CT evaluation of small pulmonary vessels area in patients with COPD with severe pulmonary hypertension

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

doi:10.1136/thoraxjnl-2015-207696

Cited by 42 publications

(62 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CT studies showed that emphysema extent was correlated to blood vessel pruning (CSA <5 mm 2 ), thereby highlighting a pulmonary vascular phenotype [22,135,136]. This decreased proportion of small pulmonary vessels has also been linked with pulmonary hypertension [116] and clinical outcomes [137] in COPD patients.…”

Section: Pulmonary Vascularisationmentioning

confidence: 98%

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

et al. 2019

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.

show abstract

Section: Pulmonary Vascularisationmentioning

confidence: 98%

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The small pulmonary vessels measurements were made automatically as described elsewhere (4, 10-12). The cross section area (CSA) and cross section number (CSN) of small pulmonary vessels were quantified separately at the subsegmental and at the sub-subsegmental levels (4,12). The subsegmental and sub-subsegmental levels are defined by a vessel area between 5 and 10 mm 2 and less than 5 mm 2 , respectively.…”

Section: Quantitative Computed Tomographymentioning

confidence: 99%

Fibrocyte accumulation in bronchi: a cellular hallmark of COPD

Dupin

Thumerel

Maurat

et al. 2018

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundThe remodeling mechanism and cellular players causing persistent airflow limitation in chronic obstructive pulmonary disease (COPD) remain largely elusive. We have recently demonstrated that circulating fibrocytes, a rare population of fibroblast-like cells produced by the bone marrow stroma, are increased in COPD patients during an exacerbation. It remains, however, unclear, whether fibrocytes are present in bronchial tissue of COPD patients.ObjectiveWe aimed to quantify fibrocytes density in bronchial specimens from both control subjects and COPD patients, and to define associations with clinical, functional and computed tomography relevant parameters.Methods17 COPD patients and 25 control subjects with normal lung function testing and no chronic symptoms, all of them requiring thoracic surgery, were recruited. LFT and CT-scan were performed before surgery. Using co-immunostaining and image analysis, we identify CD45+ FSP1+ cells as tissue fibrocytes and quantify their density in distal and proximal bronchial specimens from the whole series.ResultsHere, we demonstrate that fibrocytes are increased in both distal and proximal tissue specimens of COPD patients, compared to those of controls. The density of fibrocytes is negatively correlated with lung function parameters, such as FEV1 and FEV1/FVC, and positively with bronchial wall thickness assessed by CT scan. High density of distal bronchial fibrocytes predicts presence of COPD with a sensitivity of 83% and a specificity of 70%.ConclusionsOur results thus suggest that recruitment of fibrocytes in the bronchi may participate to lung function decline during COPD progression.Clinical ImplicationsHigh density of tissue fibrocytes is associated with a deteriorated lung function and an increase in airway wall thickness. A low density tissue fibrocytes virtually eliminates the presence of COPD.Capsule summaryBlood fibrocytes assessed during exacerbation is a predictor of mortality in COPD. This study shows an increase of bronchial fibrocytes, that is associated with lower lung function, increased bronchial thickness and air trapping in COPD.

show abstract

“…Our hypothesis is also supported by Coste et al. [21], who recently observed using CT a specific increase in total cross-sectional area and an increase in the number of small vessels (<5 mm 2 ) in COPD patients with severe PH compared to COPD patients without severe PH.…”

Section: Discussionmentioning

confidence: 98%

A diffuse lung emphysema, severe pulmonary hypertension and lack of airflow limitation

Faure

Gomez

Dorfmüller

et al. 2017

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Pulmonary veno-occlusive disease is characterized by remodeling of pulmonary arteries, capillaries and venules. We report a case of diffuse lung emphysema and pulmonary veno-occlusive disease with the characteristic of having no airflow limitation. A very low diffusing capacity for carbon monoxide and results of high-resolution computed tomography of the chest suggested pulmonary veno-occlusive disease. The diagnosis was confirmed on histological analysis after lung transplantation. The combination of results of the computed tomography of the chest and the histological analysis suggested a relationship between diffuse lung emphysema and remodeling of pulmonary vessels. A distinctive pattern of mild-to-moderate airflow limitation in patients with chronic obstructive pulmonary disease and severe pulmonary hypertension has been described. This observation of the combination of diffuse emphysema, pulmonary veno-occlusive disease and no airflow limitation supports further pathophysiological studies on severe pulmonary hypertension in chronic obstructive pulmonary disease.

show abstract

CT evaluation of small pulmonary vessels area in patients with COPD with severe pulmonary hypertension

Abstract: CT measurements of small vessels support a distinct vessel-related phenotype in patients with COPD with severe PH, and combined with WT and PaO2 parameters in the paw score, which may offer a non-invasive tool to select patients for RHC.

Cited by 42 publications

References 37 publications

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

Fibrocyte accumulation in bronchi: a cellular hallmark of COPD

A diffuse lung emphysema, severe pulmonary hypertension and lack of airflow limitation

Contact Info

Product

Resources

About