&lt;p&gt;Assessing pulmonary hypertension in COPD. Is there a role for computed tomography?&lt;/p&gt;

Coste, F; Benlala, Ilyes; Dournes, Gaël; Girodet, Pierre‐Olivier; Berger, Patrick

doi:10.2147/copd.s207363

Cited by 17 publications

(12 citation statements)

References 136 publications

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“…Although low-dose chest CT might not be the best modality for measuring cardiac indices, compared to other techniques, it is safer, rapid, and readily available while also having acceptable performance (8,19,34). For instance, right heart catheterization, which is the golden standard test for the diagnosis of PH (35), is costly and aggressive, contributing to serious adverse events such as pneumothorax, arrhythmias and even death in unstable patients (36,37). Also, despite the fact that chest X-ray is widely utilized for the measurement of CTR, it is difficult and suboptimal to perform plain chest radiography for most hospitalized patients with COVID-19 since it requires upright position and unlike chest CT, it does not provide further diagnostic and prognostic value in the setting of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

et al. 2021

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Rationale and Objectives: Cardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19. Materials and Methods: Eighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Coxregression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices. Results: Mean (§SD) age of patients was 54.55 (§15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001). Conclusion: CT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.

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Section: Discussionmentioning

confidence: 99%

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

et al. 2021

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“…For example, COPD patients with similar airflow limitation may have substantial near homogeneously-distributed emphysema without airway disease, moderate upper-dominant heterogeneously-distributed emphysema with moderate airway disease, or little emphysema with severe airway disease ( Schroeder et al, 2013 ; Lynch et al, 2015 ). Furthermore, morphological alteration of vessels is also a pathological feature, and pulmonary hypertension is a common comorbidity in patients with COPD ( Matsuoka et al, 2010 ; Coste et al, 2019 ). A combination of these airway, lung parenchyma, and vessel lesions underlies the structural heterogeneity, which not only influences lung function but can be a driving factor for the disease progression in patients with COPD ( Mondoñedo et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Fractal Analysis of Lung Structure in Chronic Obstructive Pulmonary Disease

et al. 2020

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Chest CT is often used for localizing and quantitating pathologies associated with chronic obstructive pulmonary disease (COPD). While simple measurements of areas and volumes of emphysema and airway structure are common, these methods do not capture the structural complexity of the COPD lung. Since the concept of fractals has been successfully applied to evaluate complexity of the lung, this review is aimed at describing the fractal properties of airway disease, emphysema, and vascular abnormalities in COPD. An object forms a fractal if it exhibits the property of self-similarity at different length scales of evaluations. This fractal property is governed by power-law functions characterized by the fractal dimension (FD). Power-laws can also manifest in other statistical descriptors of structure such as the size distribution of emphysema clusters characterized by the power-law exponent D. Although D is not the same as FD of emphysematous clusters, it is a useful index to characterize the spatial pattern of disease progression and predict clinical outcomes in patients with COPD. The FD of the airway tree shape and the D of the size distribution of airway branches have been proposed indexes of structural assessment and clinical predictions. Simulations are also useful to understand the mechanism of disease progression. Therefore, the power-law and fractal analysis of the parenchyma and airways, especially when combined with computer simulations, could lead to a better understanding of the structural alterations during the progression of COPD and help identify subjects at a high risk of severe COPD.

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“…Pulmonary vascular changes are one of the important mechanisms involved in the exacerbation of patients with acute exacerbations [ 31 ]. Clinically, patients with COPD can be divided into mild, moderate and severe three levels according to their clinical manifestations, arterial blood gas analysis and other indicators to guide clinical management strategies.…”

Section: Discussionmentioning

confidence: 99%

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

Yang

Chen

2021

BMC Pulm Med

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Background It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. Methods COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. Results A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. Conclusions Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.

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<p>Assessing pulmonary hypertension in COPD. Is there a role for computed tomography?</p>

Cited by 17 publications

References 136 publications

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

Fractal Analysis of Lung Structure in Chronic Obstructive Pulmonary Disease

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

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