Pulmonary artery to ascending aorta ratio by echocardiography: A strong predictor for presence and severity of pulmonary hypertension

Abstract

Background The pulmonary artery (PA) to ascending aorta diameter ratio (PA:A) has been evaluated in numerous studies analyzing cardiac magnetic resonance (CMR) and computed tomography (CT) data. Previously, no transthoracic echocardiography (TTE) cutoffs have been published. We sought to evaluate (1) the feasibility to image the pulmonary trunk in a prospective cohort, and (2) the ability of PA:A derived by TTE to predict pulmonary hypertension (PH). Methods We performed a post-hoc analysis of a prospectively recruited consecutive cohort of patients referred to our tertiary center cardiology department due to suspicion for PH. Invasive hemodynamic assessment and quasi-simultaneous TTE was performed in all participants. Results A total of 84 patients were included in the analysis, median age was 70.5 years (IQR 58–75), 46 (55%) were female. The PA was significantly wider in the PH group (28mm vs. 22.5mm, p<0.001) with a resulting median PA:A of 0.84 vs. 0.66 (p<0.001). Both PA diameter (r = 0.524 and r = 0.44, both p<0.001) and PA:A (r = 0.652 and 0.697, both p<0.001) significantly correlated with mPAP and with PVR, respectively. Area under the curve for the detection of PH was 0.853 (95%CI 0.739–0.967, p<0.001). Conclusion The PA can be visualized in almost all echocardiographic exams, especially when it is dilated. A view showing the pulmonary trunk should be included in every routine TTE. An increased PA:A should raise suspicion for PH and prompt further evaluation and follow-up examinations of these patients.

Prognostic value of computed tomography derived measurements of pulmonary artery diameter for long-term outcomes after transcatheter aortic valve replacement

“…Mean PAD measured in TTE among patients with PH (diagnosed upon invasive measure of mean pulmonary artery pressure [mPAP]), with measured in TTE mean PASP of 52 mm Hg, was 28.0 mm. This is in line with the current PAD cutoff point of 29.3 mm and corresponding PASP of 45 mm Hg [12]. The cutoff value of MDCT-measured PAD to identify PH (diagnosed with right heart catheterization) reported in previous studies ranges from 25 to 33.2 mm [13], and its corresponding correlation with mPAP ranged from r = 0.301 to r = 0.83 and it did not with larger PAD dimensions.…”

Echocardiography and Lung Ultrasound in Long COVID and Post‐COVID Syndrome, a Review Document of the Austrian Society of Pneumology and the Austrian Society of Ultrasound in Medicine

“…Schneider et al reported that a ratio of pulmonary trunk diameter to ascending aorta diameter >1 provides additional information on pulmonary hypertension and should be taken into account in the context of routine assessment of pulmonary hypertension in echocardiography. 49 Subcostal views, such as the subcostal 4-ChV, are essential for detecting pericardial effusions. 50 Additionally, the inferior vena cava should be scanned to estimate right atrial pressure.…”

“…Schneider et al reported that a ratio of pulmonary trunk diameter to ascending aorta diameter >1 provides additional information on pulmonary hypertension and should be taken into account in the context of routine assessment of pulmonary hypertension in echocardiography 49 …”

Larger pulmonary artery to ascending aorta ratios are associated with decreased survival of patients undergoing pulmonary endarterectomy

“…10 A recent study also suggested a correlation of PA diameter and pulmonary hypertension (PH) diagnosed by transthoracic echocardiography. 11 The preoperative assessment of perioperative risk and operability of CTEPH patients planned for PEA still lacks strict objective definitions. However, certain preoperative characteristics are associated with favorable surgical outcomes: history of deep venous thrombosis (DVT) or pulmonary embolism (PE), no signs of right heart failure, no comorbidities, functional class II or III, clear disease concordant on all imaging modalities, bilateral lower lobe disease, pulmonary vascular resistance (PVR) < 1000 dyn/sec/cm À5 , and higher PA pulse pressure.…”

“… 10 A recent study also suggested a correlation of PA diameter and pulmonary hypertension (PH) diagnosed by transthoracic echocardiography. 11 …”