Functional respiratory imaging identifies redistribution of pulmonary blood flow in patients with COVID-19

Thillai, Muhunthan; Patvardhan, Chinmay; Swietlik, Emilia M.; McLellan, Tom M.; Backer, Jan De; Lanclus, Maarten; Backer, Wilfried De; Ruggiero, Alessandro

doi:10.1136/thoraxjnl-2020-215395

Cited by 45 publications

(44 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In healthy patients BV5% constitutes the majority of pulmonary blood volume distribution (13), and is closely correlated with histologic assessment of vascular cross sectional area (14). Alterations in BV5% are not exclusive to COVID-19, and can manifest in other diseases that diffusely affect pulmonary perfusion, such as COPD (15) and ARDS (7). In these cohorts, chronic vascular remodeling and small vessel loss are the underlying etiology for reduced BV5% (16).…”

Section: Discussionmentioning

confidence: 99%

“…Changes in the pulmonary vasculature on chest computed tomography (CT) may reflect the angiocentric injury caused by COVID-19 (6). Quantitative analysis of chest CT scans from patients with COVID-19 demonstrates a significant decrease in the percentage of blood vessels with a cross-sectional area between 1.25-5 mm 2 (BV5%) (7). Given the effects of COVID-19 on pulmonary microcirculation, we hypothesized that BV5% reduction on chest CT in patients is associated with adverse outcomes of respiratory failure requiring intubation or death.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundEvidence suggests that vascular inflammation and thrombosis may be important drivers of poor clinical outcomes in patients with COVID-19. We hypothesized that a significant decrease in the percentage of blood vessels with a cross-sectional area between 1.25–5 mm2 (BV5%) on chest computed tomography (CT) in COVID-19 patients is predictive of adverse clinical outcomes.MethodsRetrospective analysis of chest CT scans from 10 hospitals across two state in 313 COVID-19 positive and 195 COVID-19 negative patients seeking acute medical care.ResultsBV5% was predictive of outcomes in COVID-19 patients in a multivariate model, with a BV5% threshold below 25% associated with an odds ratio (OR) 5.58 for death, OR 3.20 for intubation, and OR 2.54 for the composite of death or intubation. A model using age and BV5% had an area under the receiver operating characteristic curve 0.85 to predict the composite of intubation or death in COVID-19 patients. BV5% was not predictive of clinical outcomes in patients without COVID-19.ConclusionThis data suggests BV5% as a novel biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, this method showed low specificity. Recently, automated measurement of whole-lung vessel volume has also been applied in patients with COVID-19 [29]. These computer-aided vessel measurements might provide more information about lung perfusion in non-contrast-enhanced CT.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vascular enlargement and lesion extent on computed tomography are correlated with COVID-19 disease severity

et al. 2021

View full text Add to dashboard Cite

Purpose To assess the relationships among pulmonary vascular enlargement, computed tomography (CT) findings quantified with software, and coronavirus disease (COVID-19) severity. Materials and methods Ultra-high-resolution (UHR) CT images of 87 patients (50 males, 37 females; median age, 63 years) with COVID-19 confirmed using real-time polymerase chain reaction were analyzed. The maximum subsegmental vascular diameter was measured on CT. Total CT lung volume (CTLV total) and lesion extent (ratio of lesion volume to CTLV total) of ground-glass opacities, reticulation, and consolidation were measured using software. Maximum pulmonary vascular diameter and lesion extent were analyzed using Spearman's correlation analysis. Logistic regression analysis was performed on CT results to predict disease severity. We also assessed changes in these measures on follow-up scans in 16 patients. Results All 23 patients with severe and critical illness had vascular enlargement (> 4 mm). Pulmonary vascular enlargement (odds ratio 3.05, p = 0.018) and CT lesion extent (odds ratio 1.07, p = 0.002) were independent predictors of disease severity after adjustment for age and comorbidities. On follow-up CT, vascular diameter and CT lesion volume decreased (p = 0.001, p = 0.002; respectively), but CTLV total did not change significantly. Conclusion Subsegmental vascular enlargement is a notable finding to predict acute COVID-19 disease severity.

show abstract

“…Some image studies using CT, functional respiratory imaging on CT and dual-energy CT support the hypothesis of hyperperfusion associated with vasodilation. [1][2][3] In addition to vasodilation, vascular proliferation due to local angiogenesis might contribute to increased perfusion. Ackermann et al, 4 by using transmission and scanning electron microscopy and microvascular corrosion casts, elegantly demonstrated increased intussusceptive and sprouting angiogenesis in patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Pérez-Míes

Gómez-Rojo

Carretero‐Barrio

et al. 2021

Thorax

View full text Add to dashboard Cite

Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin. Platelet-derived growth factor receptor-β immunohistochemistry and dual immunostaining for CD34/smooth muscle actin demonstrated the presence of pericytes. These vascular alterations may contribute to the severe and refractory hypoxaemia that is common in patients with severe COVID-19.

show abstract

Functional respiratory imaging identifies redistribution of pulmonary blood flow in patients with COVID-19

Cited by 45 publications

References 10 publications

Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease

Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease

Pulmonary vascular enlargement and lesion extent on computed tomography are correlated with COVID-19 disease severity

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Contact Info

Product

Resources

About