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Yamakawa H, Oda T, Sugino K, Hirama T, Komatsu M, Katano T, Fukuda T, Takemura T, Kubota Y, Kishaba T, Norisue Y, Araya J, Ogura T. Proposed Clinical Algorithm for Pleuroparenchymal Fibroelastosis (PPFE). J Clin Med 2024; 13:3675. [PMID: 38999241 PMCID: PMC11242275 DOI: 10.3390/jcm13133675] [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: 05/17/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is characterized by fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes. As PPFE appears to occur in patients with heterogeneous etiologies, the disease course is thus also heterogenous, with some patients showing rapid progression while others have slow progression. Therefore, it is very difficult to predict prognosis with PPFE. Needless to say, this problematic matter has influenced the treatment strategy of PPFE patients. In fact, until now no evidence has been shown for use in creating an appropriate management algorithm for PPFE. We speculate that "uncoordinated breathing" is the most important reason for dyspnea in PPFE patients. Because monitoring of physique and not just pulmonary function and radiological evaluation is also very important, particularly in PPFE patients, this review focused on the characteristics of PPFE through an overview of previous studies in this field, and we proposed an algorithm as precision medicine based on the current evidence. Multiple views by the pulmonologist are needed to standardize a clinical algorithm that is necessary to correctly assess PPFE patients under the premise of maintenance of physique by providing appropriate nutritional care and pulmonary rehabilitation.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama 330-8553, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo 105-8461, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Tsuboi Hospital, Fukushima 963-0197, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
- Division of Organ Transplantation, Tohoku University, Sendai 980-8574, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Takuma Katano
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-0022, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa 904-2293, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba 279-0001, Japan
| | - Jun Araya
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo 105-8461, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
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Dimiene I, Hoppenot D, Vajauskas D, Padervinskiene L, Rimkunas A, Zemaitis M, Barkauskiene D, Lapinskas T, Ereminiene E, Miliauskas S. Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity. J Clin Med 2024; 13:2937. [PMID: 38792478 PMCID: PMC11121926 DOI: 10.3390/jcm13102937] [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: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests' results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests' results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.
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Affiliation(s)
- Ieva Dimiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Deimante Hoppenot
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Donatas Vajauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Lina Padervinskiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Airidas Rimkunas
- Laboratory of Pulmonology, Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Marius Zemaitis
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Diana Barkauskiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Skaidrius Miliauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
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Oki T, Nagatani Y, Ishida S, Hashimoto M, Oshio Y, Hanaoka J, Uemura R, Watanabe Y. Right main pulmonary artery distensibility on dynamic ventilation CT and its association with respiratory function. Eur Radiol Exp 2024; 8:50. [PMID: 38570418 PMCID: PMC10991550 DOI: 10.1186/s41747-024-00441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/22/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Heartbeat-based cross-sectional area (CSA) changes in the right main pulmonary artery (MPA), which reflects its distensibility associated with pulmonary hypertension, can be measured using dynamic ventilation computed tomography (DVCT) in patients with and without chronic obstructive pulmonary disease (COPD) during respiratory dynamics. We investigated the relationship between MPA distensibility (MPAD) and respiratory function and how heartbeat-based CSA is related to spirometry, mean lung density (MLD), and patient characteristics. METHODS We retrospectively analyzed DVCT performed preoperatively in 37 patients (20 female and 17 males) with lung cancer aged 70.6 ± 7.9 years (mean ± standard deviation), 18 with COPD and 19 without. MPA-CSA was separated into respiratory and heartbeat waves by discrete Fourier transformation. For the cardiac pulse-derived waves, CSA change (CSAC) and CSA change ratio (CSACR) were calculated separately during inhalation and exhalation. Spearman rank correlation was computed. RESULT In the group without COPD as well as all cases, CSACR exhalation was inversely correlated with percent residual lung volume (%RV) and RV/total lung capacity (r = -0.68, p = 0.003 and r = -0.58, p = 0.014). In contrast, in the group with COPD, CSAC inhalation was correlated with MLDmax and MLD change rate (MLDmax/MLDmin) (r = 0.54, p = 0.020 and r = 0.64, p = 0.004) as well as CSAC exhalation and CSACR exhalation. CONCLUSION In patients with insufficient exhalation, right MPAD during exhalation was decreased. Also, in COPD patients with insufficient exhalation, right MPAD was reduced during inhalation as well as exhalation, which implied that exhalation impairment is a contributing factor to pulmonary hypertension complicated with COPD. RELEVANCE STATEMENT Assessment of MPAD in different respiratory phases on DVCT has the potential to be utilized as a non-invasive assessment for pulmonary hypertension due to lung disease and/or hypoxia and elucidation of its pathogenesis. KEY POINTS • There are no previous studies analyzing all respiratory phases of right main pulmonary artery distensibility (MPAD). • Patients with exhalation impairment decreased their right MPAD. • Analysis of MPAD on dynamic ventilation computed tomography contributes to understanding the pathogenesis of pulmonary hypertension due to lung disease and/or hypoxia in patients with expiratory impairment.
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Affiliation(s)
- Tatsuya Oki
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan.
| | - Shota Ishida
- Department of Radiological Technology, Kyoto College of Medical Science, 1-3 Sonobecho Oyamahigashimachi Imakita, Nantan, Kyoto, 622-0041, Japan
| | - Masayuki Hashimoto
- Department of Thoracic Surgery, Takeda General Hospital, 28-1 Ishida Moriminamicho, Fushimi-Ku, Kyoto, 601-1434, Japan
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Yasuhiko Oshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Ryo Uemura
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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Nakamura H, Hirai T, Kurosawa H, Hamada K, Matsunaga K, Shimizu K, Konno S, Muro S, Fukunaga K, Nakano Y, Kuwahira I, Hanaoka M. Current advances in pulmonary functional imaging. Respir Investig 2024; 62:49-65. [PMID: 37948969 DOI: 10.1016/j.resinv.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized 129Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
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Affiliation(s)
- Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Kurosawa
- Center for Environmental Conservation and Research Safety and Department of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Kuwahira
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Ohno Y, Ozawa Y, Nagata H, Bando S, Cong S, Takahashi T, Oshima Y, Hamabuchi N, Matsuyama T, Ueda T, Yoshikawa T, Takenaka D, Toyama H. Area-Detector Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel) 2023; 13:2518. [PMID: 37568881 PMCID: PMC10416899 DOI: 10.3390/diagnostics13152518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
An area-detector CT (ADCT) has a 320-detector row and can obtain isotropic volume data without helical scanning within an area of nearly 160 mm. The actual-perfusion CT data within this area can, thus, be obtained by means of continuous dynamic scanning for the qualitative or quantitative evaluation of regional perfusion within nodules, lymph nodes, or tumors. Moreover, this system can obtain CT data with not only helical but also step-and-shoot or wide-volume scanning for body CT imaging. ADCT also has the potential to use dual-energy CT and subtraction CT to enable contrast-enhanced visualization by means of not only iodine but also xenon or krypton for functional evaluations. Therefore, systems using ADCT may be able to function as a pulmonary functional imaging tool. This review is intended to help the reader understand, with study results published during the last a few decades, the basic or clinical evidence about (1) newly applied reconstruction methods for radiation dose reduction for functional ADCT, (2) morphology-based pulmonary functional imaging, (3) pulmonary perfusion evaluation, (4) ventilation assessment, and (5) biomechanical evaluation.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Shuji Bando
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Shang Cong
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Tomoki Takahashi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takeshi Yoshikawa
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
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Hiraiwa H, Sakamoto G, Ito R, Koyama Y, Kazama S, Kimura Y, Kondo T, Morimoto R, Okumura T, Murohara T. Dynamic chest radiography as a novel minimally invasive hemodynamic imaging method in patients with heart failure. Eur J Radiol 2023; 161:110729. [PMID: 36804311 DOI: 10.1016/j.ejrad.2023.110729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Dynamic chest radiography allows for non-invasive cardiopulmonary blood flow assessment. However, data on its use for heart failure hemodynamic assessment are scarce. We utilized dynamic chest radiography to estimate heart failure hemodynamics. METHOD Twenty heart failure patients (median age, 67 years; 17 men) underwent dynamic chest radiography and right heart catheterization. The analyzed images were 16-bit images (grayscale range: 0-65,535). Right atrial, right pulmonary artery, and left ventricular apex pixel values (average of the grayscale values of all pixels within a region of interest) were measured. The correlations of the minimum, maximum, mean, amount of change, and rate of change in pixel values with right atrial pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac index were analyzed. RESULTS The mean right atrial pixel value and mean right atrial pressure (R = -0.576, P = 0.008), mean right pulmonary artery pixel value and mean pulmonary artery pressure (R = -0.546, P = 0.013), and left ventricular apex pixel value change rate and mean pulmonary artery wedge pressure (R = -0.664, P = 0.001) or cardiac index (R = 0.606, P = 0.005) were correlated. The left ventricular apex pixel value change rate identified low cardiac index (area under the curve, 0.792; 95% confidence interval, 0.590-0.993; P = 0.031) and low cardiac index with high pulmonary artery wedge pressure (area under the curve, 0.902; 95% confidence interval, 0.000-1.000; P = 0.030). CONCLUSIONS Dynamic chest radiography is a minimally invasive tool for heart failure hemodynamic assessment.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Gaku Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Ito
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuichiro Koyama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Ronderos-Botero DM, Dileep A, Yapor L, Singhal R. Disruption of cardio-pulmonary coupling in myopathies: Pathophysiological and mechanistic characterization with special emphasis on nemaline myopathy. Front Cardiovasc Med 2022; 9:996567. [DOI: 10.3389/fcvm.2022.996567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
The heart and lung are in continuous reciprocal interaction that creates a functional and anatomical reserve referred to as cardiopulmonary coupling (CPC). Disruption of CPC can occur due to various cardiac or pulmonary pathologies but also can occur in patients with myopathies. Nemaline myopathy (NM) is a skeletal muscle heterogeneous disorder due to contractile proteins' gene mutations that impact lung and cardiac mechanics and thus is expected to adversely affect CPC in a complex manner. We present a case of NM and we review the literature on cardiac and pulmonary effects of myopathy-related disruption of CPC.
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Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax 2022; 77:thoraxjnl-2021-218333. [PMID: 35772939 DOI: 10.1136/thoraxjnl-2021-218333] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD) and concomitant disease leads to reduced quality of life, increased hospitalisations and worse survival. Acute pulmonary exacerbations are an important contributor to COPD burden and are associated with increased cardiovascular (CV) events. Both COPD and CVD represent a significant global disease impact and understanding the relationship between the two could potentially reduce this burden. The association between CVD and COPD could be a consequence of (1) shared risk factors (environmental and/or genetic) (2) shared pathophysiological pathways (3) coassociation from a high prevalence of both diseases (4) adverse effects (including pulmonary exacerbations) of COPD contributing to CVD and (5) CVD medications potentially worsening COPD and vice versa. CV risk in COPD has traditionally been associated with increasing disease severity, but there are other relevant COPD subtype associations including radiological subtypes, those with frequent pulmonary exacerbations and novel disease clusters. While the prevalence of CVD is high in COPD populations, it may be underdiagnosed, and improved risk prediction, diagnosis and treatment optimisation could lead to improved outcomes. This state-of-the-art review will explore the incidence/prevalence, COPD subtype associations, shared pathophysiology and genetics, risk prediction, and treatment of CVD in COPD.
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Affiliation(s)
- Vishanna Balbirsingh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea S Mohammed
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Michael Newnham
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Shimada A, Kawata N, Sato H, Ikari J, Suzuki E, Anazawa R, Suzuki M, Masuda Y, Haneishi H, Tatsumi K. Dynamic Quantitative Magnetic Resonance Imaging Assessment of Areas of the Lung During Free-Breathing of Patients with Chronic Obstructive Pulmonary Disease. Acad Radiol 2022; 29 Suppl 2:S215-S225. [PMID: 34144888 DOI: 10.1016/j.acra.2021.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Changes in the geometry of the chest wall due to lung hyperinflation occur in COPD. However, the quantitative assessment of impaired lung motions and its association with the clinical characteristics of COPD patients are unclear. This study aimed to investigate the respiratory kinetics of COPD patients by dynamic MRI. MATERIALS AND METHODS This study enrolled 22 COPD patients and 10 normal participants who underwent dynamic MRI and pulmonary function testing (PFT). Changes in the areas of the lung and mediastinum during respiration were compared between the COPD patients and the normal controls. Relationships between MRI, CT parameters, and clinical measures that included PFT results also were evaluated. RESULTS Asynchronous movements and decreased diaphragmatic motion were found in COPD patients. COPD patients had a larger ratio of MRI-measured lung areas at expiration to inspiration, a smaller magnitude of the peak area change ratio, and a smaller mediastinal-thoracic area ratio than the normal participants. The lung area ratio was associated with FEV1/FVC, predicted RV%, and CT lung volume/predicted total lung capacity (pTLC). The lung area ratio of the right lower and left lower lungs was significantly correlated with emphysema of each lower lobe. The expiratory mediastinal-thoracic area ratio was associated with FEV1% predicted and RV/TLC. CONCLUSION Changes in the lung areas of COPD patients as shown on MRI reflected the severity of airflow limitation, hyperinflation, and the extent of emphysema. Dynamic MRI provides essential information about respiratory kinetics in COPD.
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10
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Barry JR, Akuthota P. Estimated Ventricular Size: A New Predictor of Asthma Severity and Exacerbation Rate? Chest 2020; 157:243-244. [PMID: 32033641 DOI: 10.1016/j.chest.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeffrey R Barry
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA.
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11
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Chuang ML. Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2020; 9:E1127. [PMID: 32326507 PMCID: PMC7231163 DOI: 10.3390/jcm9041127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
Physiological dead space volume (VD) and dynamic hyperinflation (DH) are two different types of abnormal pulmonary physiology. Although they both involve lung volume, their combination has never been advocated, and thus their effect and implication are unclear. This study aimed (1) to combine VD and DH, and (2) investigate their relationship and clinical significance during exercise, as well as (3) identify a noninvasive variable to represent the VD fraction of tidal volume (VD/VT). Forty-six male subjects with chronic obstructive pulmonary disease (COPD) and 34 healthy male subjects matched for age and height were enrolled. Demographic data, lung function, and maximal exercise were investigated. End-expiratory lung volume (EELV) was measured for the control group and estimated for the study group using the formulae reported in our previous study. The VD/VT ratio was measured for the study group, and reference values of VD/VT were used for the control group. In the COPD group, the DHpeak/total lung capacity (TLC, DHpeak%) was 7% and the EELVpeak% was 70%. After adding the VDpeak% (8%), the VDDHpeak% was 15% and the VDEELVpeak% was 78%. Both were higher than those of the healthy controls. In the COPD group, the VDDHpeak% and VDEELVpeak% were more correlated with dyspnea score and exercise capacity than that of the DHpeak% and EELV%, and had a similar strength of correlation with minute ventilation. The VTpeak/TLC (VTpeak%), an inverse marker of DH, was inversely correlated with VD/VT (R2 ≈ 0.50). Therefore, we recommend that VD should be added to DH and EELV, as they are physiologically meaningful and VTpeak% represents not only DH but also dead space ventilation. To obtain VD, the VD/VT must be measured. Because obtaining VD/VT requires invasive arterial blood gases, further studies on noninvasive predicting VD/VT is warranted.
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Affiliation(s)
- Ming-Lung Chuang
- Division of Pulmonary Medicine and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; ; Tel.: +886-4-2473-9595 (ext. 34718)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines. J Cardiopulm Rehabil Prev 2019; 39:9-18. [DOI: 10.1097/hcr.0000000000000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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