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Nathan SD, Tehrani B, Zhao Q, Arias R, Kim D, Pellegrini A, Collins AC, Diviney J, Chakravorty S, Khangoora V, Shlobin OA, Thomas C, Lavon BR, King CS, Chandel A. Pulmonary vascular dysfunction without pulmonary hypertension: A distinct phenotype in idiopathic pulmonary fibrosis. Pulm Circ 2024; 14:e12311. [PMID: 38174158 PMCID: PMC10762875 DOI: 10.1002/pul2.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024] Open
Abstract
Pulmonary vascular dysfunction in the absence of pulmonary hypertension (PH) has been observed in patients with idiopathic pulmonary fibrosis (IPF). We describe the prevalence and etiology of elevated pulmonary vascular resistance (PVR) without PH among patients with IPF. Hemodynamic, echocardiographic, and functional respiratory imaging (FRI) data was compared between patients with IPF without PH with normal (<3 wood units) and elevated PVR (≥3 wood units). Mortality between these two groups were compared to patients with IPF and PH. Of 205 patients with IPF, there were 146 patients without PH, of whom 114 (78.1%) had a normal PVR and 32 (21.9%) who had a high PVR. Functional testing and hemodynamics were similar in the two groups, except for the cardiac index which was significantly lower in patients with a high PVR (2.3 vs. 2.6 L/min/m2; p = 0.004). Echocardiographic comparison demonstrated a higher tricuspid regurgitant velocity in those with a high PVR (3.4 vs 3.0 m/s; p = 0.046). FRI revealed proportionately fewer large vessels as a proportion of the vasculature in the patients without PH and elevated PVRs. Among patients without PH, PVR was associated with increased mortality. In conclusion, patients with IPF without PH but a high PVR appear to be a distinct phenotype with a prognosis between those with and without PH, likely reflecting the continuum of vascular dysfunction. The basis for this unique hemodynamic profile could not be definitively discerned although FRI suggested an aberrant anatomical vascular response.
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Affiliation(s)
- Steven D. Nathan
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Benham Tehrani
- Cardiology Department, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Qiong Zhao
- Cardiology Department, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Rafael Arias
- Cardiology Department, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Dennis Kim
- Department of MedicineInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Antonia Pellegrini
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Ashley Claire Collins
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Jack Diviney
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | | | - Vikramjit Khangoora
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Oksana A. Shlobin
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Christopher Thomas
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | | | - Christopher S. King
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Abhimanyu Chandel
- Department of Pulmonary and Critical CareWalter Reed National Military Medical CenterBethesdaMarylandUSA
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Dierckx W, De Backer W, Lins M, De Meyer Y, Ides K, Vandevenne J, De Backer J, Franck E, Lavon BR, Lanclus M, Thillai M. CT-derived measurements of pulmonary blood volume in small vessels and the need for supplemental oxygen in COVID-19 patients. J Appl Physiol (1985) 2022; 133:1295-1299. [PMID: 36269576 DOI: 10.1152/japplphysiol.00458.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Throughout the COVID-19 pandemic, a portion of those affected have evolved toward acute hypoxic respiratory failure. Initially, this was hypothesized to result from acute lung injury leading to acute respiratory distress syndrome (ARDS). In previous research, a novel quantitative CT post-processing technique was described to quantify the volume of blood contained within pulmonary blood vessels of a given size. We hypothesized that patients with lower BV5 blood flow would have higher supplemental oxygen needs and less favorable arterial blood gas profiles. From the initial data analysis, 111 hospitalized COVID-19 patients were retrospectively selected based on the availability of CT scans of the lungs with a slice thickness of 1.5 mm or less, as well as PCR-confirmed SARS-CoV2 infection. Three-dimensional (3-D) reconstructions of the lungs and pulmonary vasculature were created. Further analysis was performed on 50 patients. Patients were divided into groups based on their need for oxygen at the time of CT scan acquisition. Eighteen out of 50 patients needed >2 L/min supplemental oxygen and this group demonstrated a significantly lower median percentage of total blood flow in the BV5 vessels compared with the 32 patients who needed <2 L/min supplemental oxygen (41.61% vs. 46.89%, P = 0.023). Both groups had significantly less blood as a proportion in BV5 vessels compared with healthy volunteers. These data are consistent with the hypothesis that reduced blood volume within small (BV5) pulmonary vessels is associated with higher needs for supplemental oxygen and more severe gas exchange anomalies in COVID-19 infections.NEW & NOTEWORTHY This research provides, by using new imaging analysis on CT imaging, an insight into the pathophysiology of patients with COVID-19 infection. By visualizing and quantifying the blood in small vessels in the lung, we can link these results to the clinical need for oxygen in patients with COVID-19 infection.
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Affiliation(s)
- Wendel Dierckx
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Fluidda NV, Kontich, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Wilfried De Backer
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Muriel Lins
- General Hospital Sint-Maarten, Mechelen, Belgium
| | - Yinka De Meyer
- Fluidda NV, Kontich, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Kris Ides
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Department of Engineering, Cosys Labs, University of Antwerp, Antwerp, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Jan Vandevenne
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine, University of Hasselt, Diepenbeek, Belgium
| | | | - Erik Franck
- Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - Muhunthan Thillai
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Overton PM, Toshner M, Mulligan C, Vora P, Nikkho S, Jan de Backer, Lavon BR, Klok FA. Pulmonary thromboembolic events in COVID‐19 – a systematic literature review. Pulm Circ 2022; 12:e12113. [PMID: 35942076 PMCID: PMC9349961 DOI: 10.1002/pul2.12113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022] Open
Abstract
Pulmonary thromboembolic events have been linked to coronavirus disease 2019 (COVID‐19), but their incidence and long‐term sequelae remain unclear. We performed a systematic literature review to investigate the incidence of pulmonary embolism (PE), microthrombi, thrombosis in situ (thromboinflammatory disease), and chronic thromboembolic pulmonary hypertension (CTEPH) during and after COVID‐19. PubMed and the World Health Organization Global Research Database were searched on May 7, 2021. Hospital cohort and database studies reporting data for ≥1000 patients and autopsy studies reporting data for ≥20 patients were included. Results were summarized descriptively. We screened 1438 records and included 41 references (32 hospital/database studies and 9 autopsy studies). The hospital/database studies reported the incidence of PE but not CTEPH, microthrombi, or thromboinflammatory disease. PE incidence varied widely (0%–1.1% of outpatients, 0.9%–8.2% of hospitalized patients, and 1.8%–18.9% of patients in intensive care). One study reported PE events occurring within 45 days after hospital discharge (incidence in discharged patients: 0.2%). Segmental arteries were generally the most common location for PE. In autopsy studies, PE, thromboinflammatory disease, and microthrombi were reported in 6%–23%, 43%–100%, and 45%–84% of deceased patients, respectively. Overall, the included studies mostly focused on PE during the acute phase of COVID‐19. The results demonstrate the challenges of identifying and characterizing vascular abnormalities using current protocols (e.g., visual computed tomography reads). Further research is needed to detect subtle pulmonary vascular abnormalities, distinguish thromboinflammatory disease from PE, optimize treatment, and assess the incidence of long‐term sequelae after COVID‐19.
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Affiliation(s)
| | - Mark Toshner
- Department of Medicine, School of Clinical Medicine University of Cambridge UK
| | | | | | | | | | | | - Frederikus A. Klok
- Department of Medicine–Thrombosis and Hemostasis Leiden University Medical Center Leiden the Netherlands
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Costa RD, Zanon M, Watte G, Altmayer SPL, Mohammed TL, Verma N, Backer JD, Lavon BR, Marchiori E, Hochhegger B. Expiratory CT scanning in COVID-19 patients: can we add useful data? J Bras Pneumol 2022; 48:e20210204. [PMID: 35475863 PMCID: PMC9064648 DOI: 10.36416/1806-3756/e20210204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate small airway disease in COVID-19 patients using the prevalence of air trapping (AT) and correlating it with clinical outcomes. The relationship between CT-based opacities in small blood vessels and ventilation in patients with SARS-CoV-2 pneumonia was also assessed. METHODS We retrospectively included 53 patients with positive RT-PCR results for SARS-CoV-2 between March and April of 2020. All subjects underwent HRCT scanning, including inspiratory and expiratory acquisitions. Subjects were divided into two groups based on visual identification of AT. Small blood vessel volumes were estimated by means of cross-sectional areas < 5 mm2 (BV5) derived from automated segmentation algorithms. Mixed-effect models were obtained to represent the BV5 as a function of CT-based lobar opacities and lobar ventilation. RESULTS Of the 53 participants, AT was identified in 23 (43.4%). The presence of AT was associated with increased SpO2 at admission (OR = 1.25; 95% CI, 1.07-1.45; p = 0.004) and reduced D-dimer levels (OR = 0.99; 95% CI, 0.99-0.99; p = 0.039). Patients with AT were less likely to be hospitalized (OR = 0.27; 95% CI, 0.08-0.89; p = 0.032). There was a significant but weak inverse correlation between BV5 and CT-based lobar opacities (R2 = 0.19; p = 0.03), as well as a nonsignificant and weak direct correlation between BV5 and lobar ventilation (R2 = 0.08; p = 0.54). CONCLUSIONS AT is a common finding in patients with COVID-19 that undergo expiratory CT scanning. The presence of AT may correlate with higher SpO2 at admission, lower D-dimer levels, and fewer hospitalizations when compared with absence of AT. Also, the volume of small pulmonary vessels may negatively correlate with CT opacities but not with lobar ventilation.
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Affiliation(s)
- Ruhana Dalla Costa
- . Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Matheus Zanon
- . Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Guilherme Watte
- . Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | | | - Tan-Lucien Mohammed
- . Department of Radiology, University of Florida College of Medicine, Gainesville (FL) USA
| | - Nupur Verma
- . Department of Radiology, University of Florida College of Medicine, Gainesville (FL) USA
| | - Jan De Backer
- . Department of Respiratory Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Ben R Lavon
- . Department of Respiratory Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Edson Marchiori
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
- . Department of Radiology, University of Florida College of Medicine, Gainesville (FL) USA
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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5
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Clukers J, Lanclus M, Belmans D, Van Holsbeke C, De Backer W, Vummidi D, Cronin P, Lavon BR, De Backer J, Khanna D. Interstitial lung disease in systemic sclerosis quantification of disease classification and progression with high-resolution computed tomography: An observational study. J Scleroderma Relat Disord 2021; 6:154-164. [PMID: 35386737 PMCID: PMC8892932 DOI: 10.1177/2397198320985377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/05/2020] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Systemic sclerosis-associated interstitial lung disease accounts for up to 20% of mortality in these patients and has a highly variable prognosis. Functional respiratory imaging, a quantitative computed tomography imaging technique which allows mapping of regional information, can provide a detailed view of lung structures. It thereby shows potential to better characterize this disease. PURPOSE To evaluate the use of functional respiratory imaging quantitative computed tomography in systemic sclerosis-associated interstitial lung disease staging, as well as the relationship between short-term changes in pulmonary function tests and functional respiratory imaging quantitative computed tomography with respect to disease severity. MATERIALS AND METHODS An observational cohort of 35 patients with systemic sclerosis was retrospectively studied by comparing serial pulmonary function tests and in- and expiratory high-resolution computed tomography over 1.5-year interval. After classification into moderate to severe lung disease and limited lung disease (using a hybrid method integrating quantitative computed tomography and pulmonary function tests), post hoc analysis was performed using mixed-effects models and estimated marginal means in terms of functional respiratory imaging parameters. RESULTS At follow-up, relative mean forced vital capacity percentage change was not significantly different in the limited (6.37%; N = 13; p = 0.053) and moderate to severe disease (-3.54%; N = 16; p = 0.102) groups, respectively. Specific airway resistance decreased from baseline for both groups. (Least square mean changes -25.11% predicted (p = 0.006) and -14.02% predicted (p = 0.001) for limited and moderate to severe diseases.) In contrast to limited disease from baseline, specific airway radius increased in moderate to severe disease by 8.57% predicted (p = 0.011) with decline of lower lobe volumes of 2.97% predicted (p = 0.031). CONCLUSION Functional respiratory imaging is able to differentiate moderate to severe disease versus limited disease and to detect disease progression in systemic sclerosis.
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Affiliation(s)
- Johan Clukers
- Faculty of medicine and health sciences, University of Antwerp, Antwerp, Belgium
| | | | | | | | - Wilfried De Backer
- Faculty of medicine and health sciences, University of Antwerp, Antwerp, Belgium
| | - Dharshan Vummidi
- Division of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Paul Cronin
- Division of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
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6
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Lins M, Vandevenne J, Thillai M, Lavon BR, Lanclus M, Bonte S, Godon R, Kendall I, De Backer J, De Backer W. Assessment of Small Pulmonary Blood Vessels in COVID-19 Patients Using HRCT. Acad Radiol 2020; 27:1449-1455. [PMID: 32741657 PMCID: PMC7381940 DOI: 10.1016/j.acra.2020.07.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES Mounting evidence supports the role of pulmonary hemodynamic alternations in the pathogenesis of COVID-19. Previous studies have demonstrated that changes in pulmonary blood volumes measured on computed tomography (CT) are associated with histopathological markers of pulmonary vascular pruning, suggesting that quantitative CT analysis may eventually be useful in the assessment pulmonary vascular dysfunction more broadly. MATERIALS AND METHODS Building upon previous work, automated quantitative CT measures of small blood vessel volume and pulmonary vascular density were developed. Scans from 103 COVID-19 patients and 107 healthy volunteers were analyzed and their results compared, with comparisons made both on lobar and global levels. RESULTS Compared to healthy volunteers, COVID-19 patients showed significant reduction in BV5 (pulmonary blood volume contained in blood vessels of <5 mm2) expressed as BV5/(total pulmonary blood volume; p < 0.0001), and significant increases in BV5-10 and BV 10 (pulmonary blood volumes contained in vessels between 5 and 10 mm2 and above 10 mm2, respectively, p < 0.0001). These changes were consistent across lobes. CONCLUSION COVID-19 patients display striking anomalies in the distribution of blood volume within the pulmonary vascular tree, consistent with increased pulmonary vasculature resistance in the pulmonary vessels below the resolution of CT.
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Affiliation(s)
- Muriel Lins
- General Hospital Sint-Maarten, Mechelen, Belgium
| | - Jan Vandevenne
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine, University of Hasselt, Diepenbeek, Belgium
| | - Muhunthan Thillai
- Department of Interstitial Lung Disease, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ben R Lavon
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Maarten Lanclus
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Stijn Bonte
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Rik Godon
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Irvin Kendall
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Jan De Backer
- FLUIDDA, 228 E. 45th St, 9th Floor - Suite 9E, New York, New York, NY 10017
| | - Wilfried De Backer
- Department of Respiratory Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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