CHEST pulmonary · 2026
Can Quantitative CT Scan Analysis of Pulmonary Parenchymal and Vascular Characteristics Help to Differentiate Among Various Phenotypes of COPD Associated With Pulmonary Hypertension?
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Raza Ahmad, Rali Parth, Naranjo Mario-Tovar, Gayen Shameek
Аннотация
BACKGROUND: Quantitative CT imaging has been applied to pulmonary vascular disease, but its role in characterizing phenotypes of COPD associated with pulmonary hypertension (COPD-PH) has not been evaluated systematically.
RESEARCH QUESTION: Can quantitative CT imaging reliably identify and differentiate major COPD-PH phenotypes?
STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of patients with COPD-PH at Temple University Hospital from 2010 through 2022. Patients were categorized into 3 phenotypes: pulmonary vascular (pulmonary vascular resistence [PVR] > 5 Wood units [WU]; FEV1 > 50% predicted), pulmonary parenchymal (PVR < 5 WU; FEV1 < 50% predicted), and mixed (PVR > 5 WU; FEV1 < 50%). Quantitative CT imaging-derived vascular measures (proportion of blood volume in pulmonary vessels with cross-sectional area of < 5 mm2 [BV5] and proportion of blood volume in pulmonary vessels with cross-sectional area of < 10 mm2 [BV10]) and parenchymal measures (regional lung volume, total emphysema volume, emphysema percentage) were compared using analyses of variance.
RESULTS: Ninety patients met inclusion criteria. Mean PVR was 9.5 WU, 7.5 WU, and 2.8 WU in the vascular, mixed, and parenchymal phenotypes, respectively; corresponding mean FEV1 values were 67.4%, 35.8%, and 22.3%. Survival analysis demonstrated significantly higher mortality in the mixed phenotype (31%) vs the vascular (14.2%) and parenchymal (6.7%) groups (P = .04, log-rank test). Cox regression confirmed increased mortality risk in the mixed phenotype (OR, 2.12; 95% CI, 1.17-3.86; P = .001). Quantitative CT imaging-determined phenotypes showed similar patterns, with mortality of 75%, 25%, and 7.1% in the mixed, vascular, and parenchymal groups, respectively. The BV5 to total vessel volume ratio predicted elevated PVR of > 5 WU (area under the receiver operating characteristic curve [AUC], 0.75; P < .001) with an optimal cutoff of 0.48. Emphysema percentage predicted severe airflow obstruction (FEV1 < 50%; AUC, 0.83; P = .001). Using quantitative CT imaging-derived thresholds, phenotype classification demonstrated high specificity (vascular, 86.2%; parenchymal, 89.7%; mixed, 100%) with sensitivities of 46.7%, 73.3%, and 7.1%, respectively.
INTERPRETATION: Our results show that quantitative CT imaging can differentiate COPD-PH phenotypes using vascular and parenchymal markers and may serve as a noninvasive tool to characterize disease heterogeneity.
RESEARCH QUESTION: Can quantitative CT imaging reliably identify and differentiate major COPD-PH phenotypes?
STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of patients with COPD-PH at Temple University Hospital from 2010 through 2022. Patients were categorized into 3 phenotypes: pulmonary vascular (pulmonary vascular resistence [PVR] > 5 Wood units [WU]; FEV1 > 50% predicted), pulmonary parenchymal (PVR < 5 WU; FEV1 < 50% predicted), and mixed (PVR > 5 WU; FEV1 < 50%). Quantitative CT imaging-derived vascular measures (proportion of blood volume in pulmonary vessels with cross-sectional area of < 5 mm2 [BV5] and proportion of blood volume in pulmonary vessels with cross-sectional area of < 10 mm2 [BV10]) and parenchymal measures (regional lung volume, total emphysema volume, emphysema percentage) were compared using analyses of variance.
RESULTS: Ninety patients met inclusion criteria. Mean PVR was 9.5 WU, 7.5 WU, and 2.8 WU in the vascular, mixed, and parenchymal phenotypes, respectively; corresponding mean FEV1 values were 67.4%, 35.8%, and 22.3%. Survival analysis demonstrated significantly higher mortality in the mixed phenotype (31%) vs the vascular (14.2%) and parenchymal (6.7%) groups (P = .04, log-rank test). Cox regression confirmed increased mortality risk in the mixed phenotype (OR, 2.12; 95% CI, 1.17-3.86; P = .001). Quantitative CT imaging-determined phenotypes showed similar patterns, with mortality of 75%, 25%, and 7.1% in the mixed, vascular, and parenchymal groups, respectively. The BV5 to total vessel volume ratio predicted elevated PVR of > 5 WU (area under the receiver operating characteristic curve [AUC], 0.75; P < .001) with an optimal cutoff of 0.48. Emphysema percentage predicted severe airflow obstruction (FEV1 < 50%; AUC, 0.83; P = .001). Using quantitative CT imaging-derived thresholds, phenotype classification demonstrated high specificity (vascular, 86.2%; parenchymal, 89.7%; mixed, 100%) with sensitivities of 46.7%, 73.3%, and 7.1%, respectively.
INTERPRETATION: Our results show that quantitative CT imaging can differentiate COPD-PH phenotypes using vascular and parenchymal markers and may serve as a noninvasive tool to characterize disease heterogeneity.