Figures
- FIGURE 1
Study flowchart. PH: pulmonary hypertension; RHC: right heart catheterisation; PFTs: pulmonary function tests; mPAP: mean pulmonary artery pressure; ILD: interstitial lung disease; CPFE: combined pulmonary fibrosis emphysema syndrome; CLD: chronic lung disease.
- FIGURE 2
CT small vessels and coronal images from patients with COPD/emphysema and ILD with no PH, mild to moderate and severe PH. Representative images from patients with COPD/emphysema and ILD with mean values for mPAP and SVV for each group. ILD: interstitial lung disease; PH: pulmonary hypertension; mPAP: mean pulmonary artery pressure; PVR: pulmonary vascular resistance; DLCO: diffusing capacity of the lung for carbon monoxide; SVV: small vessel volume of vessels <1.6 mm.
- FIGURE 3
Correlation of pulmonary vessel volume <1.6 mm in diameter with mPAP and PVR in COPD/emphysema and ILD. PH: pulmonary hypertension; ILD: interstitial lung disease; mPAP: mean pulmonary artery pressure; PVR: pulmonary vascular resistance.
- FIGURE 4
Kaplan–Meier plot showing patients with greater and lesser small vessel volumes (defined as small vessel diameter <1.6 mm) in patients with COPD/emphysema and ILD. ILD: interstitial lung disease; ROC: receiver operating characteristic curve.
Tables
- TABLE 1
Group comparison of computed tomography-derived vessel parameters in patients with mild to moderate PH (mPAP 21–34 mmHg) versus patients with severe PH (mPAP ≥35 mmHg) in PH-COPD/emphysema and PH-ILD
COPD/emphysema ILD Mild–moderate PH Severe PH Mild–moderate PH Severe PH Subjects n 20 24 30 16 Demographics Age years 65±13 67±11 64±12 69±16 Sex % 60% female 50% male 63% female 56% male WHO functional class (I/II/III/IV) n 0/3/16/1 0/0/18/6 1/4/23/1 0/0/10/6 Right heart catheter data mRAP, mmHg 6±4 12±6* 6±3 11±11* mPAP, mmHg 27±5 50±10** 26±4 48±9** PAWP, mmHg 11±3 15±7* 11±3 11±5 Cardiac output, L·min−1 5.75±1.14 4.44±1.65* 5.16±1.26 3.95±0.93* Cardiac index, L·min−1·m−2 3.30±0.74 2.36±0.70** 2.81±0.73 2.09±0.53* PVR, mmHg 233±90 709±405** 257±143 777±242** SaO2, % 95±2 93±4 97±2 93±3** SvO2, % 74±6 62±9** 70±4 63±10* ISWT - distance, m 231±153 105±74** 228±152 70±85** Pulmonary function tests FEV1, % pred 66±24 62±20 67±19 54±14* FVC, % pred 94±21 81±18* 68±20 55±17* FEV1/FVC ratio, % 55±11 58±16 77±9 78±9 TLCO, % pred 49.2±23.1 21.6±11.6 37.6±20.8 17.8±11.8* All vessel parameters Pulmonary vessels <0.8 mm, mL·m−2 10.6±3.9 8.1±2.7* 6.3±3.3 4.4±2.3* Pulmonary vessels <1.2 mm, mL·m−2 22.6±7.7 17.2±5.4* 13.2±6.5 9.4±4.9* Pulmonary vessels <1.6 mm, mL·m−2 34.5±11 27±8* 20.7±9.4 15±7.5* Lung volume, mL 2884±643 2395±524* 1841±559 1526±510 Total vessel volume, mL 91±17 79±21* 55±17 49±24 Data expressed as mean±sd unless otherwise indicated. PH: pulmonary hypertension; ILD: interstitial lung disease; mPAP: mean pulmonary arterial pressure; WHO: World Health Organization; mRAP: mean right atrial pressure; PAWP: pulmonary artery wedge pressure; PVR: pulmonary vascular resistance; SaO2: oxygen saturation; SvO2: mixed venous oxygen saturation; ISWT: incremental shuttle walk test; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; TLCO: transfer capacity of the lung for the uptake of carbon monoxide (CO). *: significant change between mild to moderate PH and severe PH (p<0.05); **: significant change between mild to moderate PH and severe PH (p<0.01).
- TABLE 2
Correlation of computed tomography-derived pulmonary parameters with mPAP and PVR in patients with PH and COPD/emphysema or ILD
PH–COPD/emphysema PH–ILD mPAP, R value/p-value PVR, R value/p-value mPAP, R value/p-value PVR, R value/p-value Subjects n 44 42 46 44 Pulmonary vessels <0.8 mm −0.37/0.01 −0.25/0.1 −0.37/0.01 −0.29/0.053 Pulmonary vessels <1.2 mm −0.37/0.01 −0.26/0.1 −0.37/0.01 −0.30/0.051 Pulmonary vessels <1.6 mm −0.35/0.02 −0.23/0.1 −0.37/0.01 −0.29/0.06 Lung volume −0.32/0.03 −0.25/0.1 −0.32/0.03 −0.27/0.07 Total vessel volume −0.17/0.2 −0.16/0.3 −0.16/0.2 −0.10/0.5 PH: pulmonary hypertension; ILD: interstitial lung disease; mPAP: mean pulmonary arterial pressure; PVR: pulmonary vascular resistance.
- TABLE 3
Comparison of computed tomography derived vessel volumes according to the radiological severity of emphysema and interstitial lung disease (ILD)
Emphysema ILD Variable Mild Moderate Severe Mild Moderate Severe Pulmonary vessels <0.8 mm, mL·m−2 7.6+ 9.6 11.9# 7.9¶,+ 4.9# 5# Pulmonary vessels <1.2 mm, mL·m−2 16.2+ 20 25.2# 16.6¶,+ 10.3# 10.3# Pulmonary vessels <1.6 mm, mL·m−2 25.3+ 31.1 39.1# 25.7¶,+ 16.5# 16.1# Total lung volume, mL·m−2 2353 2639 3014 2107¶ 1618# 1612 Total vessel volume, mL·m−2 71¶,+ 90# 96# 70¶,+ 48# 44# #: significant difference compared to mild; ¶: significant difference compared to moderate; +: significant difference compared to severe.
- TABLE 4
Univariate and multivariate Cox proportional hazards regression analysis
Univariate Adjustment for age and sex Adjustment for age, sex and mPAP B value Hazard ratio p-value B value Hazard ratio p-value B value Hazard ratio p-value Age 0.03 1.03 0.02 0.03 1.03 0.01 0.02 1.02 0.07 Sex −0.45 0.63 0.09 −0.49 0.61 0.01 −0.16 0.85 0.58 mPAP 0.05 1.05 <0.01 0.05 1.05 <0.01 0.05 1.05 <0.01 PVR 0.003 1.003 <0.01 0.003 1.003 <0.01 0.003 1.003 <0.01 Pulmonary vessels <0.8 mm −0.05 0.95 0.02 −0.09 0.92 0.03 −0.04 0.96 0.37 Pulmonary vessels <1.2 mm −0.03 0.97 0.03 −0.04 0.96 0.03 −0.02 0.98 0.30 Pulmonary vessels <1.6 mm −0.01 0.98 0.03 −0.03 0.97 0.05 −0.01 0.98 0.35 mPAP: mean pulmonary arterial pressure; PVR: pulmonary vascular resistance.
Supplementary Material
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Supplementary material 00503-2021.SUPPLEMENT
