Abstract
Purpose
Recent imaging studies demonstrated the usefulness of quantitative computed tomographic (CT) analysis assessing pulmonary hypertension (PH) in patients with chronic obstructive lung disease (COPD–PH). The aim of this study was to investigate whether it would be also valuable for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD–PH.
Methods
We analyzed a correlation between the extent of cystic destruction (LAA%) and total cross-sectional areas of small pulmonary vessels less than 5 mm2 (%CSA <5) in many CT slices from each of four COPD–PH patients before and after the initiation of pulmonary vasodilator. To evaluate those generalized data from patients with COPD, we evaluated multiple slices from 42 patients whose PH was not clinically suspicious. We also selected five PH patients with idiopathic interstitial pneumonia (IIP–PH) and analyzed serial changes of pulmonary artery enlargement (PA:A ratio).
Results
In 42 COPD patients without PH, LAA% had a statistically significant negative correlation with %CSA <5. However, three of four COPD–PH patients manifested no such correlation. In two patients, clinical findings were dramatically improved after the initiation of pulmonary vasodilator. Notably, LAA% and %CSA <5 in those patients correlated significantly after its treatment. In COPD–PH, the PA:A ratio was significantly decreased after the initiation of pulmonary vasodilator therapy (1.25 ± 0.13 vs. 1.13 ± 0.11, p = 0.019), but not in IIP–PH.
Conclusions
Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD–PH.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kessler R, Faller M, Weitzenblum E et al (2001) “Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am J Respir Crit Care Med 164:219–224
Dournes G, Laurent F, Coste F et al (2015) Computed tomographic measurement of airway remodeling and emphysema in advanced chronic obstructive pulmonary disease. Correlation with pulmonary hypertension. Am J Respir Crit Care Med 191:63–70
Matsuoka S, Washko GR, Yamashiro T et al (2010) Pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. Am J Respir Crit Care Med 181:218–225
Blanco I, Gimeno E, Munoz PA et al (2010) Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am J Respir Crtit Care Med 181:270–278
Stolz D, Rasch H, Linka A et al (2008) A randomized, controlled trial of bosentan in severe COPD. Eur Respir J 32:619–628
Rietema H, Holverda S, Bogaard HJ et al (2008) Sildenafil treatment in COPD does not affect stroke volume or exercise capacity. Eur Respir J 31:759–764
Carlsen J, Hasseriis Andersen K et al (2013) Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transpl 32:347–354
Galie N, Hoeper MM, Humbert M et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263
Wells JM, Washko GR, Han MK et al (2012) ECLIPSE study investigators. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med 367:913–921
Ando K, Tobino K, Kurihara M et al (2012) Quantitative CT analysis of small pulmonary vessels in lymphangioleiomyomatosis. Eur J Radiol 81:3925–3930
Ando K, Sekiya M, Tobino K, Takahashi K (2013) Relationship between quantitative CT metrics and pulmonary function in combined pulmonary fibrosis and emphysema. Lung 191:585–591
Committee of Respiratory Physiology in Japanese Respiratory Society (2004) Guideline of respiratory function tests-spirometry, flow-volume curve, diffusion capacity of the lung. Nihon Kokyuki Gakkai Zasshi suppl;1 (Japanese)
Wells AU (2013) The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF)—practical implications. Respir Res 14:S2
Santos S, Peinado VI, Ramirez J et al (2003) Enhanced expression of vascular endothelial growth factor in pulmonary arteries of smokers and patients with moderate chronic obstructive pulmonary disease. Am J Respir Crit Care Med 167:1250–1256
Barr RG, Mesia-Vela S, Austin JH et al (2007) Impaired flow-mediated dilation is associated with low pulmonary function and emphysema in ex-smokers: the emphysema and cancer action project (EMCAP) study. Am J Respir Crit Care Med 176:1200–1207
Hoffmann J, Wilhelm J, Marsh LM et al (2014) Distinct differences in gene expression patterns in pulmonary arteries of patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis with pulmonary hypertension. Am J Respir Crit Care Med 190:98–111
Acknowledgments
We thank Phyllis Minick for excellent assistance in the review of English.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interest
None of the authors has any conflicts of interest with regard to this study.
Rights and permissions
About this article
Cite this article
Ando, K., Kuraishi, H., Nagaoka, T. et al. Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension. Lung 193, 911–918 (2015). https://doi.org/10.1007/s00408-015-9813-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-015-9813-8