyes Benlala
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - François Laurent
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - Gael Dournes
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| |
Collapse
|
12
|
Bu T, Wang LF, Yin YQ. How Do Innate Immune Cells Contribute to Airway Remodeling in COPD Progression? Int J Chron Obstruct Pulmon Dis 2020; 15:107-116. [PMID: 32021149 PMCID: PMC6966950 DOI: 10.2147/copd.s235054] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Recently, the therapeutic potential of immune-modulation during the progression of chronic obstructive pulmonary disease (COPD) has been attracting increasing interest. However, chronic inflammatory response has been over-simplified in descriptions of the mechanism of COPD progression. As a form of first-line airway defense, epithelial cells exhibit phenotypic alteration, and participate in epithelial layer disorganization, mucus hypersecretion, and extracellular matrix deposition. Dendritic cells (DCs) exhibit attenuated antigen-presenting capacity in patients with advanced COPD. Immature DCs migrate into small airways, where they promote a pro-inflammatory microenvironment and bacterial colonization. In response to damage-associated molecular patterns (DAMPs) in lung tissue affected by COPD, neutrophils are excessively recruited and activated, where they promote a proteolytic microenvironment and fibrotic repair in small airways. Macrophages exhibit decreased phagocytosis in the large airways, while they demonstrate high pro-inflammatory potential in the small airways, and mediate alveolar destruction and chronic airway inflammation. Natural killer T (NKT) cells, eosinophils, and mast cells also play supplementary roles in COPD progression; however, their cellular activities are not yet entirely clear. Overall, during COPD progression, “exhausted” innate immune responses can be observed in the large airways. On the other hand, the innate immune response is enhanced in the small airways. Approaches that inhibit the inflammatory cascade, chemotaxis, or the activation of inflammatory cells could possibly delay the progression of airway remodeling in COPD, and may thus have potential clinical significance.
Collapse
Affiliation(s)
- Tegeleqi Bu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Li Fang Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yi Qing Yin
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| |
Collapse
|
13
|
Kovacs G, Agusti A, Barberà JA, Celli B, Criner G, Humbert M, Sin DD, Voelkel N, Olschewski H. Pulmonary Vascular Involvement in Chronic Obstructive Pulmonary Disease. Is There a Pulmonary Vascular Phenotype? Am J Respir Crit Care Med 2019; 198:1000-1011. [PMID: 29746142 DOI: 10.1164/rccm.201801-0095pp] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gabor Kovacs
- 1 Medical University of Graz, Graz, Austria.,2 Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Alvar Agusti
- 3 Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,4 Centro Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Joan Albert Barberà
- 3 Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,4 Centro Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Gerard Criner
- 6 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Marc Humbert
- 7 Université Paris-Sud, Université Paris-Saclay; Inserm U999; Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Don D Sin
- 8 Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,9 Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Canada; and
| | - Norbert Voelkel
- 10 Department of Pulmonary Medicine, Frije University, Medical Center, Amsterdam, the Netherlands
| | - Horst Olschewski
- 1 Medical University of Graz, Graz, Austria.,2 Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| |
Collapse
|
14
|
Coste F, Benlala I, Dournes G, Girodet PO, Laurent F, Berger P. Assessing pulmonary hypertension in COPD. Is there a role for computed tomography? Int J Chron Obstruct Pulmon Dis 2019; 14:2065-2079. [PMID: 31564854 PMCID: PMC6732516 DOI: 10.2147/copd.s207363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity and mortality. Reference standard method to diagnose PH is right heart catheterization. Several non-invasive imaging techniques have been employed in the detection of PH. Among them, computed tomography (CT) is the most commonly used for phenotyping and detecting complications of COPD. Several CT findings have also been described in patients with severe PH. Nevertheless, CT analysis is currently based on visual findings which can lead to reproducibility failure. Therefore, there is a need for quantification in order to assess objective criteria. In this review, progresses in automated analyses of CT parameters and their values in predicting PH and COPD outcomes are presented.
Collapse
Affiliation(s)
- Florence Coste
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France
| | - Ilyes Benlala
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Gaël Dournes
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Pierre-Olivier Girodet
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - François Laurent
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Patrick Berger
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| |
Collapse
|
15
|
Benlala I, Berger P, Girodet PO, Dromer C, Macey J, Laurent F, Dournes G. Automated Volumetric Quantification of Emphysema Severity by Using Ultrashort Echo Time MRI: Validation in Participants with Chronic Obstructive Pulmonary Disease. Radiology 2019; 292:216-225. [DOI: 10.1148/radiol.2019190052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
16
|
Pichl A, Sommer N, Bednorz M, Seimetz M, Hadzic S, Kuhnert S, Kraut S, Roxlau ET, Kojonazarov B, Wilhelm J, Gredic M, Gall H, Tello K, Richter MJ, Pak O, Petrovic A, Hecker M, Schermuly RT, Grimminger F, Seeger W, Ghofrani HA, Weissmann N. Riociguat for treatment of pulmonary hypertension in COPD: a translational study. Eur Respir J 2019; 53:13993003.02445-2018. [PMID: 30956210 DOI: 10.1183/13993003.02445-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/26/2019] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), which comprises the phenotypes of chronic bronchitis and emphysema, is often associated with pulmonary hypertension (PH). However, currently, no approved therapy exists for PH-COPD. Signalling of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) axis plays an important role in PH and COPD.We investigated the treatment effect of riociguat, which promotes the NO-cGMP pathway, in the mouse model of smoke-induced PH and emphysema in a curative approach, and retrospectively analysed the effect of riociguat treatment on PH in single patients with PH-COPD.In mice with established PH and emphysema (after 8 months of cigarette smoke exposure), riociguat treatment for another 3 months fully reversed PH. Moreover, histological hallmarks of emphysema were decreased. Microarray analysis revealed involvement of different signalling pathways, e.g. related to matrix metalloproteinases (MMPs). MMP activity was decreased in vivo by riociguat. In PH-COPD patients treated with riociguat (n=7), the pulmonary vascular resistance, airway resistance and circulating MMP levels decreased, while oxygenation at rest was not significantly changed.Riociguat may be beneficial for treatment of PH-COPD. Further long-term prospective studies are necessary to investigate the tolerability, efficacy on functional parameters and effect specifically on pulmonary emphysema in COPD patients.
Collapse
Affiliation(s)
- Alexandra Pichl
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany.,These two authors contributed equally to this work
| | - Natascha Sommer
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany.,These two authors contributed equally to this work
| | - Mariola Bednorz
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Michael Seimetz
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Stefan Hadzic
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Stefan Kuhnert
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Simone Kraut
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Elsa T Roxlau
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Baktybek Kojonazarov
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Jochen Wilhelm
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Marija Gredic
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Henning Gall
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Khodr Tello
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Manuel J Richter
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Oleg Pak
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Aleksandar Petrovic
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Matthias Hecker
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Ralph T Schermuly
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Friedrich Grimminger
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Werner Seeger
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany.,Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Hossein A Ghofrani
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| | - Norbert Weissmann
- Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, Giessen, Germany
| |
Collapse
|
17
|
Dupin I, Thumerel M, Maurat E, Coste F, Eyraud E, Begueret H, Trian T, Montaudon M, Marthan R, Girodet PO, Berger P. Fibrocyte accumulation in the airway walls of COPD patients. Eur Respir J 2019; 54:13993003.02173-2018. [DOI: 10.1183/13993003.02173-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
The remodelling mechanism and cellular players causing persistent airflow limitation in COPD remain largely elusive. We have recently demonstrated that circulating fibrocytes, a rare population of fibroblast-like cells produced by the bone marrow stroma, are increased in COPD patients during an exacerbation. We aimed to quantify fibrocyte density in situ in bronchial specimens from both control subjects and COPD patients, to define associations with relevant clinical, functional and computed tomography (CT) parameters, and to investigate the effect of the epithelial microenvironment on fibrocyte survival in vitro (“Fibrochir” study).A total of 17 COPD patients and 25 control subjects, all requiring thoracic surgery, were recruited. Using co-immunostaining and image analysis, we identified CD45+ FSP1+ cells as tissue fibrocytes, and quantified their density in distal and proximal bronchial specimens. Fibrocytes, cultured from the blood samples of six COPD patients, were exposed to primary bronchial epithelial cell secretions from control subjects or COPD patients.We demonstrate that fibrocytes are increased in both distal and proximal tissue specimens of COPD patients. The density of fibrocytes is negatively correlated with lung function parameters and positively correlated with bronchial wall thickness as assessed by CT scan. A high density of distal bronchial fibrocytes predicts the presence of COPD with a sensitivity of 83% and a specificity of 70%. Exposure of fibrocytes to COPD epithelial cell supernatant favours cell survival.Our results thus demonstrate an increased density of fibrocytes within the bronchi of COPD patients, which may be promoted by epithelial-derived survival-mediating factors.
Collapse
|
18
|
Tenda ED, Ridge CA, Shen M, Yang GZ, Shah PL. Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema. Respiration 2019; 98:86-94. [PMID: 31067563 DOI: 10.1159/000498949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Recent advances in bronchoscopic lung volume reduction (BLVR) offer new therapeutic alternatives for patients with emphysema and hyperinflation. Endobronchial valves and coils are 2 potential BLVR techniques which have been shown to improve pulmonary function and the quality of life in patients with emphysema. Current patient selection for LVR procedures relies on 3 main inclusion criteria: low attenuation area (in %), also known as emphysema score, heterogeneity score, and fissure integrity score. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative CT to determine emphysema severity play an important role in treatment planning and post-operative assessment. Due to the variations in lung anatomy, manual corrections are often required to ensure successful and accurate lobe segmentation for pathological and post-treatment CT scan analysis. The advanced development and utilisation of quantitative CT do not simply represent regional changes in pulmonary function but aids in analysis for better patient selection with severe emphysema who are most likely to benefit from BLVR.
Collapse
Affiliation(s)
- Eric Daniel Tenda
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.,Division of Pulmonology, Department of Internal Medicine, National General Hospital of Dr. Cipto Mangunkusumo, and Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carole A Ridge
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Mali Shen
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Pallav L Shah
- National Heart and Lung Institute, Imperial College, London, United Kingdom, .,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom,
| |
Collapse
|
19
|
Kim J, Kim MJ, Sol IS, Sohn MH, Yoon H, Shin HJ, Kim KW, Lee MJ. Quantitative CT and pulmonary function in children with post-infectious bronchiolitis obliterans. PLoS One 2019; 14:e0214647. [PMID: 30934017 PMCID: PMC6443232 DOI: 10.1371/journal.pone.0214647] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the feasibility of CT-based quantitative airway and air-trapping measurements and to assess their correlation with pulmonary function in children with post-infectious bronchiolitis obliterans (PIBO). Materials and methods This retrospective study approved by the institutional review board included chest CT scans and pulmonary function tests (PFT) completed between January 2005 and December 2016 in children diagnosed with PIBO. The quantitative analysis of segmental and subsegmental bronchi was performed on each chest CT scan, measuring the areas or diameters of lumens, walls, or the entire airway. The air-trapping volume (ATV), the volume of lung area exhibiting lower attenuation than the mean attenuation of normal and air-trapping areas, was also measured in each lobe. Comparison analyses between CT parameters and PFT results were performed with Pearson or Spearman correlation. Results In total, 23 patients were enrolled (mean age 7.0 ± 3.3 years; range, 4–15 years). We successfully measured 89.6% of all segmental bronchi. In the airway analysis, wall area showed a negative correlation with forced expiratory volume in one second (FEV1) in the majority of the pulmonary lobes. Air-trapping analyses demonstrated that ATV was negatively correlated with FEV1 and positively correlated with reactance at 5 Hz. Conclusion Quantitative airway and air-trapping measurements from chest CT are feasible and correlate with pulmonary function in pediatric PIBO patients.
Collapse
Affiliation(s)
- Jonghyeon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung-Joon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - In Suk Sol
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Haesung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (MJL); (KWK)
| | - Mi-Jung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (MJL); (KWK)
| |
Collapse
|
20
|
Coste F, Benlala I, Dournes G, Dromer C, Blanchard E, Girodet PO, Montaudon M, Baldacci F, Picard F, Marthan R, Laurent F, Berger P. Quantitative CT assessment of bronchial and vascular alterations in severe precapillary pulmonary hypertension. Int J Chron Obstruct Pulmon Dis 2019; 14:381-389. [PMID: 30809092 PMCID: PMC6377046 DOI: 10.2147/copd.s177638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Little is known about in vivo alterations at bronchial and vascular levels in severe pulmonary hypertension (PH) of different etiologies. We aimed to compare quantitative computed tomography (CT) data from the following three groups of severe precapillary PH patients: COPD, idiopathic pulmonary arterial hypertension (iPAH), and chronic thromboembolic PH (CTEPH). Patients and methods This study was approved by the institutional review board. Severe PH patients (mean pulmonary arterial pressure [mPAP] ≥35 mmHg) with COPD, iPAH, or CTEPH (n=24, 16, or 16, respectively) were included retrospectively between January 2008 and January 2017. Univariate analysis of mPAP was performed in each severe PH group. Bronchial wall thickness (WT) and percentage of cross sectional area of pulmonary vessels less than 5 mm2 normalized by lung area (%CSA<5) were measured and compared using CT, and then combined to arterial partial pressure of oxygen (PaO2) to generate a “paw score” compared within the three groups using Kruskal–Wallis and its sensitivity using Fisher’s exact test. Results WT was higher and %CSA<5 was lower in the COPD group compared to iPAH and CTEPH groups. Mosaic pattern was higher in CTEPH group than in others. In severe PH patients secondary to COPD, mPAP was positively correlated to %CSA<5. By contrast, in severe iPAH, this correlation was negative, or not correlated in severe CTEPH groups. In the COPD group, “paw score” showed higher sensitivity than in the other two groups. Conclusion Unlike in severe iPAH and CTEPH, severe PH with COPD can be predicted by “paw score” reflecting bronchial and vascular morphological differential alterations.
Collapse
Affiliation(s)
- Florence Coste
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France,
| | - Ilyes Benlala
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France,
| | - Gaël Dournes
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Claire Dromer
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Elodie Blanchard
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Pierre-Olivier Girodet
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Michel Montaudon
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Fabien Baldacci
- Université de Bordeaux, LaBRI, F-33405 Talence Cedex, France
| | - François Picard
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Roger Marthan
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - François Laurent
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Patrick Berger
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| |
Collapse
|
21
|
Dou S, Zheng C, Ji X, Wang W, Xie M, Cui L, Xiao W. Co-existence of COPD and bronchiectasis: a risk factor for a high ratio of main pulmonary artery to aorta diameter (PA:A) from computed tomography in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:675-681. [PMID: 29520135 PMCID: PMC5834179 DOI: 10.2147/copd.s156126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Pulmonary vascular disease, especially pulmonary hypertension, is an important complication of COPD. Bronchiectasis is considered not only a comorbidity of COPD, but also a risk factor for vascular diseases. The main pulmonary artery to aorta diameter ratio (PA:A ratio) has been found to be a reliable indicator of pulmonary vascular disease. It is hypothesized that the co-existence of COPD and bronchiectasis may be associated with relative pulmonary artery enlargement (PA:A ratio >1). Methods This retrospective study enrolled COPD patients from 2012 through 2016. Demographic and clinical data were collected. Bhalla score was used to determine the severity of bronchiectasis. Patient characteristics were analyzed in two ways: the high (PA:A >1) and low (PA:A ≤1) ratio groups; and COPD with and without bronchiectasis groups. Logistic regression analysis was used to assess risk factors for high PA:A ratios. Results In this study, 480 COPD patients were included, of whom 168 had radiographic bronchiectasis. Patients with pulmonary artery enlargement presented with poorer nutrition (albumin, 35.6±5.1 vs 38.3±4.9, P<0.001), lower oxygen partial pressure (74.4±34.5 vs 81.3±25.4, P<0.001), more severe airflow obstruction (FEV1.0, 0.9±0.5 vs 1.1±0.6, P=0.004), and a higher frequency of bronchiectasis (60% vs 28.8%, P<0.001) than patients in the low ratio group. Patients with both COPD and bronchiectasis had higher levels of systemic inflammation (erythrocyte sedimentation rate, P<0.001 and fibrinogen, P=0.006) and PA:A ratios (P<0.001). A higher PA:A ratio was significantly closely correlated with a higher Bhalla score (r=0.412, P<0.001). Patients with both COPD and bronchiectasis with high ratios presented higher levels of NT-proBNP (P<0.001) and systolic pulmonary artery pressure (P<0.001). Multiple logistic analyses have indicated that bronchiectasis is an independent risk factor for high PA:A ratios in COPD patients (OR =3.707; 95% CI =1.888-7.278; P<0.001). Conclusion Bronchiectasis in COPD has been demonstrated to be independently associated with relative pulmonary artery enlargement.
Collapse
Affiliation(s)
- Shuang Dou
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| | - Chunyan Zheng
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| | - Xiuli Ji
- Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, People’s Republic of China
| | - Wei Wang
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| | - Mengshuang Xie
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| | - Liwei Cui
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| | - Wei Xiao
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China
| |
Collapse
|
22
|
Ostridge K, Williams NP, Kim V, Harden S, Bourne S, Clarke SC, Aris E, Mesia-Vela S, Devaster JM, Tuck A, Williams A, Wootton S, Staples KJ, Wilkinson TMA. Relationship of CT-quantified emphysema, small airways disease and bronchial wall dimensions with physiological, inflammatory and infective measures in COPD. Respir Res 2018; 19:31. [PMID: 29458372 PMCID: PMC5819274 DOI: 10.1186/s12931-018-0734-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/01/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND COPD is a complex, heterogeneous disease characterised by progressive development of airflow limitation. Spirometry provides little information about key aspects of pathology and is poorly related to clinical outcome, so other tools are required to investigate the disease. We sought to explore the relationships between quantitative CT analysis with functional, inflammatory and infective assessments of disease to identify the utility of imaging to stratify disease to better predict outcomes and disease response. METHODS Patients from the AERIS study with moderate-very severe COPD underwent HRCT, with image analysis determining the quantity of emphysema (%LAA<- 950), small airways disease (E/I MLD) and bronchial wall thickening (Pi10). At enrolment subjects underwent lung function testing, six-minute walk testing (6MWT), blood sampling for inflammatory markers and sputum sampling for white cell differential and microbiological culture and PCR. RESULTS 122 subjects were included in this analysis. Emphysema and small airways disease had independent associations with airflow obstruction (β = - 0.34, p < 0.001 and β = - 0.56, p < 0.001). %LAA<- 950 had independent associations with gas transfer (β = - 0.37, p < 0.001) and E/I MLD with RV/TLC (β = 0.30, p =0.003). The distance walked during the 6MWT was not associated with CT parameters, but exertional desaturation was independently associated with emphysema (β = 0.73, p < 0.001). Pi10 did not show any independent associations with lung function or functional parameters. No CT parameters had any associations with sputum inflammatory cells. Greater emphysema was associated with lower levels of systemic inflammation (CRP β = - 0.34, p < 0.001 and fibrinogen β = - 0.28, p =0.003). There was no significant difference in any of the CT parameters between subjects where potentially pathogenic bacteria were detected in sputum and those where it was not. CONCLUSIONS This study provides further validation for the use of quantitative CT measures of emphysema and small airways disease in COPD as they showed strong associations with pulmonary physiology and functional status. In contrast to this quantitative CT measures showed few convincing associations with biological measures of disease, suggesting it is not an effective tool at measuring disease activity.
Collapse
Affiliation(s)
- Kristoffer Ostridge
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Nicholas P Williams
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Viktoriya Kim
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Harden
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Bourne
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Stuart C Clarke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | | | | | | | - Andrew Tuck
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Anthony Williams
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Stephen Wootton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Karl J Staples
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | | |
Collapse
|
23
|
Chen TX, Pudasaini B, Guo J, Gong SG, Jiang R, Wang L, Zhao QH, Wu WH, Yuan P, Liu JM. Sex-specific cardiopulmonary exercise testing indices to estimate the severity of inoperable chronic thromboembolic pulmonary hypertension. Int J Chron Obstruct Pulmon Dis 2018; 13:385-397. [PMID: 29416329 PMCID: PMC5790096 DOI: 10.2147/copd.s152971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Sex differences in chronic thromboembolic pulmonary hypertension (CTEPH) have been revealed in few studies. Although right heart catheterization (RHC) is the gold standard for clinical diagnosis and assessment of prognosis in pulmonary hypertension (PH), cardiopulmonary exercise testing (CPET) has been a more widely used assessment of functional capacity, disease severity, prognosis, and treatment response in PH. We hypothesized that the “sex-specific” CPET indices could estimate the severity of inoperable CTEPH. Methods Data were retrieved for 33 male (age, mean ± standard deviation [SD] =62.5±13.4 years) and 40 female (age, mean ± SD =56.3±11.8 years) patients with stable CTEPH who underwent both RHC and CPET at Shanghai Pulmonary Hospital from February 2010 to February 2016. Univariate and forward/backward multiple stepwise regression analysis was performed to assess the predictive value of CPET indices to hemodynamic parameters. Event-free survival was estimated using the Kaplan–Meier method and analyzed with the log-rank test. Cox proportional hazards models were performed to determine the independent event-free survival predictors. Results Numerous CPET parameters were different between male and female patients with CTEPH and the control group. There were no significant differences in both clinical variables and RHC parameters between male and female patients with CTEPH. O2 pulse, workload, minute ventilation (VE), and end-tidal partial pressure of O2 (PETO2) at anaerobic threshold, as well as peak O2 pulse, workload, VE, and nadir VE/CO2 were significantly higher in male patients than in female patients (P<0.05). Only oxygen uptake efficiency plateau (OUEP) showed a significantly higher difference in female than male patients (P<0.05). In addition, several CPET indices correlated with hemodynamic parameters, especially pulmonary vascular resistance (PVR), which was distinctly different between the sexes. Nadir VE/CO2 was an independent predictor of PVR in male patients with CTEPH, whereas OUEP was an independent predictor of PVR in female patients with CTEPH. Conclusion Even after confounding for age and body mass index, different CPET measurements of gas exchange efficiency correlated with PVR differently between male and female patients. This potentially could be used to estimate the severity of CTEPH.
Collapse
Affiliation(s)
- Tian-Xiang Chen
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Bigyan Pudasaini
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Jian Guo
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Su-Gang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Wen-Hui Wu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Jin-Ming Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| |
Collapse
|
24
|
Hammond E, Sloan C, Newell JD, Sieren JP, Saylor M, Vidal C, Hogue S, De Stefano F, Sieren A, Hoffman EA, Sieren JC. Comparison of low- and ultralow-dose computed tomography protocols for quantitative lung and airway assessment. Med Phys 2017; 44:4747-4757. [PMID: 28657201 DOI: 10.1002/mp.12436] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Quantitative computed tomography (CT) measures are increasingly being developed and used to characterize lung disease. With recent advances in CT technologies, we sought to evaluate the quantitative accuracy of lung imaging at low- and ultralow-radiation doses with the use of iterative reconstruction (IR), tube current modulation (TCM), and spectral shaping. METHODS We investigated the effect of five independent CT protocols reconstructed with IR on quantitative airway measures and global lung measures using an in vivo large animal model as a human subject surrogate. A control protocol was chosen (NIH-SPIROMICS + TCM) and five independent protocols investigating TCM, low- and ultralow-radiation dose, and spectral shaping. For all scans, quantitative global parenchymal measurements (mean, median and standard deviation of the parenchymal HU, along with measures of emphysema) and global airway measurements (number of segmented airways and pi10) were generated. In addition, selected individual airway measurements (minor and major inner diameter, wall thickness, inner and outer area, inner and outer perimeter, wall area fraction, and inner equivalent circle diameter) were evaluated. Comparisons were made between control and target protocols using difference and repeatability measures. RESULTS Estimated CT volume dose index (CTDIvol) across all protocols ranged from 7.32 mGy to 0.32 mGy. Low- and ultralow-dose protocols required more manual editing and resolved fewer airway branches; yet, comparable pi10 whole lung measures were observed across all protocols. Similar trends in acquired parenchymal and airway measurements were observed across all protocols, with increased measurement differences using the ultralow-dose protocols. However, for small airways (1.9 ± 0.2 mm) and medium airways (5.7 ± 0.4 mm), the measurement differences across all protocols were comparable to the control protocol repeatability across breath holds. Diameters, wall thickness, wall area fraction, and equivalent diameter had smaller measurement differences than area and perimeter measurements. CONCLUSIONS In conclusion, the use of IR with low- and ultralow-dose CT protocols with CT volume dose indices down to 0.32 mGy maintains selected quantitative parenchymal and airway measurements relevant to pulmonary disease characterization.
Collapse
Affiliation(s)
- Emily Hammond
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center, Iowa City, IA, 52242, USA
| | - Chelsea Sloan
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - John D Newell
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center, Iowa City, IA, 52242, USA
| | - Jered P Sieren
- Department of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Melissa Saylor
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Craig Vidal
- Department of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Shayna Hogue
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Frank De Stefano
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Alexa Sieren
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center, Iowa City, IA, 52242, USA.,Imaging services, VIDA Diagnostics, Inc., 2500 Crosspark Road, W250 BioVentures Center, Coralville, IA, 52241, USA
| | - Jessica C Sieren
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center, Iowa City, IA, 52242, USA
| |
Collapse
|
25
|
Li Y, Dai YL, Yu N, Guo YM. Sex-related differences in bronchial parameters and pulmonary function test results in patients with chronic obstructive pulmonary disease based on three-dimensional quantitative computed tomography. J Int Med Res 2017; 46:135-142. [PMID: 28758847 PMCID: PMC6011288 DOI: 10.1177/0300060517721309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study was performed to evaluate the effect of sex on bronchial parameters and the predicted forced expiratory volume in 1 s expressed as a percentage of the forced vital capacity (FEV1% pred) on pulmonary function testing. Methods The data of 359 patients with chronic obstructive pulmonary disease (COPD) with available FEV1% pred and computed tomography (CT) images were retrospectively reviewed. FACT-Digital lung TM software (DeXin, Xi’an, China) was used to perform fully automated three-dimensional CT quantitative measurements of the bronchi. Generation 5 to 7 bronchi were measured, and the parameters analyzed were the lumen diameter (LD), wall thickness (WT), lumen area (LA), and WA% [WA / (WA + LA) × 100%]. Results In the smoking, smoking cessation, and nonsmoking groups, women had a significantly larger WA% and smaller LD, WT, and LA than men. The FEV1% pred was significantly lower in women than men in the smoking and smoking cessation groups. The FEV1% pred was significantly higher in women than men in the nonsmoking group. Conclusion Sex-related differences may partially explain why smoking women experience more severe pulmonary function impairment than men among patients with COPD.
Collapse
Affiliation(s)
- Yan Li
- 1 Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong-Liang Dai
- 2 Department of Radiology, Weapons Industry of 521 Hospital, Xi'an, China
| | - Nan Yu
- 3 Department of Radiology, First Affiliated Hospital of Shaanxi Chinese Medicine University, Xi'an, China
| | - You-Min Guo
- 1 Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
26
|
Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
Collapse
Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
27
|
Zouk AN, Wells JM. In Rotterdam, size really does matter: implications of pulmonary artery enlargement on mortality. Eur Respir J 2017; 49:49/6/1700750. [PMID: 28619963 DOI: 10.1183/13993003.00750-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Aline N Zouk
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| |
Collapse
|
28
|
Abstract
BACKGROUND Farmer's lung (FL) is a common type of hypersensitivity pneumonitis. It is often considered that fibrosis is the most frequent finding in chronic FL. Nevertheless, three cohort studies have suggested that some patients with chronic FL may develop emphysema. We aimed to evaluate the current prevalence of emphysema in active FL, to describe the radiological and functional features of emphysema in active FL, and to identify risk factors associated with emphysema in this population. METHODS Patients aged over 18 years with active FL were prospectively recruited through the SOPHIA study (CPP Est; P-2009-521), between 2007 and 2015. Each patient had complete medical history screening, clinical examination, high resolution computed tomodensitometry, bronchoalveolar lavage, pulmonary function tests and serum precipitins. RESULTS Among 33 patients with active FL, the prevalence of emphysema in this series of incident active FL cases was higher (48.5%) than that of fibrosis (12%) and was not dependent on smoking habits. Most patients with emphysema did not have lung hyperinflation. The possible risk factors for emphysema in active FL were a longer duration of exposure to organic dusts, and at a higher level. CONCLUSION Emphysema is found in half of patients with active FL and may be influenced by exposure patterns.
Collapse
|
29
|
Wells JM, Estepar RSJ, McDonald MLN, Bhatt SP, Diaz AA, Bailey WC, Jacobson FL, Dransfield MT, Washko GR, Make BJ, Casaburi R, van Beek EJR, Hoffman EA, Sciurba FC, Crapo JD, Silverman EK, Hersh CP. Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study. BMC Pulm Med 2016; 16:169. [PMID: 27903260 PMCID: PMC5131397 DOI: 10.1186/s12890-016-0331-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Hypoxemia is a major complication of COPD and is a strong predictor of mortality. We previously identified independent risk factors for the presence of resting hypoxemia in the COPDGene cohort. However, little is known about characteristics that predict onset of resting hypoxemia in patients who are normoxic at baseline. We hypothesized that a combination of clinical, physiologic, and radiographic characteristics would predict development of resting hypoxemia after 5-years of follow-up in participants with moderate to severe COPD Methods We analyzed 678 participants with moderate-to-severe COPD recruited into the COPDGene cohort who completed baseline and 5-year follow-up visits and who were normoxic by pulse oximetry at baseline. Development of resting hypoxemia was defined as an oxygen saturation ≤88% on ambient air at rest during follow-up. Demographic and clinical characteristics, lung function, and radiographic indices were analyzed with logistic regression models to identify predictors of the development of hypoxemia. Results Forty-six participants (7%) developed resting hypoxemia at follow-up. Enrollment at Denver (OR 8.30, 95%CI 3.05–22.6), lower baseline oxygen saturation (OR 0.70, 95%CI 0.58–0.85), self-reported heart failure (OR 6.92, 95%CI 1.56–30.6), pulmonary artery (PA) enlargement on computed tomography (OR 2.81, 95%CI 1.17–6.74), and prior severe COPD exacerbation (OR 3.31, 95%CI 1.38–7.90) were independently associated with development of resting hypoxemia. Participants who developed hypoxemia had greater decline in 6-min walk distance and greater 5-year decline in quality of life compared to those who remained normoxic at follow-up. Conclusions Development of clinically significant hypoxemia over a 5-year span is associated with comorbid heart failure, PA enlargement and severe COPD exacerbation. Further studies are needed to determine if treatments targeting these factors can prevent new onset hypoxemia. Trial registration COPDGene is registered at ClinicalTrials.gov: NCT00608764 (Registration Date: January 28, 2008) Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0331-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA. .,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA. .,Birmingham VA Medical Center, Birmingham, AL, USA. .,, 1900 University Blvd, THT 422, Birmingham, AL, 35294, USA.
| | | | - Merry-Lynn N McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA
| | - Alejandro A Diaz
- Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William C Bailey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - George R Washko
- Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Edwin J R van Beek
- Department of Radiology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
30
|
Oki Y, Kaneko M, Fujimoto Y, Sakai H, Misu S, Mitani Y, Yamaguchi T, Yasuda H, Ishikawa A. Usefulness of the 6-minute walk test as a screening test for pulmonary arterial enlargement in COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:2869-2875. [PMID: 27920514 PMCID: PMC5126000 DOI: 10.2147/copd.s114497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pulmonary hypertension and exercise-induced oxygen desaturation (EID) influence acute exacerbation of COPD. Computed tomography (CT)-detected pulmonary artery (PA) enlargement is independently associated with acute COPD exacerbations. Associations between PA to aorta (PA:A) ratio and EID in patients with COPD have not been reported. We hypothesized that the PA:A ratio correlated with EID and that results of the 6-minute walk test (6MWT) would be useful for predicting the risk associated with PA:A >1. PATIENTS AND METHODS We retrospectively measured lung function, 6MWT, emphysema area, and PA enlargement on CT in 64 patients with COPD. The patients were classified into groups with PA:A ≤1 and >1. Receiver-operating characteristic curves were used to determine the threshold values with the best cutoff points to predict patients with PA:A >1. RESULTS The PA:A >1 group had lower forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1:FVC ratio, diffusion capacity of lung carbon monoxide, 6MW distance, and baseline peripheral oxygen saturation (SpO2), lowest SpO2, highest modified Borg scale results, percentage low-attenuation area, and history of acute COPD exacerbations ≤1 year, and worse BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index results (P<0.05). Predicted PA:A >1 was determined for SpO2 during 6MWT (best cutoff point 89%, area under the curve 0.94, 95% confidence interval 0.88-1). SpO2 <90% during 6MWT showed a sensitivity of 93.1, specificity of 94.3, positive predictive value of 93.1, negative predictive value of 94.3, positive likelihood ratio of 16.2, and negative likelihood ratio of 0.07. CONCLUSION Lowest SpO2 during 6MWT may predict CT-measured PA:A, and lowest SpO2 <89% during 6MWT is excellent for detecting pulmonary hypertension in COPD.
Collapse
Affiliation(s)
- Yutaro Oki
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences; Department of Rehabilitation
| | - Masahiro Kaneko
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe
| | - Yukari Fujimoto
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences
| | | | - Shogo Misu
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences; Department of Rehabilitation
| | - Yuji Mitani
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences; Department of Rehabilitation, Sapporo Nishimaruyama Hospital, Sapporo, Japan
| | - Takumi Yamaguchi
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences; Department of Rehabilitation
| | - Hisafumi Yasuda
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences
| | - Akira Ishikawa
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences
| |
Collapse
|
31
|
Mohamed Hoesein FA, Besselink T, Pompe E, Oudijk EJ, de Graaf EA, Kwakkel-van Erp JM, de Jong PA, Luijk B. Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD. Lung 2016; 194:813-9. [PMID: 27423782 PMCID: PMC5031745 DOI: 10.1007/s00408-016-9926-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/11/2016] [Indexed: 11/18/2022]
Abstract
Introduction Pulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD. Methods COPD patients evaluated for eligibility for lung transplantation between 2004 and 2015 were retrospectively analyzed. Clinical characteristics, chest CTs, spirometry, and right-sided heart catheterizations (RHC) were studied. Diameters of PA and ascending aorta (A) were measured on CT. Diagnostic properties of different cut-offs of PA diameter and PA:A ratio in diagnosing PH were calculated. Results Of 92 included COPD patients, 30 (32.6 %) had PH at RHC (meanPAP > 25 mm Hg). PA:A > 1 had a negative predictive value (NPV) of 77.9 % and a positive predictive value (PPV) of 63.1 % with an odds ratio (OR (CI 95 %)) of 5.60 (2.00–15.63). PA diameter ≥30 mm had a NPV of 78 % and PPV of 64 % with an OR (CI 95 %) of 6.95 (2.51–19.24). Conclusion A small PA diameter and PA:A make the presence of PH unlikely but cannot exclude its presence in end-stage COPD. A large PA diameter and PA:A maybe used to detect PH early.
Collapse
Affiliation(s)
- Firdaus A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands.
| | - Tim Besselink
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Erik-Jan Oudijk
- Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ed A de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M Kwakkel-van Erp
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Bart Luijk
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
32
|
Grimminger J, Ghofrani HA, Weissmann N, Klose H, Grimminger F. COPD-associated pulmonary hypertension: clinical implications and current methods for treatment. Expert Rev Respir Med 2016; 10:755-66. [PMID: 27212458 DOI: 10.1080/17476348.2016.1190275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, one serious complication being pulmonary hypertension, which occurs in up to 30% of patients and increases mortality drastically. Difficulties in diagnosis and the unclear beneficial effects of PH-specific therapy have hitherto resulted in the absence of approved therapies. Consequently, PH and right heart failure in COPD are still currently treated according to symptoms and not underlying cause Areas covered: This review focuses on the current knowledge of its pathogenesis, clinical picture, diagnosis as well as methods for treatment Expert commentary: Since PH-COPD is an orphan disease with grievous consequences, and diagnosis as well as the right choice of possible treatment is crucial, referral to an expert center in cases of suspicion is necessary. Hitherto there is no officially approved treatment available even though several studies have shown notable improvement in selected individuals, making diagnostics, prognostic markers, and the search for therapeutic agents key issues of interest in this field.
Collapse
Affiliation(s)
- Jan Grimminger
- a University of Giessen and Marburg Lung Center (UGMLC), University of Giessen , Giessen , Germany.,b German Center for Lung Research (DZL) , University of Giessen , Giessen , Germany.,c Excellence Cluster Cardio-Pulmonary System (ECCPS) , University of Giessen , Giessen , Germany.,d University Medical Center Hamburg-Eppendorf (UKE), University of Hamburg , Hamburg , Germany.,e Center for Pulmonary Arterial Hypertension Hamburg (CPAHH), Martin Zeitz Center for Rare Diseases , University of Hamburg , Hamburg , Germany
| | - Hossein Ardeschir Ghofrani
- a University of Giessen and Marburg Lung Center (UGMLC), University of Giessen , Giessen , Germany.,b German Center for Lung Research (DZL) , University of Giessen , Giessen , Germany.,c Excellence Cluster Cardio-Pulmonary System (ECCPS) , University of Giessen , Giessen , Germany.,f Department of Medicine , Imperial College London , London , UK
| | - Nobert Weissmann
- a University of Giessen and Marburg Lung Center (UGMLC), University of Giessen , Giessen , Germany.,b German Center for Lung Research (DZL) , University of Giessen , Giessen , Germany.,c Excellence Cluster Cardio-Pulmonary System (ECCPS) , University of Giessen , Giessen , Germany
| | - Hans Klose
- d University Medical Center Hamburg-Eppendorf (UKE), University of Hamburg , Hamburg , Germany.,e Center for Pulmonary Arterial Hypertension Hamburg (CPAHH), Martin Zeitz Center for Rare Diseases , University of Hamburg , Hamburg , Germany.,g German Center for Lung Research (DZL) , University of Hamburg , Hamburg , Germany
| | - Friedrich Grimminger
- a University of Giessen and Marburg Lung Center (UGMLC), University of Giessen , Giessen , Germany.,b German Center for Lung Research (DZL) , University of Giessen , Giessen , Germany.,c Excellence Cluster Cardio-Pulmonary System (ECCPS) , University of Giessen , Giessen , Germany
| |
Collapse
|
33
|
Frantz RP. Pulmonary arterial hypertension or left heart disease with pulmonary hypertension? Toward noninvasive clarity, but time for a new paradigm. Eur Respir J 2016; 46:299-302. [PMID: 26232475 DOI: 10.1183/13993003.00456-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
34
|
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
|
35
|
Coste F, Dournes G, Dromer C, Blanchard E, Freund-Michel V, Girodet PO, Montaudon M, Baldacci F, Picard F, Marthan R, Berger P, Laurent F. CT evaluation of small pulmonary vessels area in patients with COPD with severe pulmonary hypertension. Thorax 2016; 71:830-7. [DOI: 10.1136/thoraxjnl-2015-207696] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
|
36
|
Blood fibrocytes are recruited during acute exacerbations of chronic obstructive pulmonary disease through a CXCR4-dependent pathway. J Allergy Clin Immunol 2016; 137:1036-1042.e7. [DOI: 10.1016/j.jaci.2015.08.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/11/2015] [Accepted: 08/24/2015] [Indexed: 02/05/2023]
|
37
|
Affiliation(s)
- Surinder Kumar Jindal
- Jindal Clinics, Chandigarh, India; Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
| |
Collapse
|
38
|
Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension. Lung 2015; 193:911-8. [PMID: 26453478 DOI: 10.1007/s00408-015-9813-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Recent imaging studies demonstrated the usefulness of quantitative computed tomographic (CT) analysis assessing pulmonary hypertension (PH) in patients with chronic obstructive lung disease (COPD-PH). The aim of this study was to investigate whether it would be also valuable for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH. METHODS We analyzed a correlation between the extent of cystic destruction (LAA%) and total cross-sectional areas of small pulmonary vessels less than 5 mm(2) (%CSA <5) in many CT slices from each of four COPD-PH patients before and after the initiation of pulmonary vasodilator. To evaluate those generalized data from patients with COPD, we evaluated multiple slices from 42 patients whose PH was not clinically suspicious. We also selected five PH patients with idiopathic interstitial pneumonia (IIP-PH) and analyzed serial changes of pulmonary artery enlargement (PA:A ratio). RESULTS In 42 COPD patients without PH, LAA% had a statistically significant negative correlation with %CSA <5. However, three of four COPD-PH patients manifested no such correlation. In two patients, clinical findings were dramatically improved after the initiation of pulmonary vasodilator. Notably, LAA% and %CSA <5 in those patients correlated significantly after its treatment. In COPD-PH, the PA:A ratio was significantly decreased after the initiation of pulmonary vasodilator therapy (1.25 ± 0.13 vs. 1.13 ± 0.11, p = 0.019), but not in IIP-PH. CONCLUSIONS Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.
Collapse
|
39
|
Kirby M, Coxson HO. Uncovering the Bronchovascular Links in Patients with Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension. Am J Respir Crit Care Med 2015; 191:8-10. [DOI: 10.1164/rccm.201411-2101ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Miranda Kirby
- Department of RadiologyUniversity of British ColumbiaVancouver, British Columbia, Canadaand
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouver, British Columbia, Canada
| | - Harvey O. Coxson
- Department of RadiologyUniversity of British ColumbiaVancouver, British Columbia, Canadaand
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouver, British Columbia, Canada
| |
Collapse
|