TOPLINE:

Increased airway wall thickness (Pi10) measured on quantitative CT (qCT) during hospitalised exacerbations of chronic obstructive pulmonary disease (ECOPD) was correlated with reduced left ventricular ejection fraction (LVEF). Cardiac assessment revealed "undiagnosed" moderate-to-severe left ventricular systolic dysfunction (LVSD) in 8.9% of patients, heart failure without moderate-to-severe LVSD in 23.2%, and right heart failure in 14.3%.

METHODOLOGY:

• A total of 56 participants hospitalised with ECOPD underwent structured cardiac assessment, including transthoracic echocardiography, CT coronary artery calcium score, 24-hour three-lead ECG monitoring, and both inspiratory and expiratory chest CT imaging.
• Participants (mean [SD] age, 72.5 [6.5] years; 58.9% women) had findings consistent with moderate-to-severe COPD (mean forced expiratory volume in 1 second [FEV1], 50.6% predicted with an SD of 19.2).
• qCT analysis was performed using a semiautomated lung analysis tool to measure Pi10, emphysema burden, and gas trapping.
• Researchers compared qCT parameters with echocardiographic findings, including LVEF and tricuspid annular plane systolic excursion, as well as clinical and outcome data.
• Multivariable linear regression was performed to assess the independent association between Pi10 and LVEF, adjusting for age, sex, smoking status, and FEV1.

TAKEAWAY:

• Pi10 was negatively correlated with LVEF, and in adjusted multivariable linear regression, increased Pi10 remained independently associated with a lower LVEF (beta-coefficient, -0.4; P = .005).
• Gas trapping and emphysema burden were strongly correlated with lower FEV1 and worse airflow obstruction (P < .001 for both gas trapping and emphysema vs FEV1 % predicted and FEV1/forced vital capacity).
• Cardiac assessment revealed moderate-to-severe LVSD in 10.7% of patients, heart failure without moderate-to-severe LVSD in 25%, and right heart failure in 17.9%, of whom 8.9%, 23.2%, and 14.3%, respectively, were newly diagnosed.
• Severe coronary artery disease (defined as a CT coronary artery calcium score ≥ 400) was diagnosed in 43.1% (22/51) of patients, excluding five patients with stents.
• Pi10 was higher in participants who died within 90 days than in those who survived (6.61 vs 6.10 mm; P = .03), although this finding was based on only three deaths and should be interpreted cautiously.

IN PRACTICE:

"Incorporating cardiac insights into routine COPD imaging may help close an important gap in comorbidity detection and contribute to more personalised, holistic care in this population," the authors wrote.

"Future research should evaluate whether these findings are reproducible in larger, multicentre cohorts and whether CT-based metrics can be integrated into clinical pathways to prompt further cardiac evaluation," they added.

SOURCE:

This study was led by Grace Talor Mussell, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, England. It was published online on May 14, 2026, in BMJ Open Respiratory Research.

LIMITATIONS:

The study was limited by technical incompatibilities between reconstruction kernels and the CT analysis software, image quality issues, a modest sample size, and a small number of deaths. Additionally, echocardiographic assessments were occasionally incomplete due to difficulties of acquiring high-quality imaging in acutely unwell patients. Finally, the study lacked longitudinal imaging, postrecovery cardiac assessments, and an evaluation of cost-effectiveness or service implications of using qCT for cardiac assessment.

DISCLOSURES:

The research received funding from the Northumbria Healthcare NHS Foundation Trust, Chiesi Limited, and Menarini Pharmaceutica. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.