Assessment of exercise tolerance and respiratory failure risk by chest muscle CT attenuation values and cross-sectional area in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LIU Wensi , ZHANG Guxiang , GUO Lei , CHEN Liangliang

Imaging Department, Anhui West Health Vocational College Affiliated Hospital, Lu'an, Anhui 237000, P. R. China;

Corresponding author：

LIU Wensi, Email: xjqxz20001@163.com

Keywords：

Chronic obstructive pulmonary disease; sarcopenia; chest CT; pectoralis muscle; exercise tolerance; respiratory failure

DOI：

10.7507/1671-6205.202411084

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Objective To investigate the correlation between pectoralis muscle CT attenuation value (PMT) and cross-sectional area (PMA) with clinical characteristics, exercise tolerance, and respiratory failure in patients with chronic obstructive pulmonary disease (COPD), providing a new perspective for COPD assessment. Methods A total of 120 COPD patients (67 in stable phase, 53 in acute exacerbation phase) admitted between January 2020 and December 2023 and 60 healthy controls in the same period were included. All participants underwent chest CT scans for the measurement of PMA and PMT. Pulmonary function indices, 6-minute walk distance (6MWD), and quality of life scores were also collected from COPD patients. Statistical analysis was conducted to explore the relationship between PMA and PMT with clinical characteristics of COPD patients, and their predictive value for exercise tolerance in stable COPD patients and respiratory failure in acute exacerbation COPD patients was evaluated. Results Both PMA and PMT were significantly lower in the COPD patients compared with the control group (P<0.05) and were significantly correlated with pulmonary function, exercise capacity, and quality of life (P<0.05). PMA was identified as an independent risk factor for exercise intolerance in stable COPD patients (OR=1.261, 95%CI 1.075-1.496, P=0.004). Receiver operating characteristic (ROC) curve analysis revealed an area under curve (AUC) of 0.849 with a cut-off value of 23.72 cm² for PMA. Both PMA (OR=1.141, 95%CI 1.002-1.299, P=0.046) and PMT (OR=1.178, 95%CI 1.085-1.293, P<0.001) were independent risk factors for respiratory failure in acute exacerbation COPD patients. The ROC curve analysis showed an AUC of 0.804 with a cut-off value of 24.15 cm² for PMA and an AUC of 0.831 with a cut-off value of 37.65 Hu for PMT. Conclusions Pectoralis muscle PMA and PMT can serve as effective indicators for assessing the severity and prognosis of COPD. A lower pectoralis muscle PMA is a risk factor for exercise intolerance in patients with stable COPD, while lower pectoralis muscle PMA and PMT are risk factors for the development of respiratory failure in patients with acute exacerbations of COPD.

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2.	Attaway AH, Welch N, Hatipoğlu U, et al. Muscle loss contributes to higher morbidity and mortality in COPD: an analysis of national trends. Respirology, 2021, 26(1): 62-71.
3.	Valisoltani N, Mohammadi H, Aliannejad R, et al. Association of phase angle with sarcopenia and muscle function in patients with COPD: a case-control study. BMC Pulm Med, 2024, 24(1): 18.
4.	Qian Y, Cai C, Sun M, et al. Analyses of factors associated with acute exacerbations of chronic obstructive pulmonary disease: a review. Int J Chron Obstruct Pulmon Dis, 2023, 18: 2707-2723.
5.	Sepúlveda-Loyola W, Osadnik C, Phu S, et al. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2020, 11(5): 1164-1176.
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11.	Aubrey J, Esfandiari N, Baracos VE, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf), 2014, 210(3): 489-497.
12.	Ertan Yazar E, Niksarlioglu EY, Yigitbas B, et al. How to utilize CAT and mMRC scores to assess symptom status of patients with COPD in clinical practice? Medeni Med J, 2022, 37(2): 173-179.
13.	Makuch M, Milanowska J, Michnar M, et al. The relationship between COPD Assessment Test (CAT) scores and Distress Thermometer (DT) results in COPD patients. Ann Agric Environ Med, 2020, 27(4): 689-694.
14.	Ferrer M, Villasante C, Alonso J, et al. Interpretation of quality of life scores from the St George's Respiratory Questionnaire. Eur Respir J, 2002, 19(3): 405-413.
15.	Li CL, Chang HC, Tseng CW, et al. Comparison of BODE and ADO Indices in predicting COPD-related medical costs. Medicina (Kaunas), 2023, 59(3): 577.
16.	Cote CG, Casanova C, Marín JM, et al. Validation and comparison of reference equations for the 6-min walk distance test. Eur Respir J, 2008, 31(3): 571-578.
17.	Zhou K, Wu F, Zhao N, et al. Association of pectoralis muscle area on computed tomography with airflow limitation severity and respiratory outcomes in COPD: a population-based prospective cohort study. Pulmonology, 2025, 31(1): 2416782.
18.	Bak SH, Kwon SO, Han SS, et al. Computed tomography-derived area and density of pectoralis muscle associated disease severity and longitudinal changes in chronic obstructive pulmonary disease: a case control study. Respir Res, 2019, 20(1): 226.
19.	Qiao X, Hou G, Kang J, et al. CT Attenuation and cross-sectional area of the pectoralis are associated with clinical characteristics in chronic obstructive pulmonary disease patients. Front Physiol, 2022, 13: 833796.
20.	洪丽月, 黄种杰, 黄鑫成, 等. 慢性阻塞性肺疾病患者胸大肌CT参数与肺功能及疾病严重程度的关系. 武警医学, 2024, 35(7): 582-587,592.
21.	Yun R, Bai Y, Lu Y, et al. How Breathing exercises influence on respiratory muscles and quality of life among patients with COPD? A systematic review and meta-analysis. Can Respir J, 2021, 2021: 1904231.
22.	O'Brien ME, Zou RH, Hyre N, et al. CT pectoralis muscle area is associated with DXA lean mass and correlates with emphysema progression in a tobacco-exposed cohort. Thorax, 2023, 78(4): 394-401.
23.	da Rocha DS, Tessari JA, Mainardi NB, et al. Assessment of muscle mass using chest computed tomography-based quantitative and qualitative measurements in patients with systemic sclerosis: a retrospective study with cross-sectional and longitudinal analyses. Semin Arthritis Rheum, 2023, 59: 152168.
24.	Perrot L, Greil A, Boirie Y, et al. Prevalence of sarcopenia and malnutrition during acute exacerbation of COPD and after 6 months recovery. Eur J Clin Nutr, 2020, 74(11): 1556-1564.
25.	Ammous O, Feki W, Lotfi T, et al. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev, 2023, 1(1): CD013778.
26.	Zhang F, Zhong Y, Qin Z, et al. Effect of muscle training on dyspnea in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 2021, 100(9): e24930.

1. Ferrera MC, Labaki WW, Han MK. Advances in chronic obstructive pulmonary disease. Annu Rev Med, 2021, 72: 119-134.
2. Attaway AH, Welch N, Hatipoğlu U, et al. Muscle loss contributes to higher morbidity and mortality in COPD: an analysis of national trends. Respirology, 2021, 26(1): 62-71.
3. Valisoltani N, Mohammadi H, Aliannejad R, et al. Association of phase angle with sarcopenia and muscle function in patients with COPD: a case-control study. BMC Pulm Med, 2024, 24(1): 18.
4. Qian Y, Cai C, Sun M, et al. Analyses of factors associated with acute exacerbations of chronic obstructive pulmonary disease: a review. Int J Chron Obstruct Pulmon Dis, 2023, 18: 2707-2723.
5. Sepúlveda-Loyola W, Osadnik C, Phu S, et al. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2020, 11(5): 1164-1176.
6. Zhou J, Liu Y, Yang F, et al. Risk factors of sarcopenia in COPD patients: a meta-analysis. Int J Chron Obstruct Pulmon Dis, 2024, 19: 1613-1622.
7. Suleymanova AK, Baranova IA. Evaluation of the relationship between the parameters of peripheral skeletal and respiratory muscles in patients with chronic obstructive pulmonary disease. Ter Arkh, 2020, 92(3): 36-41.
8. 岑国荣, 郭燕敏, 彭达明, 等. 胸肌CT值在预测老年稳定期COPD患者急性加重风险中的应用研究. 影像研究与医学应用, 2024, 8(7): 63-65.
9. Dournes G, Zysman M, Benlala I, et al. CT imaging of chronic obstructive pulmonary disease: what aspects and what role? Rev Mal Respir, 2024, 41(10): 738-750.
10. Lin X, Zhang Z, Zhou T, et al. The role of computed tomography and artificial intelligence in evaluating the comorbidities of chronic obstructive pulmonary disease: a one-stop CT scanning for lung cancer screening. Int J Chron Obstruct Pulmon Dis, 2025, 20: 1395-1406.
11. Aubrey J, Esfandiari N, Baracos VE, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf), 2014, 210(3): 489-497.
12. Ertan Yazar E, Niksarlioglu EY, Yigitbas B, et al. How to utilize CAT and mMRC scores to assess symptom status of patients with COPD in clinical practice? Medeni Med J, 2022, 37(2): 173-179.
13. Makuch M, Milanowska J, Michnar M, et al. The relationship between COPD Assessment Test (CAT) scores and Distress Thermometer (DT) results in COPD patients. Ann Agric Environ Med, 2020, 27(4): 689-694.
14. Ferrer M, Villasante C, Alonso J, et al. Interpretation of quality of life scores from the St George's Respiratory Questionnaire. Eur Respir J, 2002, 19(3): 405-413.
15. Li CL, Chang HC, Tseng CW, et al. Comparison of BODE and ADO Indices in predicting COPD-related medical costs. Medicina (Kaunas), 2023, 59(3): 577.
16. Cote CG, Casanova C, Marín JM, et al. Validation and comparison of reference equations for the 6-min walk distance test. Eur Respir J, 2008, 31(3): 571-578.
17. Zhou K, Wu F, Zhao N, et al. Association of pectoralis muscle area on computed tomography with airflow limitation severity and respiratory outcomes in COPD: a population-based prospective cohort study. Pulmonology, 2025, 31(1): 2416782.
18. Bak SH, Kwon SO, Han SS, et al. Computed tomography-derived area and density of pectoralis muscle associated disease severity and longitudinal changes in chronic obstructive pulmonary disease: a case control study. Respir Res, 2019, 20(1): 226.
19. Qiao X, Hou G, Kang J, et al. CT Attenuation and cross-sectional area of the pectoralis are associated with clinical characteristics in chronic obstructive pulmonary disease patients. Front Physiol, 2022, 13: 833796.
20. 洪丽月, 黄种杰, 黄鑫成, 等. 慢性阻塞性肺疾病患者胸大肌CT参数与肺功能及疾病严重程度的关系. 武警医学, 2024, 35(7): 582-587,592.
21. Yun R, Bai Y, Lu Y, et al. How Breathing exercises influence on respiratory muscles and quality of life among patients with COPD? A systematic review and meta-analysis. Can Respir J, 2021, 2021: 1904231.
22. O'Brien ME, Zou RH, Hyre N, et al. CT pectoralis muscle area is associated with DXA lean mass and correlates with emphysema progression in a tobacco-exposed cohort. Thorax, 2023, 78(4): 394-401.
23. da Rocha DS, Tessari JA, Mainardi NB, et al. Assessment of muscle mass using chest computed tomography-based quantitative and qualitative measurements in patients with systemic sclerosis: a retrospective study with cross-sectional and longitudinal analyses. Semin Arthritis Rheum, 2023, 59: 152168.
24. Perrot L, Greil A, Boirie Y, et al. Prevalence of sarcopenia and malnutrition during acute exacerbation of COPD and after 6 months recovery. Eur J Clin Nutr, 2020, 74(11): 1556-1564.
25. Ammous O, Feki W, Lotfi T, et al. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev, 2023, 1(1): CD013778.
26. Zhang F, Zhong Y, Qin Z, et al. Effect of muscle training on dyspnea in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 2021, 100(9): e24930.

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