Quantitative computed tomography measures of pectoralis muscle area and disease severity in chronic obstructive pulmonary disease: A cross-sectional study

Merry Lynn N. McDonald, Alejandro A. Diaz, James C. Ross, Raul San Jose Estepar, Linfu Zhou, Elizabeth A. Regan, Eric Eckbo, Nina Muralidhar, Carolyn E. Come, Michael H. Cho, Craig P. Hersh, Christoph Lange, Emiel Wouters, Richard H. Casaburi, Harvey O. Coxson, William MacNee, Stephen I. Rennard, David A. Lomas, Alvar Agusti, Bartolome R. CelliJennifer L. Black-Shinn, Greg L. Kinney, Sharon M. Lutz, John E. Hokanson, Edwin K. Silverman, George R. Washko

Research output: Contribution to journalArticlepeer-review

162 Scopus citations


Rationale: Muscle wasting in chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis and is not readily assessed by measures of body mass index (BMI). BMI does not discriminate between relative proportions of adipose tissue andleanmuscle andmaybe insensitive to early pathologic changes in body composition. Computed tomography (CT)-based assessments of the pectoralis muscles may provide insight into the clinical significance of skeletal muscles in smokers. Objectives: We hypothesized that objective assessment of the pectoralis muscle area on chest CT scans provides information that is clinically relevant and independent of BMI. Methods: Data from the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) Study (n = 73) were used to assess the relationship between pectoralismuscle area and fat-freemass. We then used data in a subset (n = 966) of a larger cohort, the COPDGene (COPD Genetic Epidemiology) Study, to explore the relationship between pectoralis muscle area and COPD-related traits. Measurements and Main Results: We first investigated the correlation between pectoralis muscle area and fat-free mass, using data from a subset of participants in the ECLIPSE Study. We then further investigated pectoralis muscle area in COPDGene Study participants and found that higher pectoralis muscle area values were associated with greater height, male sex, and younger age. On subsequent clinical correlation, compared with BMI, pectoralis muscle area was more significantly associated with COPD-related traits, including spirometric measures, dyspnea, and 6-minute-walk distance (6MWD). For example, on average, each 10-cm2 increase in pectoralis muscle area was associated with a 0.8-unit decrease in the BODE (Body mass index, Obstruction, Dyspnea, Exercise) index (95% confidence interval, -1.0 to -0.6; P < 0.001). Furthermore, statistically significant associations between pectoralismuscle area and COPD-related traits remained even after adjustment for BMI. Conclusions: CT-derived pectoralismuscle area provides relevant indices of COPD morbidity that may be more predictive of important COPD-related traits than BMI. However, the relationship with clinically relevant outcomes such as hospitalization and death requires additional investigation. Pectoralis muscle area is a convenientmeasure that can be collected in the clinical setting in addition to BMI.

Original languageEnglish (US)
Pages (from-to)326-334
Number of pages9
JournalAnnals of the American Thoracic Society
Issue number3
StatePublished - Mar 2014


  • COPD
  • Imaging
  • Pectoral muscle area
  • Wasting

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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