Quantitative Skeletal Muscle Ultrasonography In Patients With Chronic Obstructive Pulmonary Disease

Part I Two-dimensional strain ultrasound speckle tracking as a novel approach for the evaluation of right hemidiaphragmatic longitudinal deformationObjective: The aim of this study was to quantitatively evaluate the longitudinal deformation of the right hemidiaphragm in normal adult’s subjects using two-dimensional strain ultrasound speckle tracking.Method: Twenty-one healthy subjects were enrolled in this study. A commercially available Doppler echocardiograph Vivid E9 Diagnostic Ultrasound System(GE Healthcare, Horten, Norway), with an appropriate total gain and depth, 50~70 frames/sec and equipped with a M5 S convex transducer was used. Assessment of right diaphragm excursion on the cranial-caudal axis and the diaphragmatic strain were performed in supine position during quiet and forced breathing.Results: Pulmonary function assessments by spirometry were normal in all subjects.The mean quiet and forced diaphragm excursion values were 15.52 ± 0.60 mm and 59.29 ± 1.88 mm, respectively, measured by M-mode ultrasound. Negative strain values first appeared in the zone of apposition and then in the crura of the right hemidiaphragm in the inspiratory phase; the dome of the diaphragm was observed to be passively stretched. The longitudinal strain of the right hemidiaphragm in the zone of apposition was higher than that in the crura in forced breathing(P = 0.024). The strains of the whole diaphragm and the zone of apposition changed significantly in quiet(P = 0.000) and forced breathing(P = 0.005).Conclusion: Ultrasound strain imaging may quantitatively assess diaphragm deformation and provide another useful modality for evaluating diaphragmatic kinetics as a novel methodology.Part II Ultrasonographic echo intensity of the quadriceps in chronic obstructive pulmonary disease patientsObjective: We investigated whether echo intensity of quadriceps measured by ultrasound can distinguish muscles affected by chronic obstructive pulmonary disease(COPD) from healthy muscles and whether severity of ultrasound abnormalities is associated with health-related quality of life(HRQL) and lung function.Methods: Echo intensity, thickness and areas of the quadriceps muscles using ultrasound were measured in 50 patients with COPD and 21 non-COPD controls. Specially trained nurses performed the interviews and the lung function tests. The questionnaires includes 8-Item Short-Form Health Survey, the functional assessment of chronic illness therapy fatigue scale, respiratory symptoms, heart diseases, hypertension, diabetes, use of medicines and smoking habits. For spirometry and the 6-minute walk distance(6MWD) test, the ATS guidelines were followed.Results: There was no statistical significance in age, BMI and gender compared non-COPD subjects to COPD patients. There were significantly higher echo intensity of the rectus femoris in all stages of COPD patients than in age-matched non-COPD subjects, the quadriceps muscle thickness and rectus femoris cross-sectional area significantly decreased in COPD GOLD Ⅲ~Ⅳ only. In COPD patients, echo intensity of the rectus femoris associated with HRQL independently.Conclusion: Quantitative ultrasound distinguishes healthy muscles from those affected by COPD stageⅠ~ Ⅳ, measures of muscle quality and quantity are associated with HRQL and FEV1. Ultrasound echo intensity of the rectus femoris may be a useful tool for assessing disease severity and monitoring the changes of skeletal muscle resulting from disease progression or clinical intervention in patients with COPD.Part III A novel approach of measurement the adductor pollicis muscle thickness as a predictor of handgrip strength in stable chronic obstructive pulmonary disease patientsObjective: This study aimed to analyze the adductor pollicis muscle thickness(APMT) in stable chronic obstructive pulmonary disease patients, asthma patients and normal adult’s subjects using ultrasound and to investigate the correlation between APMT and handgrip strength(HGS), as well as its association with lung function.Method: The study included 20 chronic obstructive pulmonary disease(COPD) patients, 20 asthma patients and 20 non-COPD / non-asthmatic subjects. Using the LOGIQ A5(GE company, USA) color ultrasound diagnostic apparatus, the probe is placed in the back side against the first metacarpal and phalangeal triangle between the first and second metacarpal and phalanx formation measurements in patients with COPD, asthma and non-COPD / non-asthmatic controls. The correlation between APMT and HGS, lung function were calculated using Pearson’s linear correlation.Results: COPD patients were aged 63.70 ± 7.37 years on average, 50 % were men with age and gender marched controls. APMT was 8.91 ± 1.82 mm(9.85 ± 0.44 mm in men; 7.97 ± 0.56 mm in women; P < 0.0001) in COPD patients and was positively correlated with HGS(r = 0.584; P < 0.001 in male and r = 0.637; P = 0.000 in female), FEV1(r = 0.396; P = 0.012 in male) and FVC(r = 0.506; P = 0.001 in male).Conclusion: Adductor pollicis muscle thickness can be measured fastly and accurately using ultrasound and can predict hand grip strength. The parameter does not to be significantly affected by different stages in COPD patients. Ultrasonic measurement of adductor thickness may be a novel approach for upper limb skeletal muscle morphological evaluation.