Diagnostic value of computed tomography‐based pulmonary artery to aorta ratio measurement in chronic obstructive pulmonary disease with pulmonary hypertension: A systematic review and meta‐analysis

Abstract

Objective We conducted a meta‐analysis to systematic assess the diagnostic value of computed tomography (CT)‐based pulmonary artery to aorta (PA:A) ratio measurement in COPD with pulmonary hypertension (COPD‐PH). Methods Published studies referring to diagnostic accuracy of PA:A ratio for COPD‐PH were screened out from PubMed, Embase, Web of science, China National Knowledge databases (CNKI), Wan fang databases, and VIP databases. We used bivariate random‐effects model to estimate pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), and diagnostic odds ratios (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also calculated to summarize the aggregate diagnostic performance. Results Nine eligible studies were included and the pooled SEN was 69% (95% CI: 59 ~ 78), SPE was 85% (95% CI: 77 ~ 90), PLR was 4.5 (95% CI: 2.8 ~ 7.5), and NLR was 0.36 (95% CI: 0.26 ~ 0.51), respectively. DOR reached 13.00 (95% CI: 6.00 ~ 28.00), and value of AUC was 0.84 (95% CI: 0.81 ~ 0.87). Subgroup analysis indicated that when the value of PA:A ratio was equal or greater than one (PA/A ≥ 1), the combined SEN, SPE, AUC, and DOR was 69%, 89%, 0.90, and 19.65, respectively. Conclusions PA:A ratio is helpful for appraisal of COPD‐PH, and PA/A ≥ 1 possessed prominent diagnostic accuracy.

Pulmonary hypertension in interstitial lung disease and in chronic obstructive pulmonary disease: different entities?

“…Unfortunately, by the time most patients are diagnosed, they already have a severely reduced exercise tolerance [60,80] hindering assessment of activity. Some significant differences exist in the CT scan of PH in CLD: although the pulmonary artery to aorta ratio is a solid PH screening tool in COPD [81], its usefulness in ILD is more controversial [7]. Furthermore, although severe PH is associated with total loss of pulmonary vascular bed in both [56 && ], ILD patients of any PH severity have half the total pulmonary vascular bed compared with COPD, because of reduced lung volume [56 && ].…”

Emerging phenotypes of pulmonary hypertension associated with COPD: a field guide

“…Due to the importance of early PH detection, research has focused on CT imaging, routinely performed on COPD patients. Although no correlation exists [ 9 , 57 , 63 ] between the extent of emphysema and PH severity, airway remodeling and pulmonary artery to aorta diameter ratio are proportional to the degree of PH [ 57 , 64 ] and in severe COPD patients a ratio >1 is predictive of PH [ 65 ]. Furthermore, patients with severe PH have increased remodeling of small pulmonary vessels on chest CT [ 66 ].…”