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Purpose <p>Diaphragmatic dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). Although diaphragmatic excursion during deep breathing (DE<sub>max</sub>) is associated with exercise capacity, the relationship between computed tomography (CT)-derived diaphragm morphology and diaphragmatic function remains unclear. We investigated the association of CT-derived diaphragmatic crus thickness with diaphragmatic excursion and exercise capacity in COPD.</p> Methods <p>This retrospective single-centre study included 100 patients with stable COPD who underwent chest CT, spirometry, ultrasonographic assessment of DE<sub>max</sub>, and 6-minute walk distance (6MWD) testing. Diaphragmatic crus thickness was measured on axial CT images, and the diaphragmatic thickness index (DTI) was calculated after adjustment for body mass index. Multivariable linear regression analyses were performed to identify factors independently associated with DE<sub>max</sub> and 6MWD. Patients were stratified according to DTI and DE<sub>max</sub> to evaluate combined structural and functional diaphragm phenotypes.</p> Results <p>In multivariable analyses, DTI was independently associated with DE<sub>max</sub> (β = 0.57, <i>p</i> &lt; 0.001) and 6MWD (β = 0.25, <i>p</i> &lt; 0.01) after adjustment for age, pulmonary function, and skeletal muscle indices. The combined low-DTI/low- DE<sub>max</sub> phenotype was independently associated with reduced exercise capacity (6MWD &lt; 350&#xa0;m; odds ratio 14.89, 95% confidence interval 3.51–87.89, <i>p</i> &lt; 0.001).</p> Conclusion <p>CT-derived diaphragmatic thickness was independently associated with diaphragmatic excursion and exercise capacity in COPD. Combined structural and functional diaphragm assessment identified patients with markedly reduced exercise capacity, suggesting a role for integrated diaphragm evaluation in functional risk stratification.</p>

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Association of Diaphragmatic Crus Thickness Assessed by Computed Tomography with Diaphragmatic Excursion and Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Masashi Shiraishi,
  • Yuji Higashimoto,
  • Hiroki Mizusawa,
  • Yu Takeda,
  • Masaya Noguchi,
  • Kengo Kanki,
  • Honoka Natsume,
  • Osamu Nishiyama,
  • Ryo Yamazaki,
  • Tamotsu Kimura,
  • Hisako Matsumoto

摘要

Purpose

Diaphragmatic dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). Although diaphragmatic excursion during deep breathing (DEmax) is associated with exercise capacity, the relationship between computed tomography (CT)-derived diaphragm morphology and diaphragmatic function remains unclear. We investigated the association of CT-derived diaphragmatic crus thickness with diaphragmatic excursion and exercise capacity in COPD.

Methods

This retrospective single-centre study included 100 patients with stable COPD who underwent chest CT, spirometry, ultrasonographic assessment of DEmax, and 6-minute walk distance (6MWD) testing. Diaphragmatic crus thickness was measured on axial CT images, and the diaphragmatic thickness index (DTI) was calculated after adjustment for body mass index. Multivariable linear regression analyses were performed to identify factors independently associated with DEmax and 6MWD. Patients were stratified according to DTI and DEmax to evaluate combined structural and functional diaphragm phenotypes.

Results

In multivariable analyses, DTI was independently associated with DEmax (β = 0.57, p < 0.001) and 6MWD (β = 0.25, p < 0.01) after adjustment for age, pulmonary function, and skeletal muscle indices. The combined low-DTI/low- DEmax phenotype was independently associated with reduced exercise capacity (6MWD < 350 m; odds ratio 14.89, 95% confidence interval 3.51–87.89, p < 0.001).

Conclusion

CT-derived diaphragmatic thickness was independently associated with diaphragmatic excursion and exercise capacity in COPD. Combined structural and functional diaphragm assessment identified patients with markedly reduced exercise capacity, suggesting a role for integrated diaphragm evaluation in functional risk stratification.