1
|
Zhu Z. Advancements in automated classification of chronic obstructive pulmonary disease based on computed tomography imaging features through deep learning approaches. Respir Med 2024; 234:107809. [PMID: 39299523 DOI: 10.1016/j.rmed.2024.107809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) represents a global public health issue that significantly impairs patients' quality of life and overall health. As one of the primary causes of chronic respiratory diseases and global mortality, effective diagnosis and classification of COPD are crucial for clinical management. Pulmonary function tests (PFTs) are standard for diagnosing COPD, yet their accuracy is influenced by patient compliance and other factors, and they struggle to detect early disease pathologies. Furthermore, the complexity of COPD pathological changes poses additional challenges for clinical diagnosis, increasing the difficulty for physicians in practice. Recently, deep learning (DL) technologies have demonstrated significant potential in medical image analysis, particularly for the diagnosis and classification of COPD. By analyzing key radiological features such as airway alterations, emphysema, and vascular characteristics in Computed Tomography (CT) scan images, DL enhances diagnostic accuracy and efficiency, providing more precise treatment plans for COPD patients. This article reviews the latest research advancements in DL methods based on principal radiological features of COPD for its classification and discusses the advantages, challenges, and future research directions of DL in this field, aiming to provide new perspectives for the personalized management and treatment of COPD.
Collapse
Affiliation(s)
- Zirui Zhu
- School of Medicine, Xiamen University, Xiamen 361102, China; National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361102, China.
| |
Collapse
|
2
|
Lee JK, Kho BG, Yoon JY, Yoon CS, Na YO, Park HY, Kim TO, Kwon YS, Kim YI, Lim SC, Shin HJ. The clinical characteristics associated with the ratio between the main pulmonary artery and ascending aorta diameter in patients with acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis 2024; 16:4924-4934. [PMID: 39268104 PMCID: PMC11388226 DOI: 10.21037/jtd-24-62] [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: 01/10/2024] [Accepted: 06/21/2024] [Indexed: 09/15/2024]
Abstract
Background A pulmonary artery-to-aorta (PA/A) ratio of ≥1 is a reliable indicator of pulmonary hypertension and is associated with an increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) and long-term mortality in patients with stable COPD. However, it is unclear whether a PA/A ratio of ≥1 is associated with mortality in patients hospitalized with acute exacerbation of COPD. The purpose of this study was to evaluate the clinical course and mortality of patients with PA/A ratios of ≥1 who were hospitalized with acute exacerbation of COPD. Methods We retrospectively reviewed the medical charts of patients admitted to a tertiary referral hospital and a secondary hospital with acute exacerbation of COPD between 2016 and 2021. Chest computed tomography was used to measure the pulmonary artery (PA), aorta (A) diameter, and the PA/A ratio. The study involved 324 and 111 patients with PA/A ratios <1 and ≥1, respectively. Results The average age in the two groups was 74.1 and 74.5 years, which was not significantly different. When compared with the group with PA/A ratios of <1, the group with PA/A ratios of ≥1 had a lower proportion of males (71.2% vs. 89.5%, P<0.001), more patients with type 2 respiratory failure (35.1% vs. 18.8%), higher high-flow nasal cannula use (10.8% vs. 4.6%), higher use of non-invasive ventilation (NIV) (21.6% vs. 7.7%), and longer hospital stay (10.9 vs. 9.5 days). In-hospital mortality was not significantly different between the two groups. A PA/A ratio of ≥1 was identified as an independent predictor of the need for high-flow nasal cannula, NIV, and intubation in COPD patients. Conclusions Patients with PA/A ratios of ≥1 had a high incidence of type 2 acute respiratory failure and required advanced treatment, including high-flow nasal cannula, NIV, and intubation. Therefore, hospitalized patients with acute exacerbation of COPD and PA/A ratios of ≥1 require more aggressive treatment.
Collapse
Affiliation(s)
- Jae-Kyeong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Bo-Gun Kho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Joon-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chang-Seok Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young-Ok Na
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ha-Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hong-Joon Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
3
|
Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
Collapse
Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| |
Collapse
|
4
|
Ferrufino RA, Alfadhel A, Gonzalez-Ciccarelli LF, Gebhardt B, Kawabori M, Ortoleva J, Brovman E, Cobey F. Preoperative Pulmonary Artery-to-Aorta Diameter Ratio as a Predictor of Postoperative Severe Right Ventricular Failure and 1-Year Mortality After Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00183-0. [PMID: 37173169 DOI: 10.1053/j.jvca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To evaluate the association of pulmonary artery diameter and pulmonary artery- to-aorta diameter ratio (PA/Ao) with right ventricular failure and mortality within 1 year after left ventricular assist device implantation. DESIGN This was a retrospective observational study between March 2013 and July 2019. SETTING The study was conducted at a single, quaternary-care academic center. PARTICIPANTS Adults (≥18 years old) receiving a durable left ventricular assist device (LVAD). Inclusion if (1) a chest computed tomography scan was performed within 30 days before the LVAD and (2) a right and left heart catheterization was completed within 30 days before the LVAD. INTERVENTIONS A left ventricular assist device was used for intervention. MEASUREMENTS AND MAIN RESULTS A total of 176 patients were included in this study. Median PA diameter and PA/Ao ratio were significantly greater in the severe right ventricular failure (RVF) group (p = 0.001, p < 0.001, respectively). Receiver operating characteristic analysis revealed PA/Ao and RVF as predictors for mortality (area under the curve = 0.725 and 0.933, respectively). Logistic regression analysis-predicted probability gave a PA/Ao ratio cutoff point of 1.04 (p < 0.001). Survival probability was significantly worse in patients with a PA/Ao ratio ≥1.04 (p = 0.005). CONCLUSIONS The PA/Ao ratio is an easily measurable noninvasive indicator that can predict RVF and 1-year mortality after LVAD implantation.
Collapse
Affiliation(s)
- Renan A Ferrufino
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Abdulaziz Alfadhel
- Department of Anesthesiology, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Luis F Gonzalez-Ciccarelli
- Department of Anesthesiology, Perioperative and Pain Medicine. Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - Masashi Kawabori
- Department of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Jamel Ortoleva
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Ethan Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Frederick Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| |
Collapse
|
5
|
Chen H, Shu T, Wang L, Yang L, Hu C, Du S, Wei H. 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] [Abstract] [Key Words] [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
Abstract
No previous meta-analysis has evaluated the relationship between pulmonary artery enlargement (PAE) measured by computed tomography (CT) and prognosis for patients with chronic obstructive pulmonary disease (COPD). Recently, several studies have suggested poor survival and reduced exercise capacity in COPD patients with PAE on CT scan, but there were conflicting results. We aimed to assess the prognostic value of PAE-CT in patients with COPD. Relevant studies were identified by searching major databases. Pooled outcomes were determined to assess the prognostic value of PAE-CT in COPD patients. Eighteen studies including 5694 participants were included. PAE indicated higher mortality in COPD patients (odds ratio [OR] = 3.06; 95% confidence interval [95% CI]: 1.76-5.32; p < 0.0001), shorter 6-minute walk distance (mean difference [MD] = -67.53 m; 95% CI: -85.98 to -49.08; p < 0.00001), higher pulmonary artery systolic pressure (MD = 15.65 mmHg; 95% CI: 13.20-18.11; p < 0.00001), longer length of hospital stay (MD = 2.92 days; 95% CI: 0.71-5.12; p = 0.009) and more severe symptom such as dyspnea (COPD Assessment Test MD = 3.14; 95% CI: 2.48-3.81; p < 0.00001). We also conducted a subgroup analysis regarding the lung function and blood gas analysis for a stable period and acute exacerbation of COPD patients. In conclusion, PAE is significantly associated with mortality, lower exercise tolerance, and poor quality of life in patients with COPD. PAE may serve as a novel imaging biomarker for risk stratification in patients with COPD in the future.
Collapse
Affiliation(s)
- Huaqiao Chen
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Tingting Shu
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lu Wang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lingzhi Yang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Changchun Hu
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Shanshan Du
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Huang Wei
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| |
Collapse
|
6
|
Kovacs G, Avian A, Bachmaier G, Troester N, Tornyos A, Douschan P, Foris V, Sassmann T, Zeder K, Lindenmann J, Brcic L, Fuchsjaeger M, Agusti A, Olschewski H. Severe Pulmonary Hypertension in COPD: Impact on Survival and Diagnostic Approach. Chest 2022; 162:202-212. [PMID: 35092746 PMCID: PMC10808070 DOI: 10.1016/j.chest.2022.01.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Severe pulmonary hypertension (PH) is prognostically highly relevant in patients with COPD. The criteria for severe PH have been defined based on hemodynamic thresholds in right heart catheterization. RESEARCH QUESTION Can noninvasive clinical tools predict severe PH in patients with COPD? How does the mortality risk change with increasing severity of airflow limitation and pulmonary vascular disease? STUDY DESIGN AND METHODS We retrospectively analyzed all consecutive patients with COPD with suspected PH undergoing in-depth clinical evaluation, including right heart catheterization, in our PH clinic between 2005 and 2018. Clinical variables potentially indicative of severe PH or death were analyzed using univariate and stepwise multivariate logistic regression and Cox regression analysis adjusted for age and sex. RESULTS We included 142 patients with median FEV1 of 55.0% predicted (interquartile range [IQR], 42.4%-69.4% predicted) and mean pulmonary arterial pressure of 35 mm Hg (IQR, 27-43 mm Hg). A multivariate model combining echocardiographic systolic pulmonary arterial pressure of ≥ 56 mm Hg, N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels of ≥ 650 pg/mL, and pulmonary artery (PA) to ascending aorta (Ao) diameter ratio on chest CT scan of ≥ 0.93 predicted severe PH with high positive and negative predictive values (both 94%). After correction for age and sex, both airflow limitation (P = .002; Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-2 vs stage 3: hazard ratio [HR], 1.56 [95% CI, 0.90-2.71]; GOLD stages 1-2 vs stage 4: HR, 3.45 [95% CI, 1.75-6.79]) and PH severity (P = .012; HR, 1.85 [95% CI, 1.15-2.99]) remained associated independently with survival. The combination of GOLD stages 3 and 4 airflow limitation and severe PH showed the poorest survival (HR for death, 3.26 [95% CI, 1.62-6.57; P = .001] vs GOLD stages 1-2 combined with nonsevere PH). INTERPRETATION In patients with COPD, the combination of echocardiography, NT-proBNP level, and PA to Ao diameter ratio predicts severe PH with high sensitivity and specificity. The contribution of severe PH and severe airflow limitation to impaired survival is comparable.
Collapse
Affiliation(s)
- Gabor Kovacs
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Gerhard Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Natascha Troester
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria
| | - Adrienn Tornyos
- Division of General Radiology, Department of Radiology, Graz, Austria
| | - Philipp Douschan
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Teresa Sassmann
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria
| | - Katarina Zeder
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Jörg Lindenmann
- Department of Thoracic and Hyperbaric Surgery, University Clinic of Surgery, Graz, Austria
| | - Luka Brcic
- Institute for Pathology, Medical University of Graz, Graz, Austria
| | | | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Ciberes, Spain
| | - Horst Olschewski
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| |
Collapse
|
7
|
Cheng Y, Li L, Tu X, Pei R. The Main Pulmonary Artery to the Ascending Aorta Diameter Ratio (PA/A) as a Predictor of Worse Outcomes in Hospitalized Patients with AECOPD. Int J Chron Obstruct Pulmon Dis 2022; 17:1157-1165. [PMID: 35601020 PMCID: PMC9122045 DOI: 10.2147/copd.s357696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/30/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The main pulmonary artery (PA) to ascending aorta diameter ratio (PA/A) greater than one is a promising indicator of pulmonary hypertension (PH) in acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) (AECOPD). This study aims to disclose the associations between the PA/A ratio and clinical outcomes in hospitalized patients with AECOPD. Patients and Methods Consecutive AECOPD patients admitted to the Department of Respiratory Medicine from September 2017 to July 2021 were reviewed. The treatment success of AECOPD patients was defined as improvement in the clinical condition when discharged from the hospital. Conversely, treatment failure was considered to be an event of in-hospital death or deterioration of the clinical condition prior to discharge. Results A total of 118 individuals were ultimately reviewed in this study: 74 individuals with a PA/A ratio <1 and 44 individuals with a PA/A ratio ≥1. The outcomes of 21 patients were treatment failure, and 97 patients were considered successes. Patients with a PA/A ratio ≥1 had significantly higher PaCO2, red cell distribution width, brain natriuretic peptide, PA diameters, RICU admission rates, and proportions of treatment failure than patients with PA/A ratios <1 (P < 0.05). The PA diameter and PA/A ratio were significantly increased in the treatment failure group compared with the success group (P < 0.05). A survival analysis indicated that patients with a PA/A ratio ≥1 had worse outcomes than patients with a PA/A ratio <1 during hospitalization (P < 0.05). A multivariate analysis showed that a PA/A ratio ≥1 was an independent risk factor for treatment failure in patients with AECOPD. Conclusions AECOPD patients with a PA/A ratio ≥1 may have worse outcomes during hospitalization. A PA/A ratio ≥1 may be a promising predictor of treatment failure in patients with AECOPD.
Collapse
Affiliation(s)
- Yusheng Cheng
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, People’s Republic of China
| | - Lingling Li
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, People’s Republic of China
| | - Xiongwen Tu
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, People’s Republic of China
| | - Renguang Pei
- Department of Interventional Therapy, Yijishan Hospital, Wannan Medical College, Wuhu, People’s Republic of China
| |
Collapse
|
8
|
Mousa M, Matar M, Matar M, Jaber S, Jaber FS, Al Ajerami Y, Falak A, Abujazar M, Oglat AA, Abu-Odah H. Role of cardiovascular computed tomography parameters and lungs findings in predicting severe COVID-19 patients: a single-centre retrospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:222. [PMCID: PMC9574172 DOI: 10.1186/s43055-022-00910-0] [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] [Indexed: 01/08/2023] Open
Abstract
Background Results Conclusions
Collapse
Affiliation(s)
- Mahmoud Mousa
- Department of Radiology, Turkish Friendship Hospital, Gaza Strip, Palestine
| | - Marwan Matar
- Department of Radiology, Turkish Friendship Hospital, Gaza Strip, Palestine
| | - Mohammad Matar
- Department of Radiology, Al-Shifa Medical Complex, Gaza Strip, Palestine
| | - Sadi Jaber
- Department of Radiology, Nasser Medical Complex, Gaza Strip, Palestine
| | - Fouad S. Jaber
- grid.266756.60000 0001 2179 926XInternal Medicine Department, University of Missouri–Kansas City, Missouri, USA
| | - Yasser Al Ajerami
- grid.133800.90000 0001 0436 6817Department of Medical Imaging, Applied Medical Sciences, Al-Azhar University, Gaza Strip, Palestine
| | - Amjad Falak
- grid.6979.10000 0001 2335 3149Department of Advanced Material Technologies, Faculty of Material Engineering, Silesian University of Technology (SUT), Gliwice, Poland
| | - Mohammed Abujazar
- grid.412354.50000 0001 2351 3333Center for Medical Imaging, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Ammar A. Oglat
- grid.33801.390000 0004 0528 1681Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133 Jordan
| | - Hammoda Abu-Odah
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, FG 414 a-b, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
| |
Collapse
|
9
|
Baldi BG, dos Santos Fernandes CJC, Heiden GI, Freitas CSG, Sobral JB, Kairalla RA, Carvalho CRR, Souza R. Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases. Medicine (Baltimore) 2021; 100:e26483. [PMID: 34160461 PMCID: PMC8238321 DOI: 10.1097/md.0000000000026483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves.Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ± 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ± 20% and 38 ± 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ± 6 mm and 0.95 ± 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
Collapse
Affiliation(s)
| | | | | | | | - Juliana Barbosa Sobral
- Laboratório de Ecocardiografia, Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Rogério Souza
- Divisão de Pneumologia, Instituto do Coração (InCor)
| |
Collapse
|
10
|
Eslami V, Abrishami A, Zarei E, Khalili N, Baharvand Z, Sanei-Taheri M. The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19. Acad Radiol 2021; 28:8-17. [PMID: 33041195 PMCID: PMC7528899 DOI: 10.1016/j.acra.2020.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 01/23/2023]
Abstract
RATIONALE AND OBJECTIVES Cardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19. MATERIALS AND METHODS Eighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Cox-regression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices. RESULTS Mean (±SD) age of patients was 54.55 (±15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001). CONCLUSION CT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.
Collapse
Affiliation(s)
- Vahid Eslami
- Department of Cardiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Zarei
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Baharvand
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei-Taheri
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Iranian Society of Radiology, Tehran, Iran
| |
Collapse
|
11
|
Ferrante G, Fazzari F, Cozzi O, Maurina M, Bragato R, D’Orazio F, Torrisi C, Lanza E, Indolfi E, Donghi V, Mantovani R, Liccardo G, Voza A, Azzolini E, Balzarini L, Reimers B, Stefanini GG, Condorelli G, Monti L. Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography. Cardiovasc Res 2020; 116:2239-2246. [PMID: 32637999 PMCID: PMC7454387 DOI: 10.1093/cvr/cvaa193] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. METHODS AND RESULTS This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th-75th percentile, 27-32) mm vs. 27.7 (25-30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02-1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02-1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27-3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. CONCLUSIONS An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.
Collapse
Affiliation(s)
- Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Fabio Fazzari
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Ottavia Cozzi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Matteo Maurina
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Renato Bragato
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Federico D’Orazio
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Chiara Torrisi
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Ezio Lanza
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Eleonora Indolfi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Valeria Donghi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Riccardo Mantovani
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Gaetano Liccardo
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Antonio Voza
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Emergency, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Elena Azzolini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Luca Balzarini
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Lorenzo Monti
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| |
Collapse
|
12
|
Rangelov BA, Young AL, Jacob J, Cahn AP, Lee S, Wilson FJ, Hawkes DJ, Hurst JR. Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2020; 15:1751-1787. [PMID: 32801677 PMCID: PMC7385406 DOI: 10.2147/copd.s250746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/03/2020] [Indexed: 01/20/2023] Open
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are currently diagnosed based on changes in respiratory symptoms. Characterizing the imaging manifestation of exacerbations could be useful for objective diagnosis of exacerbations in the clinic and clinical trials, as well as provide a mechanism for monitoring exacerbation treatment and recovery. In this systematic review, we employed a comprehensive search across three databases (Medline, EMBASE, Web of Science) to identify studies that performed imaging of the thorax at COPD exacerbation. We included 51 from a total of 5,047 articles which met all our inclusion criteria. We used an adapted version of the Modified Newcastle-Ottawa Quality Assessment Scale for cohort studies to assess the quality of the included studies. Conclusions were weighted towards higher-quality articles. We identified a total of 36 thoracic imaging features studied at exacerbation of COPD. Studies were generally heterogeneous in their measurements and focus. Nevertheless, considering studies which performed consecutive imaging at stable state and exacerbation, which scored highest for quality, we identified salient imaging biomarkers of exacerbations. An exacerbation is characterized by airway wall and airway calibre changes, hyperinflation, pulmonary vasoconstriction and imaging features suggestive of pulmonary arterial hypertension. Most information was gained from CT studies. We present the first ever composite imaging signature of COPD exacerbations. While imaging during an exacerbation is comparatively new and not comprehensively studied, it may uncover important insights into the acute pathophysiologic changes in the cardiorespiratory system during exacerbations of COPD, providing objective confirmation of events and a biomarker of recovery and treatment response.
Collapse
Affiliation(s)
- Bojidar A Rangelov
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Computer Science, University College London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,UCL Respiratory, University College London, London, UK
| | | | | | | | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| |
Collapse
|
13
|
Zouk AN, Gulati S, Xing D, Wille KM, Rowe SM, Wells JM. Pulmonary artery enlargement is associated with pulmonary hypertension and decreased survival in severe cystic fibrosis: A cohort study. PLoS One 2020; 15:e0229173. [PMID: 32078644 PMCID: PMC7032721 DOI: 10.1371/journal.pone.0229173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary artery (PA) enlargement, defined as pulmonary artery to ascending aorta diameter ratio (PA:A)>1 on computed tomography (CT), is a marker of pulmonary vascular disease in chronic lung diseases. PA enlargement is prevalent in cystic fibrosis (CF), but its relationship to hemodynamics and prognostic utility in severe CF are unknown. We hypothesized that the PA:A would have utility in identifying pulmonary hypertension (PH) in severe CF and that PA enlargement would be associated with reduced transplant-free survival. METHODS We conducted a retrospective study of adults with CF undergoing lung transplant evaluation at a single center between 2000 and 2015. CT, right heart catheterization (RHC), and clinical data were collected. The PA:A was measured from a single CT slice. We measured associations between PA:A and invasive hemodynamic parameters including PH defined as a mPAP ≥25mmHg using adjusted linear and logistic regression models. Kaplan-Meier and adjusted Cox regression models were used to measure associations between PA:A>1, RHC-defined PH, and transplant-free survival in severe CF. RESULTS We analyzed 78 adults with CF that had CT scans available for review, including 44 that also had RHC. RHC-defined PH defined as a mPAP ≥25mmHg was present in 36% of patients with CF undergoing transplant evaluation. The PA:A correlated with mPAP (r = 0.73; 95% CI 3.87-7.80; p<0.001) and PVR (r = 0.42, p = 0.005) and the PA:A>1 was an independent predictor of PH (aOR 4.50; 95% CI 1.05-19.2; p = 0.042). PA:A>1 was independently associated with increased hazards for death or transplant (aHR 2.69; 95% CI 1.41-5.14; P = 0.003). The presence of mPAP ≥25mmHg was independently associated with decreased survival in this cohort. CONCLUSIONS PA enlargement is associated with pulmonary hemodynamics and PH in severe CF. PA enlargement is an independent prognostic indicator of PH and decreased survival in this population.
Collapse
Affiliation(s)
- Aline N. Zouk
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
| | - Swati Gulati
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
| | - Dongqi Xing
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
- Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL, United States of America
- UAB Lung Health Center, Birmingham, AL, United States of America
| | - Keith M. Wille
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
| | - Steven M. Rowe
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
- Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL, United States of America
- UAB Lung Health Center, Birmingham, AL, United States of America
| | - J. Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
- Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL, United States of America
- UAB Lung Health Center, Birmingham, AL, United States of America
- Birmingham VA Medical Center, Birmingham, AL, United States of America
- * E-mail:
| |
Collapse
|
14
|
LaFon DC, Bhatt SP, Labaki WW, Rahaghi FN, Moll M, Bowler RP, Regan EA, Make BJ, Crapo JD, San Jose Estepar R, Diaz AA, Silverman EK, Han MK, Hobbs B, Cho MH, Washko GR, Dransfield MT, Wells JM. Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene. Eur Respir J 2020; 55:13993003.01812-2019. [PMID: 31772001 DOI: 10.1183/13993003.01812-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,UAB Lung Imaging Core, Birmingham, AL, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ P Bowler
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Division of Rheumatology, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hobbs
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark T Dransfield
- 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
| | - 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
|
15
|
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
|
16
|
Crisafulli E, Torres A. Hospitalized acute exacerbations of chronic obstructive pulmonary disease: which patients may have a negative clinical outcome? Expert Rev Respir Med 2019; 13:691-693. [DOI: 10.1080/17476348.2019.1635459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- Pneumology Department, Clinic Thorax Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, CIBERES, Barcelona, Spain
| |
Collapse
|
17
|
Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
Collapse
Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| |
Collapse
|
18
|
Kogo M, Otsuka K, Morimoto T, Nagata K, Nakagawa A, Tomii K. Pulmonary artery enlargement predicts poor outcome during acute exacerbations of fibrotic interstitial lung disease. Respirology 2019; 24:777-782. [DOI: 10.1111/resp.13504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Mariko Kogo
- Department of Respiratory MedicineKobe City Medical Centre General Hospital Kobe Japan
| | - Kojiro Otsuka
- Department of Respiratory MedicineKobe City Medical Centre General Hospital Kobe Japan
| | - Takeshi Morimoto
- Clinical Research CentreKobe City Medical Centre General Hospital Kobe Japan
- Department of Clinical EpidemiologyHyogo College of Medicine Nishinomiya Japan
| | - Kazuma Nagata
- Department of Respiratory MedicineKobe City Medical Centre General Hospital Kobe Japan
| | - Atsushi Nakagawa
- Department of Respiratory MedicineKobe City Medical Centre General Hospital Kobe Japan
| | - Keisuke Tomii
- Department of Respiratory MedicineKobe City Medical Centre General Hospital Kobe Japan
| |
Collapse
|
19
|
Gao E, Zhang C, Wang J. Effects of Budesonide Combined with Noninvasive Ventilation on PCT, sTREM-1, Chest Lung Compliance, Humoral Immune Function and Quality of Life in Patients with AECOPD Complicated with Type II Respiratory Failure. Open Med (Wars) 2019; 14:271-278. [PMID: 30886898 PMCID: PMC6419390 DOI: 10.1515/med-2019-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Our objective is to explore the effects of budesonide combined with noninvasive ventilation on procalcitonin (PCT), soluble myeloid cell triggering receptor-1 (sTREM-1), thoracic and lung compliance, humoral immune function, and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type II respiratory failure. Methods There were 82 patients with AECOPD complicated with type II respiratory failure admitted into our hospital between March, 2016-September, 2017. They were selected and randomly divided into observation group (n=41) and control group (n=41). The patients in the control group received noninvasive mechanical ventilation and the patients in the observation group received budesonide based on the control group. The treatment courses were both 10 days. Results The total effective rate in the observation group (90.25%) was higher than the control group (65.85%) (P<0.05). The scores of cough, expectoration, and dyspnea were decreased after treatment (Observation group: t=18.7498, 23.2195, 26.0043, control group: t=19.9456, 11.6261, 14.2881, P<0.05); the scores of cough, expectoration, and dyspnea in the observation group were lower than the control group after treatment (t=11.6205, 17.4139, 11.6484, P<0.05). PaO2 was increased and PaCO2 was decreased in both groups after treatment (Observation group: t=24.1385, 20.7360, control group: t=11.6606, 9.2268, P<0.05); PaO2 was higher and PaCO2 was lower in the observation group than the control group after treatment (t=10.3209, 12.0115, P<0.05). Serum PCT and sTREM-1 in both groups were decreased after treatment (Observation group: t=16.2174, 12.6698, control group: t=7.2283, 6.1634, P<0.05); serum PCT and sTREM-1 in the observation group were lower than the control group after treatment (t=10.1017, 7.8227, P<0.05). The thoracic and lung compliance in both groups were increased after treatment (Observation group: t=30.5359, 17.8471, control group: t=21.2426, 13.0007, P<0.05); the thoracic and lung compliance in the observation group were higher than the control group after treatment (t=10.8079, 5.9464, P<0.05). IgA and IgG in both groups were increased after treatment (Observation group: t=9.5794, 25.3274, control group: t=5.5000, 4.7943, P<0.05), however IgM was not statistically different after treatment (Observation group: t=0.7845, control group: t=0.1767, P>0.05); IgA and IgG in the observation group were higher than the control group (t=4.9190, 4.7943, P<0.05), however IgM was not statistically different between two groups after treatment (t=0.6168, P>0.05). COPD assessment test (CAT) scores were decreased in both groups after treatment (Observation group: t=20.6781, control group: t=9.0235, P<0.05); CAT score in the observation group was lower than the control group after treatment (t=12.9515, P<0.05). Forced expiratory volume in one second (FEV1%) and forced expiratory volume in one second/ forced expiratory volume in one second (FEV1/FVC) were increased in both groups after treatment (Observation group: t=15.3684, 15.9404, control group: t=10.6640, 12.8979, P<0.05); FEV1% and FEV1/FVC in the observation group were higher than the control group (t=6.9528, 7.3527,P<0.05). The rates of complication were not statistically different between two groups (P>0.05). Conclusion Budesonide combined with noninvasive mechanical ventilation has good curative effects in treating AECOPE patients complicated with type II respiratory failure. It can decrease serum PCT and sTREM-1, increase thoracic lung compliance, and improve the humoral immune function and life quality.
Collapse
Affiliation(s)
- Erxiang Gao
- Emergency Department, Xingyuan Hospital of Yulin, Shaanxi 719000, China
| | - Chi Zhang
- The Second Department of Internal Medicine, Xingyuan Hospital of Yulin, Shaanxi 719000, China
| | - Jianping Wang
- Department of Emergency, 1st Hospital of Yulin, Yulin City, Shaanxi Province 719000, China
| |
Collapse
|
20
|
Ghobadi H, Janbazi H, Matin S, Lari SM, Ansarin K. The pulmonary artery-aorta ratio: Is it related to quality of life in chronic obstructive pulmonary disease? CLINICAL RESPIRATORY JOURNAL 2018; 12:2390-2396. [PMID: 30073796 DOI: 10.1111/crj.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 02/02/2018] [Accepted: 05/06/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Little is known about the relationship between health status and pulmonary artery diameter in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to evaluate correlation between pulmonary artery-aorta ratio (P-A ratio) and health status of the individuals, using COPD assessment test (CAT). MATERIALS AND METHODS In a cross-sectional study, 112 COPD patients were recruited. The severity of COPD was determined by global initiative for obstructive lung disease (GOLD). After digital chest CT scan, the P-A ratio was measured at the level of bifurcation and compared with CAT score, GOLD stage, exacerbation rate and Modified Medical Research Council (MMRC) score. RESULTS The average P-A ratio was 0.89 ± 0.16 and 62.5% of patients had ratio less than one. The P-A ratio correlates significantly with different GOLD stages, CAT score and MMRC score (P < .001, P < .001, P < .001, respectively). Compared patients with low P-A ratio (<1), those with high P-A ratio (≥ 1) showed higher CAT score [11.94 ± 5.94 vs 25.17 ± 5.84] (P < .001). The P-A ratio was significantly higher in frequent (≥2) comparing low (<2) exacerbations [1.07 ± 0.07 vs 0.77 ± 0.06] (P < .001). CONCLUSION Significant correlations were found between P-A ratio and GOLD, exacerbation rate and health status, using CAT of patients with COPD. These findings also may suggest the potential role of P-A ratio, in the management of COPD patients.
Collapse
Affiliation(s)
- Hassan Ghobadi
- Pulmonary Division, Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamid Janbazi
- Department on Internal Medicine, Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Somaieh Matin
- Department on Internal Medicine, Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shahrzad M Lari
- Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Ansarin
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
21
|
Crisafulli E, Barbeta E, Ielpo A, Torres A. Management of severe acute exacerbations of COPD: an updated narrative review. Multidiscip Respir Med 2018; 13:36. [PMID: 30302247 PMCID: PMC6167788 DOI: 10.1186/s40248-018-0149-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
Collapse
Affiliation(s)
- Ernesto Crisafulli
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enric Barbeta
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonella Ielpo
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
22
|
Kitajima T, Marumo S, Shima H, Shirata M, Kawashima S, Inoue D, Katayama Y, Itotani R, Sakuramoto M, Fukui M. Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:843-853. [PMID: 29563784 PMCID: PMC5846764 DOI: 10.2147/copd.s153200] [Citation(s) in RCA: 12] [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
Purpose Episodic nocturnal hypercapnia (eNH) caused by rapid eye movement (REM) sleep-related hypoventilation is often noted in patients with advanced COPD. The purpose of this study was to clarify the clinical significance of eNH and the effectiveness of eNH-targeted noninvasive positive pressure ventilation (NPPV). Patients and methods We enrolled patients with stable, severe, or very severe COPD with daytime arterial partial oxygen pressure PaO2 ≥55 mmHg and daytime arterial partial carbon dioxide pressure PaCO2 <55 mmHg, who underwent overnight transcutaneous carbon dioxide pressure (PtcCO2) monitoring from April 2013 to April 2016. We retrospectively compared clinical characteristics, daytime blood gas analysis, frequency of exacerbation, serum albumin levels, and ratio of pulmonary artery to aorta diameter (PA:A ratio), between patients with COPD with and without eNH. For those with eNH, we applied NPPV and compared these clinical characteristics before and after NPPV. Results Twenty-one patients were finally included in this study. Ten patients (47.6%) were evaluated to have eNH. These patients had lower albumin levels (p=0.027), larger PA:A ratio (p=0.019), and higher frequency of exacerbations during the last year (p=0.036). NPPV for the patients with eNH improved daytime PaCO2 compared with that 12 months after NPPV (p=0.011). The frequency of exacerbations 1 year before NPPV decreased 1 year after NPPV (p=0.030). Serum albumin levels improved 1 year after NPPV (p=0.001). Conclusion In patients with stable severe or very severe COPD, eNH may be a risk factor of exacerbations, hypoalbuminemia, and pulmonary hypertension. NPPV may be effective against hypoalbuminemia and acute exacerbations. However, further study is necessary to validate these findings.
Collapse
Affiliation(s)
- Takamasa Kitajima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Satoshi Marumo
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Hiroshi Shima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Masahiro Shirata
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Satoru Kawashima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Daiki Inoue
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yuko Katayama
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Ryo Itotani
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Minoru Sakuramoto
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| |
Collapse
|
23
|
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
|
24
|
Pellicori P, Urbinati A, Zhang J, Joseph AC, Costanzo P, Lukaschuk E, Capucci A, Cleland JGF, Clark AL. Clinical and prognostic relationships of pulmonary artery to aorta diameter ratio in patients with heart failure: a cardiac magnetic resonance imaging study. Clin Cardiol 2018; 41:20-27. [PMID: 29359813 DOI: 10.1002/clc.22840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pulmonary artery (PA) distends as pressure increases. HYPOTHESIS The ratio of PA to aortic (Ao) diameter may be an indicator of pulmonary hypertension and consequently carry prognostic information in patients with chronic heart failure (HF). METHODS Patients with chronic HF and control subjects undergoing cardiac magnetic resonance imaging were evaluated. The main PA diameter and the transverse axial Ao diameter at the level of bifurcation of the main PA were measured. The maximum diameter of both vessels was measured throughout the cardiac cycle and the PA/Ao ratio was calculated. RESULTS A total of 384 patients (mean age, 69 years; mean left ventricular ejection fraction, 40%; median NT-proBNP, 1010 ng/L [interquartile range, 448-2262 ng/L]) and 38 controls were included. Controls and patients with chronic HF had similar maximum Ao and PA diameters and PA/Ao ratio. During a median follow-up of 1759 days (interquartile range, 998-2269 days), 181 patients with HF were hospitalized for HF or died. Neither PA diameter nor PA/Ao ratio predicted outcome in univariable analysis. In a multivariable model, only age and NT-proBNP were independent predictors of adverse events. CONCLUSIONS The PA/Ao ratio is not a useful method to stratify prognosis in patients with HF.
Collapse
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alessia Urbinati
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom.,Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti,", Ancona, Italy
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Anil C Joseph
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Pierluigi Costanzo
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Elena Lukaschuk
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti,", Ancona, Italy
| | - John G F Cleland
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom.,National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| |
Collapse
|
25
|
Pettenuzzo T, Fan E, Del Sorbo L. Extracorporeal carbon dioxide removal in acute exacerbations of chronic obstructive pulmonary disease. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:31. [PMID: 29430448 PMCID: PMC5799148 DOI: 10.21037/atm.2017.12.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/30/2017] [Indexed: 01/15/2023]
Abstract
Extracorporeal carbon dioxide removal (ECCO2R) has been proposed as an adjunctive intervention to avoid worsening respiratory acidosis, thereby preventing or shortening the duration of invasive mechanical ventilation (IMV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD). This review will present a comprehensive summary of the pathophysiological rationale and clinical evidence of ECCO2R in patients suffering from severe COPD exacerbations.
Collapse
Affiliation(s)
- Tommaso Pettenuzzo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- The Extracorporeal Life Support Program and Department of Medicine, University Health Network, Toronto, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- The Extracorporeal Life Support Program and Department of Medicine, University Health Network, Toronto, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- The Extracorporeal Life Support Program and Department of Medicine, University Health Network, Toronto, Canada
| |
Collapse
|
26
|
MacDonald MI. Broader implications for the widened pulmonary artery? Respirology 2017; 22:1495-1496. [DOI: 10.1111/resp.13119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
|
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
|