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Chest. 2014 Apr;145(4):824-832. doi: 10.1378/chest.13-1422.

CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD.

Author information

1
Department of Internal Medicine, University of Alabama at Birmingham.
2
Department of Internal Medicine, University of Alabama at Birmingham; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, AL. Electronic address: jmwells@uab.edu.
3
Department of Internal Medicine, University of Alabama at Birmingham; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham.
4
Department of Internal Medicine, University of Alabama at Birmingham; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, AL.

Abstract

BACKGROUND:

COPD is associated with significant morbidity primarily driven by acute exacerbations. Relative pulmonary artery (PA) enlargement, defined as a PA to ascending aorta (A) diameter ratio greater than one (PA:A>1) identifies patients at increased risk for exacerbations. However, little is known about the correlation between PA:A, echocardiography, and invasive hemodynamics in COPD.

METHODS:

A retrospective observational study of patients with severe COPD being evaluated for lung transplantation at a single center between 2007 and 2011 was conducted. Clinical characteristics, CT scans, echocardiograms, and right-sided heart catheterizations were reviewed. The PA diameter at the bifurcation and A diameter from the same CT image were measured. Linear and logistic regression were used to examine the relationships between PA:A ratio by CT scan and PA systolic pressure (PASP) by echocardiogram with invasive hemodynamics. Receiver operating characteristic analysis assessed the usefulness of the PA:A ratio and PASP in predicting resting pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP]>25 mm Hg).

RESULTS:

Sixty patients with a mean predicted FEV1 of 27%±12% were evaluated. CT scan-measured PA:A correlated linearly with mPAP after adjustment for multiple covariates (r=0.30, P=.03), a finding not observed with PASP. In a multivariate logistic model, mPAP was independently associated with PA:A>1 (OR, 1.44; 95% CI, 1.02-2.04; P=.04). PA:A>1 was 73% sensitive and 84% specific for identifying patients with resting PH (area under the curve, 0.83; 95% CI, 0.72-0.93; P<.001), whereas PASP was not useful.

CONCLUSIONS:

A PA:A ratio>1 on CT scan outperforms echocardiography for diagnosing resting PH in patients with severe COPD.

PMID:
24114440
PMCID:
PMC3971971
DOI:
10.1378/chest.13-1422
[Indexed for MEDLINE]
Free PMC Article

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