Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease

• Published in: Respiratory medicine Vol. 108; no. 11; pp. 1626 - 1632
• Main Authors: Shin, Stephanie, King, Christopher S., Brown, A. Whitney, Albano, Maria C., Atkins, Melany, Sheridan, Michael J., Ahmad, Shahzad, Newton, Kelly M., Weir, Nargues, Shlobin, Oksana A., Nathan, Steven D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2014; Elsevier Limited
• Subjects: Aorta - pathology; Arterial Pressure - physiology; Body mass index; Cardiology; Chronic obstructive pulmonary disease; Female; Forced Expiratory Volume - physiology; Humans; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - pathology; Hypertension, Pulmonary - physiopathology; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Prognosis; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - pathology; Pulmonary Artery - physiopathology; Pulmonary artery diameter; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary hypertension; Pulmonary to aortic artery diameter ratio; Pulmonary/Respiratory; Retrospective Studies; Risk Factors; Studies; Tomography, X-Ray Computed; mPAP; Pulmonary artery diameter; PCWP; HR; RHC; Pulmonary hypertension; Pulmonary to aortic artery diameter ratio; AUC; CT; PAD; DLco; dPAP; PH; sPAP; Chronic obstructive pulmonary disease; FEV1; PA:A; COPD; mean pulmonary artery pressure; systolic pulmonary artery pressure; right heart catheterization; area under the ROC curve; computed tomography; pulmonary capillary wedge pressure; diffusing capacity for carbon monoxide; FEV 1; forced expiratory volume in 1 second; hazard ratio; diastolic pulmonary artery pressure
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2014.08.009

The relationship between pulmonary artery size with underlying pulmonary hypertension and mortality remains to be determined in COPD. We sought to evaluate the relationships in a cohort of patients with advanced COPD. A retrospective study of advanced COPD patients evaluated between 1998 and 2012 was conducted at a tertiary care center. Patients with chest computed tomography images and right heart catheterizations formed the study cohort. The diameters of the pulmonary artery and ascending aorta were measured by independent observers and compared to pulmonary artery pressures. Intermediate-term mortality was evaluated for the 24-month period subsequent to the respective studies. Cox proportional hazards model was used to determine independent effects of variables on survival. There were 65 subjects identified, of whom 38 (58%) had pulmonary hypertension. Patients with and without pulmonary hypertension had mean pulmonary artery diameters of 34.4 mm and 29.1 mm, respectively (p = 0.0003). The mean PA:A ratio for those with and without pulmonary hypertension was 1.05 and 0.87, respectively (p = 0.0003). The PA:A ratio was an independent predictor of mortality with a reduced survival in those with a PA:A >1 (p = 0.008). The PA:A ratio is associated with underlying pulmonary hypertension in patients with COPD and is an independent predictor of mortality. This readily available measurement may be a valuable non-invasive screening tool for underlying pulmonary hypertension in COPD patients and appears to impart important independent prognostic information.