Shear wave elastography of the diaphragm in acute exacerbation of chronic obstructive pulmonary disease: A prospective observational study

Abstract

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are prone to diaphragmatic dysfunction. However, dynamic assessment of diaphragmatic function is complex and difficult, and whether the assessment of diaphragmatic function can reflect clinical indicators such as lung function in AECOPD patients remains unclear. We studied diaphragm stiffness and diaphragm stiffening rate (DSR) in AECOPD patients with acute exacerbations ≥ 2 times within 1 year and their correlation with clinical data, the diaphragmatic thickening fraction (DTF), lung function, and blood gas values. In total, 112 AECOPD patients in group C and Group D who had acute exacerbations ≥ 2 times within 1 year in the Global Initiative for Chronic Obstructive Lung Disease Guideline A (low risk, few symptoms), B (low risk, many symptoms), C (High risk, few symptoms), D (High risk, many symptoms) grouping system were included in the study. Their general clinical data, chronic obstructive pulmonary disease assessment test (CAT), modified medical research council (mMRC), number of acute exacerbations in 1 year, DTF, lung function, and blood gas analysis were collected. The diaphragm shear wave elasticity at functional residual capacity (DsweFRC) and DSR were measured by ultrasound. The DsweFRC and DSR of Group D were higher than those of Group C (P < .05). DsweFRC, DSR were negatively correlated with DTF, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC (r ranged from −0.293 to −0.697, all P < .05), and positively correlated with CAT score, mMRC score, and arterial carbon dioxide pressure (r ranged from 0.274 to 0.462, all P < .05) in both groups; the correlation coefficients of DsweFRC, DSR and DTF, FEV1/FVC in group D were greater than those in group C. There was no correlation between DsweFRC, DSR and arterial oxygen partial pressure in both groups (P > .05). The DsweFRC, DSR increased with the number of acute exacerbations per year in both groups. We found that diaphragmatic stiffness in AECOPD patients increased with the number of acute exacerbations within 1 year, correlated with DTF, CAT, mMRC, lung function, and arterial carbon dioxide pressure and provides a simple and practical method for dynamically assessing diaphragmatic function and disease severity in AECOPD patients.

Current evidence for lung ultrasound elastography in the field of pneumology: a systematic review

“…Moreover, 2D-SWE has also been applied to monitor cases of COVID-19, although the results for the detection of sequelae after the discharge were not significant [35]. Similarly, publication of elastography in patients with chronic obstructive pulmonary disease (COPD) showed that decreased diaphragmatic elasticity correlated to disease severity on the Global Initiative for Chronic Obstructive Lung Disease scale stratification [36]. Finally, a sign called 'elasto-lung point' when strain elastography is applied to pneumothorax has been described and can help identify and confirm the conventional 'lung point' [37].…”

Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients

“…However, it has also been applied to the study of the elastic properties of the lung parenchyma in chronic obstructive pulmonary disease (COPD) [34]. Two recent studies suggest that diaphragm stiffness estimated by ultrasonography is significantly correlated with pulmonary volumes and spirometric parameters, such as the Tiffeneau index, in COPD, predicting the number of acute exacerbations over time and stratifying disease severity [35,36]. In critically ill patients undergoing mechanical ventilation, diaphragm stiffness estimated by shear-wave elastosonography was correlated with transdiaphragmatic pressure, providing useful information for estimating respiratory load and regulating ventilatory settings [37,38].…”