<scp>CT</scp>‐determined pulmonary artery to aorta ratio as a predictor of elevated pulmonary artery pressure and survival in idiopathic pulmonary fibrosis

Yagi, Mitsuaki; Taniguchi, Hiroyuki; Kondoh, Yasuhiro; Ando, Masahiko; Kimura, Tomoki; Kataoka, Kensuke; Furukawa, Taiki; Suzuki, Atsushi; Johkoh, Takeshi; Hasegawa, Yoshinori

doi:10.1111/resp.13066

Cited by 46 publications

(43 citation statements)

References 33 publications

(76 reference statements)

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“…The relationship was significant, which is in line with previous reports [62][63][64][65]. However, in our study, PA size and PA:A ratio did not show a significant correlation with 6MWD, and, from this perspective, they may not serve as surrogates for RHC for the assessment of exercise capacity, until further, larger studies are obtained.…”

Section: Discussionsupporting

confidence: 77%

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

et al. 2018

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Background: Associated pulmonary hypertension (APH) is frequently observed in fibrosing interstitial pneumonias (FIP), such as idiopathic pulmonary fibrosis (IPF). APH is associated with worse prognosis, but it remains unclear whether it is associated with greater functional impairment. Six-minute walk distance (6MWD) is widely used to assess functional capacity in pulmonary hypertension and FIP. Objectives: To investigate if APH independently contributes to exercise intolerance in FIP, irrespective of the extent of underlying fibrosis. Methods: Patients diagnosed with FIP (September 2009 to June 2017) were included in the study if they underwent right heart catheterization, high-resolution chest computed tomography (HRCT), and 6MWD within 3 months. Recruitment was not limited only to patients undergoing lung transplant assessment. APH was defined as mean pulmonary artery pressure (mPAP) ≥25 mm Hg. The extent of fibrosis was quantified on HRCT using a visual fibrosis score by 2 separate observers. Results: Seventy-two patients (60 with IPF) were identified. Fifty-five patients had APH. mPAP was not significantly different in subgroups stratified according to the extent of fibrosis on HRCT. Pulmonary vascular resistance (PVR) was the strongest predictor of 6MWD on both univariate and stepwise regression analyses, and remained so considering only patients with normal wedge pressure (< 15 mm Hg) (n = 61). HRCT fibrosis score and pulmonary function tests did not significantly correlate with 6MWD. Conclusions: In patients with FIP, PVR is a significant contributor of 6MWD, independently from the extent of fibrosis on HRCT. These results strengthen both the rationale to use 6MWD as endpoint in FIP and to target APH with specific therapies.

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Section: Discussionsupporting

confidence: 77%

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

et al. 2018

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“…The PA/A is easily measured with good reproducibility without special software and is suitable for clinical routine use . Many studies have reported an association between a higher PA/A and poor prognosis in chronic lung diseases .…”

Section: Discussionmentioning

confidence: 99%

“…With regards to f‐ILD, Price et al emphasized the importance of the PA/A at stable disease stage in predicting early mortality . Judge et al described that pulmonary hypertension in f‐ILD was associated with an increased risk of AE and poor survival and other studies suggested the correlation between the PA/A and PA pressure . In some studies, the relationship between PA/A and pulmonary hypertension appears weaker in f‐ILD than in COPD .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery enlargement predicts poor outcome during acute exacerbations of fibrotic interstitial lung disease

et al. 2019

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Background and objective: In fibrotic interstitial lung disease (f-ILD), pulmonary artery diameter to ascending aorta diameter ratio (PA/A) ≥ 1 during the stable stage is associated with worse outcomes; however, the effect of acute exacerbation (AE) on the PA/A is unknown. Methods: Patients with a diagnosis of AE of f-ILD and with a computed tomography (CT) scan performed during stable period to confirm background fibrosis, as well as a CT scan at admission, were included. The pulmonary arterial diameter, ascending aortic diameter and PA/A were measured using CT during AE and CT prior to AE, when available, to evaluate the changes. Demographic data, co-morbidities and clinical outcome (90-day mortality) were analysed. Results: Of the 123 patients included, 45 had a PA/A ≥ 1 during AE and compared to the PA/A < 1 group, they were younger, had lower % vital capacity (VC) and % forced vital capacity (FVC), required more long-term oxygen therapy and other treatments, and had lower PaO 2 /FiO 2 (P/F) ratios. During AE, the PA/A increased from that during stable periods (P < 0.001), and a PA/A ≥ 1 was significantly associated with 90-day mortality both before and after adjustment for age, the P/F ratio at admission, long-term oxygen therapy usage and the type of background f-ILD (P = 0.018 and 0.025). Conclusion: To the best of our knowledge, this is the first longitudinal examination of the PA/A ratio and evaluation during AE of f-ILD. Our data show that a PA/A ≥ 1 during AE predicted poor survival outcome in f-ILD.

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“…Concerning fibrosing ILDs [97], only CT automatic quantification of lung disease extent by means of a density mask is considered insufficient. To date, different methods for recognising a parenchymal pattern and its quantification have been suggested.…”

Section: Imagingmentioning

confidence: 99%

Pulmonary hypertension and chronic lung disease: where are we headed?

et al. 2019

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Pulmonary hypertension related to chronic lung disease, mainly represented by COPD and idiopathic pulmonary fibrosis, is associated with a worse outcome when compared with patients only affected by parenchymal lung disease. At present, no therapies are available to reverse or slow down the pathological process of this condition and most of the clinical trials conducted to date have had no clinically significant impact. Nevertheless, the importance of chronic lung diseases is always more widely recognised and, along with its increasing incidence, associated pulmonary hypertension is also expected to be growing in frequency and as a health burden worldwide. Therefore, it is desirable to develop useful and reliable tools to obtain an early diagnosis and to monitor and follow-up this condition, while new insights in the therapeutic approach are explored.

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CT‐determined pulmonary artery to aorta ratio as a predictor of elevated pulmonary artery pressure and survival in idiopathic pulmonary fibrosis

Abstract: Measurement of the PA:A is a useful and convenient method to predict elevated mPAP in IPF at initial evaluation. Moreover, a PA:A >0.9 was found to be an indicator of worse prognosis.

Cited by 46 publications

References 33 publications

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

Pulmonary artery enlargement predicts poor outcome during acute exacerbations of fibrotic interstitial lung disease

Pulmonary hypertension and chronic lung disease: where are we headed?

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