Severe Emphysema on HRCT Signals Higher Heart Disease Risk in COPD Patients: Study
China: Severe emphysema, quantitatively assessed using high-resolution computed tomography (HRCT), is a strong independent predictor of coronary artery disease (CAD) in patients with chronic obstructive pulmonary disease (COPD), a new retrospective study has found. The study was published online in the International Journal of Chronic Obstructive Pulmonary Disease.
Researchers found that CAD risk more than doubled when the low attenuation area (LAA%) exceeded 16.95%. Furthermore, patients with more severe emphysema exhibited more complex coronary lesions and were more likely to require percutaneous coronary intervention (PCI), highlighting the critical interplay between structural lung changes and cardiovascular risk.
The study was led by Dr. Luoman Su and colleagues from the Department of Pulmonary and Critical Care Medicine, Key Laboratory of Interventional Pulmonology of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. The research team aimed to clarify the role of emphysema—a key structural subtype of COPD—in the development of CAD, a relationship that had remained poorly understood. Using quantitative HRCT, the investigators sought to determine whether emphysema severity could independently stratify cardiovascular risk beyond traditional factors.
The study retrospectively analyzed 392 COPD patients without prior CAD, who underwent HRCT between 2015 and 2020. Emphysema extent was measured as the percentage of low attenuation areas below −950 Hounsfield units, with severe emphysema defined as LAA% above 16.95%.
Logistic regression and restricted cubic spline analyses revealed the following:
- Severe emphysema was independently associated with a higher risk of coronary artery disease (adjusted OR 2.28).
- The predictive model showed strong performance, with an area under the ROC curve of 0.81.
- Patients with severe emphysema had higher SYNTAX scores, indicating more complex coronary lesions (median 16.29 vs. 10.0 in mild emphysema).
- Rates of percutaneous coronary intervention (PCI) were significantly higher in patients with severe emphysema (68.2% vs. 33.3%).
“These findings highlight the clinical relevance of emphysema quantification in COPD patients,” Dr. Su and colleagues noted. “Incorporating HRCT-based emphysema severity into cardiovascular risk assessment may enable earlier identification of high-risk individuals, prompting timely evaluation and intervention.”
Despite its insights, the study had several limitations. The retrospective, single-center design limits causal inference and generalizability, while residual confounding from unmeasured factors such as lifestyle and smoking history may persist. Variations in CT imaging protocols and the absence of long-term cardiac event data further constrain the findings. Nonetheless, the observed associations are biologically plausible and complement existing evidence linking emphysema with heightened cardiovascular risk.
"The study demonstrates that quantitatively assessed emphysema on HRCT is an independent predictor of CAD in COPD patients and correlates with more complex coronary lesions. The identified threshold of 16.95% LAA-950 offers a potential imaging biomarker for cardiovascular risk stratification in this population, though prospective multicenter validation is needed before clinical adoption," the authors wrote.
"These findings highlight the importance of integrating lung structural assessment into comprehensive cardiovascular management strategies for patients with COPD," they concluded.
Reference:
Su L, Qian C, Yu C, Weng Z, Zhao H, Chen C. Quantitatively Assessed Emphysema Severity on HRCT Independently Predicts Coronary Artery Disease in COPD: A Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis. 2025;20:3147-3161. https://doi.org/10.2147/COPD.S540503
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