Korean J Intern Med.  2014 Nov;29(6):746-753. 10.3904/kjim.2014.29.6.746.

The diagnostic utility of chest computed tomography scoring for the assessment of amiodarone-induced pulmonary toxicity

• Kang IS
• Kim KJ
• Kim Y
• Park SH

• KMID: 2070132
• DOI: http://doi.org/10.3904/kjim.2014.29.6.746

Abstract

BACKGROUND/AIMS
Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT.
METHODS
Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores.
RESULTS
Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% +/- 6.9% vs. 89.7% +/- 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission.
CONCLUSIONS
Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.

Keyword

Amiodarone; Pulmonary toxicity; Computed tomography; Cumulative dose

MeSH Terms

Aged
Amiodarone/*adverse effects
Anti-Arrhythmia Agents/*adverse effects
Atrial Fibrillation/diagnosis/*drug therapy
Cross-Sectional Studies
Cryptogenic Organizing Pneumonia/chemically induced/physiopathology/*radiography/therapy
Feasibility Studies
Female
Forced Expiratory Volume
Hospitalization
Humans
Lung/drug effects/physiopathology/*radiography
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Pulmonary Diffusing Capacity
Pulmonary Fibrosis/chemically induced/physiopathology/*radiography/therapy
Respiratory Function Tests
Risk Factors
Time Factors
*Tomography, X-Ray Computed
Vital Capacity
Amiodarone
Anti-Arrhythmia Agents