Korean J Radiol.  2014 Dec;15(6):871-877. 10.3348/kjr.2014.15.6.871.

Quantitative Computed Tomography of Pulmonary Emphysema and Ventricular Function in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension

• Huang YS
• Hsu HH
• Chen JY
• Tai MH
• Jaw FS
• Chang YC

• KMID: 1794662
• DOI: http://doi.org/10.3348/kjr.2014.15.6.871

Abstract

OBJECTIVE
This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT).
MATERIALS AND METHODS
Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators.
RESULTS
Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed.
CONCLUSION
The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

Keyword

Pulmonary hypertension; Chronic obstructive pulmonary disease; Emphysema; Right ventricular function

MeSH Terms

Adult
Aged
Electrocardiography
Female
Heart Ventricles/radiography
Humans
Hypertension, Pulmonary/complications/*diagnosis
Lung/radiography
Male
Middle Aged
Multidetector Computed Tomography
Pulmonary Disease, Chronic Obstructive/complications/*radiography
Pulmonary Emphysema/complications/*radiography
Regression Analysis
Ventricular Function/*physiology

Figure

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  Fig. 1 Snap shot of successful segmentation of each of cardiac chambers after semiautomatic processing and manual adjustment during different cardiac phases. Ventricular volume equals sum of all endocardial areas multiplied by slice thickness.

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  Fig. 2 Coronal reformatted lung window image in 57-year-old man with severe chronic obstructive pulmonary disease amenable to lung transplantation. Red areas indicate voxels below -910 Hounsfield units in lung parenchyma, which represent emphysematous change.

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  Fig. 3 Axial image of whole lung CT without intravenous contrast, in 60-year-old man with severe chronic obstructive pulmonary disease, demonstrates severe emphysema in lung window.

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  Fig. 4 Coronal short-axis image of contrast-enhanced CT in end-systole phase, in 67-year-old woman with severe chronic obstructive pulmonary disease, demonstrates straightening of interventricular septum (arrow) to left ventricle (LV) which indicates right ventricle (RV) dysfunction.

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  Fig. 5 Relationship of pulmonary percent emphysema and right ventricle parameters in chronic obstructive pulmonary disease patients with pulmonary hypertension. A. Right ventricular end-diastolic volume (R2 = 0.340, p = 0.023). B. Right ventricular stroke volume (R2 = 0.406, p = 0.011). C. Right ventricular cardiac output (R2 = 0.382, p = 0.014).

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