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Chest. 2016 May;149(5):1197-204. doi: 10.1378/chest.15-1504. Epub 2016 Jan 12.

Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD.

Author information

1
Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL. Electronic address: jmwells@uab.edu.
2
Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
3
Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL.
4
Division of Cardiothoracic Imaging, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
5
Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL.

Abstract

BACKGROUND:

Relative pulmonary arterial enlargement, defined by a pulmonary artery to aorta (PA/A) ratio > 1 on CT scanning, predicts hospitalization for acute exacerbations of COPD (AECOPD). However, it is unclear how AECOPD affect the PA/A ratio. We hypothesized that the PA/A ratio would increase at the time of AECOPD and that a ratio > 1 would be associated with worse clinical outcomes.

METHODS:

Patients discharged with an International Classification of Diseases, Ninth Revision, diagnosis of AECOPD from a single center over a 5-year period were identified. Patients were included who had a CT scan performed during the stable period prior to the index AECOPD episode as well as a CT scan at the time of hospitalization. A subset of patients also underwent postexacerbation CT scans. The pulmonary arterial diameter, ascending aortic diameter, and the PA/A ratio were measured on CT scans. Demographic data, comorbidities, troponin level, and hospital outcome data were analyzed.

RESULTS:

A total of 134 patients were included in the study. They had a mean age of 65 ± 10 years, 47% were male, and 69% were white; overall, patients had a mean FEV1 of 47% ± 19%. The PA/A ratio increased from baseline at the time of exacerbation (0.97 ± 0.15 from 0.91 ± 0.17; P < .001). Younger age and known pulmonary hypertension were independently associated with an exacerbation PA/A ratio > 1. Patients with PA/A ratio > 1 had higher troponin values. Those with a PA/A ratio > 1 and troponin levels > 0.01 ng/mL had increased acute respiratory failure, ICU admission, or inpatient mortality compared with those without both factors (P = .0028). The PA/A ratio returned to baseline values following AECOPD.

CONCLUSIONS:

The PA/A ratio increased at the time of severe AECOPD and a ratio > 1 predicted cardiac injury and a more severe hospital course.

KEYWORDS:

COPD; CT scan; acute exacerbation of COPD; enzymes (cardiology); pulmonary circulation

PMID:
26501747
PMCID:
PMC4944777
DOI:
10.1378/chest.15-1504
[Indexed for MEDLINE]
Free PMC Article

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