Complementary assessment of cardiopulmonary morphometric changes in COPD using 3D multidetector computed tomography: relationship with functional indices

This study aimed to quantitatively evaluate the structural remodeling of cardiopulmonary tissues in Chronic Obstructive Pulmonary Disease (COPD) using three-dimensional multidetector computed tomography (3D-MDCT) and to investigate the relationship between these morphometric changes and functional disease severity across genders. A retrospective analysis was performed on 114 participants (58 stable COPD patients and 56 age-matched controls). Pulmonary function tests (PFT), Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, and clinical scores (CAT, mMRC) were recorded. Right/left lung volumes (RLV, LLV) and heart ventricular volumes (RV, LV) were measured via 3D-Slicer software. Major vascular diameters (VCS, VCI, PA) were assessed on axial CT sections. Distinct gender-related structural patterns were identified. Male COPD patients exhibited significantly higher right lung volumes compared to controls (p < 0.01), which showed a strong negative correlation with the Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio, indicating hyperinflation-driven remodeling. Conversely, male patients demonstrated significantly lower right heart ventricular volumes (RV) (p < 0.05), supporting the “pseudomicrocardia” effect where hyperinflation mechanically restricts cardiac filling. In female COPD patients, pulmonary artery (PA) diameters were higher than in controls, showing a borderline significant trend (p = 0.050), while total lung volume negatively correlated with Vena Cava Superior (VCS) diameter (p < 0.05). Across both genders, smoking pack-years were identified as a significant independent predictor of increased total lung volume (p < 0.05). Although morphometric parameters did not differ significantly across GOLD stages, RV volume was notably increased in the GOLD E subgroup, reflecting higher symptom burden. 3D-MDCT provides a quantitative and objective assessment of secondary cardiopulmonary structural changes that may accompany COPD. The study suggests a potential gender dimorphism in structural remodeling; while hyperinflation-related cardiac compression (pseudomicrocardia) appears more notable in males, vascular alteration trends seem more prominent in females. These morphometric insights may serve as a valuable complementary tool to spirometry, especially in monitoring disease progression and evaluating systemic structural effects in clinical practice.