Stephanie Shin1, Christopher S King2, A Whitney Brown2, Maria C Albano3, Melany Atkins3, Michael J Sheridan2, Shahzad Ahmad2, Kelly M Newton4, Nargues Weir2, Oksana A Shlobin2, Steven D Nathan5. 1. Pulmonary & Critical Care Medicine, University of California San Diego, San Diego, CA, USA. 2. Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. 3. Fairfax Radiological Consultants, Falls Church, VA, USA. 4. Department of Medicine, Division of Critical Care and Hospital Medicine, National Jewish Health, Denver, CO, USA. 5. Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: steven.nathan@inova.org.
Abstract
RATIONALE: The relationship between pulmonary artery size with underlying pulmonary hypertension and mortality remains to be determined in COPD. We sought to evaluate the relationships in a cohort of patients with advanced COPD. METHODS: A retrospective study of advanced COPD patients evaluated between 1998 and 2012 was conducted at a tertiary care center. Patients with chest computed tomography images and right heart catheterizations formed the study cohort. The diameters of the pulmonary artery and ascending aorta were measured by independent observers and compared to pulmonary artery pressures. Intermediate-term mortality was evaluated for the 24-month period subsequent to the respective studies. Cox proportional hazards model was used to determine independent effects of variables on survival. RESULTS: There were 65 subjects identified, of whom 38 (58%) had pulmonary hypertension. Patients with and without pulmonary hypertension had mean pulmonary artery diameters of 34.4 mm and 29.1 mm, respectively (p = 0.0003). The mean PA:A ratio for those with and without pulmonary hypertension was 1.05 and 0.87, respectively (p = 0.0003). The PA:A ratio was an independent predictor of mortality with a reduced survival in those with a PA:A >1 (p = 0.008). CONCLUSIONS: The PA:A ratio is associated with underlying pulmonary hypertension in patients with COPD and is an independent predictor of mortality. This readily available measurement may be a valuable non-invasive screening tool for underlying pulmonary hypertension in COPD patients and appears to impart important independent prognostic information.
RATIONALE: The relationship between pulmonary artery size with underlying pulmonary hypertension and mortality remains to be determined in COPD. We sought to evaluate the relationships in a cohort of patients with advanced COPD. METHODS: A retrospective study of advanced COPDpatients evaluated between 1998 and 2012 was conducted at a tertiary care center. Patients with chest computed tomography images and right heart catheterizations formed the study cohort. The diameters of the pulmonary artery and ascending aorta were measured by independent observers and compared to pulmonary artery pressures. Intermediate-term mortality was evaluated for the 24-month period subsequent to the respective studies. Cox proportional hazards model was used to determine independent effects of variables on survival. RESULTS: There were 65 subjects identified, of whom 38 (58%) had pulmonary hypertension. Patients with and without pulmonary hypertension had mean pulmonary artery diameters of 34.4 mm and 29.1 mm, respectively (p = 0.0003). The mean PA:A ratio for those with and without pulmonary hypertension was 1.05 and 0.87, respectively (p = 0.0003). The PA:A ratio was an independent predictor of mortality with a reduced survival in those with a PA:A >1 (p = 0.008). CONCLUSIONS: The PA:A ratio is associated with underlying pulmonary hypertension in patients with COPD and is an independent predictor of mortality. This readily available measurement may be a valuable non-invasive screening tool for underlying pulmonary hypertension in COPDpatients and appears to impart important independent prognostic information.
Authors: David C LaFon; Surya P Bhatt; Wassim W Labaki; Farbod N Rahaghi; Matthew Moll; Russ P Bowler; Elizabeth A Regan; Barry J Make; James D Crapo; Raul San Jose Estepar; Alejandro A Diaz; Edwin K Silverman; MeiLan K Han; Brian Hobbs; Michael H Cho; George R Washko; Mark T Dransfield; J Michael Wells Journal: Eur Respir J Date: 2020-02-12 Impact factor: 16.671
Authors: James Benjamin Gleason; Krunal B Patel; Felix Hernandez; Anas Hadeh; Kristin B Highland; Franck Rahaghi; Jinesh P Mehta Journal: Lung Date: 2017-04-29 Impact factor: 2.584