Why the study?
Dyspnea is common in both COPD and CHF, complicating differentiation during emergency hospital admission, particularly when spirometry is impossible due to pronounced bronchial obstruction.
Does chest multispiral CT help differentiate COPD exacerbation from acute decompensated CHF in patients with dyspnea?
Observational (n=32)
Does chest multispiral CT help differentiate COPD exacerbation from acute decompensated CHF in patients with dyspnea?
Relative Risk: 19.28
Chest CT signs of extensive air trapping and centrilobular emphysema can serve as additional criteria to differentiate COPD exacerbation from acute decompensated heart failure.
These CT signs may support COPD identification in dyspnea; hypothesis-generating for differentiation from decompensated HF, pending prospective validation.
Dyspnea is common both in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). This complicates a differentiation between COPD exacerbation and acute decompensated CHF during emergency hospital admission. Another challenge is the impossibility of spirometry in pronounced bronchial obstruction. Computed tomography (CT) reveals the signs of damage to the lung parenchyma in COPD exacerbations. Therefore, CT can determine additional diagnostic criteria for this disease. Objective. To determine additional criteria to differentiate between COPD exacerbation and acute decompensated CHF. Material and methods. The study involved 32 patients admitted to the hospital with pronounced dyspnea and bronchial obstruction signs. The patients were retrospectively divided into two groups based on spirometry, EchoCG, and N-terminal brain natriuretic propeptide content. Group 1 included patients with confirmed COPD (forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ratio <70%), Group 2 — patients with acute decompensated CHF and normal FEV1/FVC ratio. All patients underwent chest multispiral CT using Optima General Electric apparatus. The results were statistically processed using the Statistica 13.0 software. Results. 100% of Group 1 and 80% of Group 2 patients had CT signs of air trapping and centrilobular emphysema. The probability of COPD was 19.28 times higher in patients with signs of air trapping in 6 or more segments and centrilobular emphysema in 8 or more segments. Conclusion. The signs of air trapping in 6 or more segments and centrilobular emphysema in 8 or more segments can be considered additional criteria for chronic obstructive pulmonary disease in patients with dyspnea.
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Mishlanov et al. (2024) conducted an observational in COPD exacerbation and acute decompensated CHF (n=32). CT signs of air trapping in ≥6 segments and centrilobular emphysema in ≥8 segments vs. Absence of these extensive CT signs was evaluated on Probability of confirmed COPD (19.28 times higher probability).
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