Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Ratanawatkul, Pailin; Oh, Andrea; Richards, James H.; Swigris, Jeffrey J.

doi:10.1183/23120541.00232-2019

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Our results did not change even when we assessed the correlation between PA-Ao ratio and mPAP in LAM and PLCH isolatedly (data not shown). We found that 0.86 was the cut-off with the highest accuracy for predicting PH, which was quite similar to that obtained in investigations with patients with IPF and COPD [36,37] . The lack of difference in pulmonary function parameters between patients with PA-Ao ratio > 1 and those with PA-Ao ratio ≤ 1 suggests that other mechanisms in addition to parenchymal involvement and hypoxic vasoconstriction, such as pulmonary vascular involvement and cardiac dysfunction, may have contributed to the enlargement of PA-Ao ratio in our study.…”

Section: Discussionsupporting

confidence: 89%

Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases

et al. 2021

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To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs). We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan–Meier curves. Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ± 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ± 20% and 38 ± 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ± 6 mm and 0.95 ± 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1. The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.

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Section: Discussionsupporting

confidence: 89%

Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases

et al. 2021

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“…This is the first study to identify an increased PA diameter, as assessed by CT, as an independent predictor of both myocardial injury and mortality in COVID-19 patients. PA diameter has been shown to correlate with the presence of pulmonary hypertension 16 and has been associated with increased mortality in patients with chronic obstructive pulmonary disease. 17 COVID-19 pneumonia is characterized by a systemic inflammatory disorder with a hypercoagulation state, endothelial dysfunction, hypoxic vasoconstriction leading to a hypoxia-inducible transcription factor-dependent signalling pathway, that may predispose to acute endothelial damage of the pulmonary circulation, the occurrence of thrombo-embolic phenomena, and/or small vessel thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

Ferrante

Fazzari

Cozzi

et al. 2020

Cardiovascular Research

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Abstract Aims Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. Methods and Results This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I > 20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, <iP > < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, <iP > < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO<sub2>/FiO<sub2> ratio on admission were other independent predictors for both myocardial injury and death. Conclusions An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death. Translational perspective The present study identifies myocardial injury as a clinically relevant independent risk factor for death in the short term in a population of hospitalized patients with laboratory-confirmed COVID-19 outside of China undergoing chest computed tomography for suspected pneumonia on admission. The study also provides novel insights into the risk factors for myocardial injury, showing that an increased pulmonary artery diameter, assessed by chest computed tomography, is an independent predictor of myocardial injury as well as of mortality, suggesting that pulmonary circulation dysfunction is a pivotal pathological event with cardiac implications in COVID-19.

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“…After eliminating of duplicates and reading of the titles/abstracts, we agreed on 36 articles meeting inclusive criteria to further browse the full text. Ultimately, nine retrospective studies 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 were taken into our review for further meta‐analysis (Figure 1 ), including 1238 COPD participants, of whom 548 patients were diagnosed as COPD‐PH. The patients with COPD‐PH in five studies were definite diagnosed according to RHC and the cut‐off value of CT‐based PA: A ratio was greater than or equal to one in six research (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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

Shi

Wang

et al. 2022

Clinical Respiratory J

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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.

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Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Cited by 9 publications

References 29 publications

Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases

Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases

Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

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

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