aAirway wall thickness measured on routine computed tomography (CT) scans during hospitalised comorbidity in chronic obstructive pulmonary disease (COPD) exacerbations is associated with impaired left ventricular function, suggesting quantitative CT (qCT) could support opportunistic cardiac risk assessment in this high-risk population.

Cardiovascular disease is a common but frequently unrecognised comorbidity in COPD, particularly among patients admitted to hospital with exacerbations.

Although qCT is established for evaluating COPD severity in stable disease, its connection with cardiac function during acute exacerbations is less well understood.

As such, a research team from the north of England investigated whether qCT performed during hospitalised exacerbations of COPD could provide additional insights into underlying cardiac disease.

Published in BMJ Open Respiratory Research, this sub-study of the Structured Cardiac Assessment and Treatment following Exacerbations of COPD (SCATECOPD) trial included 56 patients admitted with COPD exacerbations who underwent structured cardiac assessment alongside inspiratory and expiratory thoracic CT imaging.

Participants had a mean age of 72.5 years, 58.9% were female, and the mean forced expiratory volume in one second was 50.6% predicted, which is consistent with moderate-to-severe COPD.

Patients underwent echocardiography, ECG monitoring and coronary artery calcium scoring, alongside assessment of three qCT parameters: airway wall thickness, emphysema burden and gas trapping.

Airway wall thickness and cardiac function

A substantial burden of previously undiagnosed cardiovascular disease was identified in patients experiencing COPD exacerbations. Moderate-to-severe left ventricular systolic dysfunction (LVSD) was present in 10.7% of patients, heart failure without moderate-to-severe LVSD in 25.0%, and right heart failure in 17.9%. Severe coronary artery disease was identified in 43.1% of evaluable participants.

The principal finding was a significant association between increased airway wall thickness and reduced left ventricular ejection fraction. This relationship remained significant after adjustment for age, sex, smoking status and lung function.

In contrast, emphysema burden and gas trapping were strongly associated with airflow obstruction but not with measures of cardiac dysfunction.

Higher airway wall thickness was also observed among the small number of patients who died within 90 days of discharge, although the authors cautioned that this finding was based on only three deaths. No significant relationship was observed between qCT measures and hospital readmission.

Potential implications for cardiac screening in COPD

The authors suggested that airway wall thickness may reflect mechanisms linking COPD and cardiovascular disease, including systemic inflammation, airway oedema and haemodynamic stress.

Given that CT imaging is frequently performed during admissions for COPD exacerbations, qCT could potentially provide additional information to identify patients who may benefit from further cardiac assessment.

Several limitations were acknowledged, including the single-centre design, modest sample size, incomplete imaging data in some patients and technical challenges associated with imaging acutely unwell individuals. The study was also not designed to assess cost-effectiveness and the authors emphasised that qCT should not replace echocardiography.

Further research is needed to determine whether these findings can be replicated in larger multicentre cohorts and whether CT-derived metrics can be incorporated into clinical pathways to support targeted cardiac investigation in patients admitted with COPD exacerbations, they concluded.

Reference
Mussell GT et al. Relationship between quantitative CT and cardiac function in patients with severe COPD exacerbations (ECOPD). BMJ Open Respir Res 2026;13:e003815.