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2014 ; 145
(4
): 824-832
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CT scan-measured pulmonary artery to aorta ratio and echocardiography for
detecting pulmonary hypertension in severe COPD
#MMPMID24114440
Iyer AS
; Wells JM
; Vishin S
; Bhatt SP
; Wille KM
; Dransfield MT
Chest
2014[Apr]; 145
(4
): 824-832
PMID24114440
show ga
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.
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