Tracheal Eccentricity is Associated with Respiratory Morbidity and Mortality in Chronic Obstructive Pulmonary Disease
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Background
Chronic obstructive pulmonary disease (COPD) is characterized by airway remodeling, which may affect tracheal morphology. However, the relationship between tracheal morphometry and COPD severity, quality of life, functional capacity, and mortality remains poorly understood.
Objective
To investigate the associations between CT-derived tracheal lumen eccentricity and clinical outcomes in COPD.
Methods
We analyzed data from 8,383 participants in the multicenter COPDGene study. Tracheal lumen eccentricity (ε) was calculated at each cross-section using the major and minor axes lengths and deriving final value using the arithmetic mean across all tracheal slices, where ε = 0 represents a circle and ε > 0 indicates an ellipse. Baseline assessments included spirometry measurements, 6-minute walk distance (6MWD), St. George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) dyspnea score. Longitudinal assessments included annualized lung function change and all-cause mortality. Multivariable models were used to evaluate associations between tracheal eccentricity and clinical outcomes.
Results
Tracheal eccentricity increased with severity of airflow obstruction (0.60±0.07, 0.61±0.07, 0.62±0.07, 0.64±0.08, and 0.64±0.08 in GOLD stages 0 through 4, respectively). Higher tracheal eccentricity was independently associated with lower FEV 1 (β = −0.30 L, 95% CI: −0.47 to −0.14, p<0.001), lower FEV 1 /FVC (β = −0.06, 95% CI: −0.09 to −0.04, p<0.001), lower 6MWD (β = −15.7 m, 95% CI: −25.2 to −6.2, p=0.001), higher SGRQ score (β = 16.9, 95% CI: 11.2 to 22.5, p<0.001), higher mMRC dyspnea score (β = 0.4, 95% CI: 0.1 to 0.6, p=0.007), and accelerated lung function decline (β = −23.8 ml/year, 95% CI: −2.48 to −45.13, p=0.029). Increased tracheal eccentricity is associated with increased all-cause mortality (adjusted HR: 1.81 [95% CI, 1.01-3.26]; p = 0.047).
Conclusions
These findings suggest that tracheal morphology may serve as an imaging biomarker for COPD outcomes, supported by significant associations with lower quality of life, lung function decline, and all-cause mortality.
