Computed Tomographic Measurement of Airway Remodeling and Emphysema in Advanced Chronic Obstructive Pulmonary Disease. Correlation with Pulmonary Hypertension

Dournes, Gaël; Laurent, François; Coste, F; Dromer, C.; Blanchard, Élodie; Picard, François; Baldacci, Fabien; Montaudon, Michel; Girodet, Pierre‐Olivier; Marthan, Roger; Berger, Patrick

doi:10.1164/rccm.201408-1423oc

Cited by 58 publications

(68 citation statements)

References 48 publications

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“…There are new parameters that may offer prognostic insight in the future, e.g., PAP m may correlate with increased airway wall thickness. Furthermore, patients with pulmonary hypertension have significantly higher pulmonary artery/ascending aorta ratios [21]. For the prediction of mortality, a normalised emphysema score was formulated in the study conducted by Gallardo-Estrella et al [22].…”

Section: Ct Quantification Of Emphysemamentioning

confidence: 99%

Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema

et al. 2019

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Recent advances in bronchoscopic lung volume reduction (BLVR) offer new therapeutic alternatives for patients with emphysema and hyperinflation. Endobronchial valves and coils are 2 potential BLVR techniques which have been shown to improve pulmonary function and the quality of life in patients with emphysema. Current patient selection for LVR procedures relies on 3 main inclusion criteria: low attenuation area (in %), also known as emphysema score, heterogeneity score, and fissure integrity score. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative CT to determine emphysema severity play an important role in treatment planning and post-operative assessment. Due to the variations in lung anatomy, manual corrections are often required to ensure successful and accurate lobe segmentation for pathological and post-treatment CT scan analysis. The advanced development and utilisation of quantitative CT do not simply represent regional changes in pulmonary function but aids in analysis for better patient selection with severe emphysema who are most likely to benefit from BLVR.

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Section: Ct Quantification Of Emphysemamentioning

confidence: 99%

Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema

et al. 2019

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“…Remodeling of pulmonary arteries is not only seen in advanced COPD patients, but also in non-hypoxic mild COPD patients [28,36,39,40]. However, "muscling" in pulmonary arterioles may be frequently observed in COPD patients who have not yet developed PHT but undergone organ transplantation [41].…”

Section: Pulmonary Vascular Remodelingmentioning

confidence: 99%

“…Peinado et al [39] reported that there was an infiltration of the adventitia layer of pulmonary artery by inflammatory cells and they showed that there was a relationship with the number of inflammation cells, the expansion in the intimal layer and endothelial cell dysfunction. It was reported by Chaout et al [43] that circulating IL-6 levels were associated with the mean PAP.…”

Section: Pulmonary Vascular Remodelingmentioning

confidence: 99%

“…Findings supporting this circumstance can be listed as follows: 1) non-normalization of PAP with oxygen therapy [51] and variability of the hemodynamic response to oxygen therapy [52], 2) the relationship between PAP and oxygen partial pressure (PaO 2 ) is not strong and cannot always be shown [3,10]) changes in pulmonary vasculature and detection of endothelial dysfunction in non-hypoxic mild COPDs [39,53,54] and 4) observation of PAP increase in animal models exposed to cigarette smoke before COPD [55]. As a result, hypoxia plays a key role in the development of PHT in this patient group, but it cannot be held responsible alone for all hemodynamic changes.…”

Section: Hypoxiamentioning

confidence: 99%

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Pulmonary Hypertension in Patients with Chronic Obstructive Pulmonary Disease: A Review for Definition, Epidemiology, Pathology, and Diagnosis

Gülmez¹

2017

Gen Med

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Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by progressive and persistent restriction of airflow with a prevalence of 19-25%. The main symptoms are shortness of breath, cough, and sputum production. Smoking is the most common cause and quitting smoking is the only action which prevents developing and progressing of COPD.Pulmonary hypertension (PHT) which is defined as a mean pulmonary artery pressure of ≥ 25 mmHg measured by right heart catheterization at rest is a common complication of COPD and it has been investigated under the title of "Class III: Pulmonary Hypertension due to Pulmonary Disease and/or Hypoxia" according to the updated clinical classification in the 5 th World Pulmonary Hypertension Symposium. Although pathogenesis is complex, it often involves HPV and pulmonary vascular remodeling. In this review, the PHT which mainly develops secondary to COPD is discussed.

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“…Progress has been made in understanding the prognostic implications of pulmonary hypertension across disease entities [1]. Advances in defining mixed pre-and post-capillary pulmonary hypertension, uncovering occult pulmonary vascular and left heart disease in the catheterisation laboratory [8,9], and understanding lung pathologic changes in pulmonary hypertension associated with parenchymal lung disease have been substantial [10][11][12]. Sorely lacking are noninvasive markers of pulmonary vascular pathology, tools to detect ongoing vascular injury versus quiescence or healing, understanding of mediators of the right heart response to haemodynamic and environmental stressors, and myocardial targets for therapy.…”

Section: Heeding the Call: The Nhlbi Pulmonary Vascular Disease Phenomentioning

confidence: 99%

Pulmonary arterial hypertension or left heart disease with pulmonary hypertension? Toward noninvasive clarity, but time for a new paradigm

Frantz

2015

Eur Respir J

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@ERSpublications PAH or left heart disease with PH? Perspective on group 1 and 2 PH differentiators and a call for a unified approach http://ow.ly/OtRxU Widespread availability of Doppler echocardiography, combined with increasing community awareness of pulmonary arterial hypertension (PAH) as an important and treatable disease, results in frequent referral of patients with suspected PAH to tertiary pulmonary hypertension centres. While this state of affairs is laudable, it does result in substantial numbers of patients who turn out not to have PAH being seen at tertiary pulmonary hypertension centres. In this issue of the European Respiratory Journal, JACOBS et al. [1] describe the retrospective development and prospective validation of a simple tool designed to improve accurate noninvasive distinction between PAH and pulmonary hypertension due to left heart disease (systolic, diastolic or valvular; World Classification of pulmonary hypertension group 2). This tool was derived from analysis of patients with PAH or group 2 pulmonary hypertension seen at a major European pulmonary hypertension centre. It may enhance noninvasive exclusion of group 1 PAH in a subset of patients seen with pulmonary hypertension who have risk factors for group 2 pulmonary hypertension.The tool utilises a combination of historical, echocardiographic and electrocardiographic parameters to create a risk score for presence of pulmonary hypertension related to left heart disease, defined as a pulmonary capillary wedge pressure or left ventricular end diastolic pressure >15 mmHg, or rising above that level following administration of 500 cm 3 i.v. saline. A risk score of ⩾64 had a positive predictive value of 92% for presence of pulmonary hypertension related to left heart disease with a specificity of 99%, i.e. misclassifying one in 100 PAH patients. A score of 64 can be achieved simply by having a clinical history of left heart disease combined with echocardiographic findings of left atrial enlargement and more than mild left valve disease.A remarkably higher proportion of patients were confirmed to have PAH (79% in the development cohort and 59% in the validation cohort) than would be the case in a community cohort, where group 2 pulmonary hypertension would be of much greater prevalence. Accordingly, the authors appropriately describe the need for validation of this tool in a community cohort prior to utilisation in clinical practice.The authors settle on a risk score of 72 as a cut-off value beyond which there is no need to suspect PAH and to refer to a pulmonary hypertension centre, since one in 100 patients ultimately felt to have PAH had risk scores above 64, and 100% specificity was felt important in order not to miss any PAH cases. This

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Computed Tomographic Measurement of Airway Remodeling and Emphysema in Advanced Chronic Obstructive Pulmonary Disease. Correlation with Pulmonary Hypertension

Cited by 58 publications

References 48 publications

Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema

Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema

Pulmonary Hypertension in Patients with Chronic Obstructive Pulmonary Disease: A Review for Definition, Epidemiology, Pathology, and Diagnosis

Pulmonary arterial hypertension or left heart disease with pulmonary hypertension? Toward noninvasive clarity, but time for a new paradigm

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