Anne-Catherine Maynard-Paquette,1 Claude Poirier,2 Carl Chartrand-Lefebvre,3,4 Bruno-Pierre Dubé2,5
1Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada; 2Centre Hospitalier de l’Université de Montréal (CHUM), Department of Medicine, Respiratory Medicine Division, Montreal, Quebec, Canada; 3Centre Hospitalier de l’Université de Montréal (CHUM), Department of Radiology, Montréal, Québec, Canada; 4Research Center of the CHUM (CRCHUM) – Imaging and Engineering Axis, Montreal, Quebec, Canada; 5Research Center of the CHUM (CRCHUM) – Health Innovation and Evaluation Hub, Montreal, Quebec, Canada
Correspondence: Bruno-Pierre Dubé
Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 850 Rue St-Denis, Montréal, Qc H2X0A9, Canada
Tel +1 514 890-8000
Email [email protected]
Rationale: Chronic obstructive pulmonary disease (COPD) is associated with changes in the composition and function of peripheral and respiratory muscles, which can negatively impact quality of life. Ultrasonography can provide a non-invasive evaluation of the integrity of both peripheral muscles and diaphragm, but its use in patients with COPD is still being investigated. We aimed at evaluating the relationship between quadriceps size, using ultrasonography and symptoms, lung function and diaphragm contractility in a cohort of patients with COPD.
Methods: COPD patients were prospectively recruited and ultrasonography of the dominant quadriceps and of the diaphragm was performed. Quadriceps size was evaluated using three measurements: 1) cross-sectional area of the rectus femoris (Qcsa), 2) thickness (Qthick) and 3) contractile index (Qci), defined as the ratio of quadriceps thickness/total anterior thigh thickness. Diaphragm contractility was evaluated using thickening fraction (TFdi). Clinical characteristics and number of moderate-to-severe exacerbations in the previous year were retrieved from medical files. Dyspnea (mMRC scale) and disease impact on health status (COPD Assessment Test (CAT)) were measured at inclusion. Fat-free mass index (FFMI) was assessed using bioelectrical impedance.
Results: Forty patients were recruited (20 males, mean age and FEV1 66±6 years and 49±17%predicted, respectively). Mean Qcsa, Qthick and Qci were 336±145 mm2, 1.55±0.53 cm and 64±16%, respectively, and mean TFdi was 91±36%. Qci was significantly correlated with FFMI (rho=0.59, p=0.001), TFdi (rho=0.41, p=0.008), FEV1 (rho=0.43, p=0.001) but not with age (rho=0.18, p=0.28). Qci was significantly correlated to CAT score (rho=−0.47, p=0.002), even when controlled for FEV1, and was lower in patients with an mMRC score ≥2 (55±15 vs 70±14%, p=0.002). Qcsa and Qci were significantly lower in patients with frequent exacerbations. In a multiple linear regression analysis that included age, gender, FFMI, FEV1 and TFdi, only FFMI and TFdi were found to be significantly related to lower Qci values.
Conclusion: In patients with COPD, ultrasound evaluation of the quadriceps contractile index is feasible and related to disease severity, clinical symptoms, exacerbation history and diaphragm contractility. As such, it may provide a novel tool for the evaluation of the severity and burden of the disease in this population. Further studies are required to better delineate its potential role as a prognostic marker in this population.
Keywords: COPD, ultrasound, quadriceps, diaphragm, contractile index
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