Relationship between quantitative CT and cardiac function in patients with severe COPD exacerbations (ECOPD)

Quantitative assessment of emphysema, gas trapping and airway wall thickness on CT correlates with chronic obstructive pulmonary disease (COPD) disease severity and exacerbation risk. In stable COPD, airway wall thickness is associated with prior myocardial infarction. Cardiac disease is often undiagnosed in COPD, and the risk of cardiac events following hospitalised exacerbations of COPD (ECOPD) is high. CT scans during hospitalised exacerbations may help clinicians identify patients with heart disease.

As part of the SCATECOPD study (IRAS 277817), patients with ECOPD underwent a detailed cardiac assessment encompassing an ECG, echocardiogram, CT coronary calcium score, and inspiratory and expiratory CT chest. Expiratory gas trapping (Exp%856), emphysema (Insp%950) and airway wall thickness (Pi10) were compared with clinical and cardiac data.

56 participants were recruited: 33 (58.9%) were female, with a mean (SD) age of 72.5 (6.5) years. The mean forced expiratory volume in 1 s was 50.6% predicted (SD 19.2), consistent with moderate-to-severe COPD.Cardiac assessment identified moderate-severe left ventricular systolic dysfunction (LVSD) in 10.7%, heart failure without moderate-severe LVSD in 25.0% and right heart failure in 17.9%; these were newly diagnosed in 8.9%, 23.2% and 14.3%, respectively. Severe coronary artery disease was found in 43.1%. Airway wall thickness was significantly negatively correlated with left ventricular ejection fraction. Emphysema and gas trapping correlated with spirometric airflow obstruction and showed weaker associations with cardiac dysfunction.

Quantitative CT performed during ECOPD may offer opportunistic insights into cardiac health, particularly through Pi10. Further research is warranted to evaluate its utility as a screening tool in COPD admissions.