DOI: http://dx.doi.org/10.18203/2349-3933.ijam20160973

Estimation of measured pulmonary artery to aorta ratio for prognosis of pulmonary hypertension in chronic obstructive pulmonary disease patients

Swetha Madas, D. Sai Vittal

Abstract


Background: Chronic obstructive pulmonary disease is a type of obstructive lung disease which is characterized by poor air flow to the lungs which worsens over time. Enlargement of the pulmonary artery is associated with the severe exacerbations of chronic obstructive pulmonary disease. Furthermore, it was indicated that MPA/AAo >1 could be an indicator to predict acute exacerbations of COPD. This study was thus undertaken to identify the association of MPA/AAo ratio and pulmonary hypertension by CT chest.

Methods: 157 patients with definite diagnosis of COPD and 50 patients without any cardiovascular disease or lung disease were included into the study. The patients were asked to lay down in left lateral position with calm breathing during the Doppler test for PH measurement; electrocardiogram and heart rate were also measured for all patients.

Results: Out of these 157 patients, 98 (62.4%) were males and 59 (37.6%) were females. Of the pulmonary artery diameter, the main, right and the left arterial diameter was considerably higher than that of the controls with 28.6, 21.8 and 21.5 mm respectively. There was no significant difference in the diameters of the ascending and the descending aorta between that of the patients and the controls. The ratio of MPA/AAo and MPA/DAo was higher in the patients that the controls. The MPA, LPA, RPA diameters were 30.3mm, 23.5mm and 23.2 mm in the patients with PH while they were significantly lesser in the COPD patients without PH. the most common comorbidities found was obesity, diabetes, dyslipidemia, stroke, abnormal CT findings, Emphysema, Fibrosis and Bronchiectasis with the MPA and AAo diameters significantly higher.

Conclusions: We conclude that a high MPA:AAo ratio correlated with increase in the MPA and AAo diameter and as a result, increased arterial pressure and presence of PH.


Keywords


Chronic obstructive pulmonary disorder, Main pulmonary artery diameter, Ascending aorta diameter, MPA/AAo ratio

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References


Vestbo, Jørgen. Definition and Overview (PDF). Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease. 2013;1-7.

Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Chronic obstructive pulmonary disease. Harrison's Principles of Internal Medicine. 18th ed. McGraw Hill; 2011:2151-2159.

GOLD. Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2013. Available at: http://www.goldcopd.org. Accessed on 5 March, 2016.

Petty TL. Scope of the COPD problem in North America: early studies of prevalence and NHANES III data: basis for early identification and intervention. Chest. 2000;117(5,2):326S-31S.

Centers for disease control and prevention (CDC) chronic obstructive pulmonary disease among adults-United States, 2011. Morb Mortal Wkly Rep. 2012;61(46):938-43.

Barbera JA. Mechanisms of development of chronic obstructive pulmonary disease-associated pulmonary hypertension. Pulm Circ. 2013;3(1):160-4.

Blanco I, Mathia S, Shafiq M. Severity of systemic sclerosis-associated pulmonary arterial hypertension in African Americans. Midicine (Baltimore). 2014;9:177-85.

Carrington M, Murphy NF, Strange G. Survival in patients with primary pulmonary hypertension: a population based analysis. Int J Cardiol. 2008;124:183-7.

Wells JM, Washko GR, Han MK, Abbas N, Nath H, Mamary AJ. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012;367:913-21.

Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J. 2008;32:1371-85.

Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imag. 1999;14:270-8.

Sanal S, Aronow WS, Ravipati G, Maguire GP, Belkin RN, Lehrman SG. Prediction of moderate or severe pulmonary hypertension by main pulmonary artery diameter and main pulmonary artery diameter/ascending aorta diameter in pulmonary embolism. Cardiol Rev. 2006;14:213-4.

Schmidt HC, Kauczor HU, Schild HH, Renner C, Kirchhoff E, Lang P et al. Pulmonary hypertension in patients with chronic pulmonary thromboembolism: chest radiograph and CT evaluation before and after surgery. Eur Radiol. 1996;6:817-25.

Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin lung transplant group. Chest. 1998;113:1250-6.

Haimovici JB, Trotman-Dickenson B, Halpern EF, Dec GW, Ginns LC, Shepard JA et al. Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program. Acad Radiol. 1997;4:327-34.

Yogchun S, Chun W, Panwen T, Yanqui W, Iaoou I, Ting Y et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension. Medicine (Baltimore). 2014;93(27):e256.

Epler GR, McLoud TC, Gaensler EA, Mikus JP, Carrington CB. Normal chestroentgenograms in chronic diffuse infiltrative lung disease. N Engl J Med. 1978;298:934-9.

Zompatori M, Bna C, Poletti V, Spaggiari E, Ormitti F, Calabro E et al. Diagnostic imaging of diffuse infiltrative disease of the lung. Respiration. 2004;71:4-19.

Shin S, King CS, Brown AW. Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease. Respir Med. 2014;108(11):1626-32.

Chen X, Liu K, Wang Z, Zhu Y, Zhao Y, Kng H et al. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension. Int J Chr obst Pulm Dis. 2015;10(1):2525-33.

Perez-Enguix D, Morales P, Tomas JM, Vera F, Lloret RM. Computed tomographic screening of pulmonary arterial hypertension in candidates for lung transplantation. Transplant Proc. 2007;39(7):2405-8.

Seeger W, Adir Y, Barbera JA. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013;62(25):D109-16.

Wells JM, Washko GR, Han MK. COPD Gene Investigators; ECLIPSE Study Investigators Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012;367(10):913-21.

Hoeper MM, Andreas S, Bastian A. Pulmonary hypertension due to chronic lung disease: updated Recommendations of the Cologne Consensus Conference. Int J Cardiol. 2011;154(1):S45-53.

Kessler R, Faller M, Weitzenblum E. Natural history of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am J Respir Crit Care Med. 2001;164(2):219-24.

Minai OA, Chaouat A, Adnot S. Pulmonary hypertension in COPD: epidemiology, significance, and management: pulmonary vascular disease: the global perspective. Chest. 2010;137(6):39S-51S.

Matsuoka S, Washko GR, Yamashiro T. National emphysema treatment trial research group pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. Am J Respir Crit Care Med. 2010;181(3):218-25.

Stevens GR, Fida N, Sanz J. Computed tomography and cardiac magnetic resonance imaging in pulmonary hypertension. Prog Cardiovasc Dis. 2012;55(2):161-71.

Fisher MR, Criner GJ, Fishman AP. NETT Research group estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J. 2007;30(5):914-21.

Lee SH, Kim YJ, Lee HJ, Kim HY, Kang YA, Park MS. Comparison of CT-determined pulmonary artery diameter, aortic diameter, and their ratio in healthy and diverse clinical conditions. PLoS One. 2015;10(5):e0126646.

Edwards PD, Bull RK, Coulden R. CT measurement of main pulmonary artery diameter. Br J Radiol. 1998;71:1018-20.

Karazincir S, Balci A, Seyfeli E, Akoglu S, Babayigit C, Akgul F. CT assessment of main pulmonary artery diameter. Diagn Interv Radiol. 2008;14:72-4.

Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH. CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol. 1984;19:16-22.

Rogers IS, Massaro JM, Truong QA, Mahabadi AA, Kriegel MF, Fox CS. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol. 2013;111:1510-6.

Mao SS, Ahmadi N, Shah B, Beckmann D, Chen A, Ngo L. Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender. Acad Radiol. 2008;15:827-34.

Santos S, Peinado VI, Ramirez J, Melgosa T, Roca J, Rodriguez-Roisin R et al. Characterization of pulmonary vascular remodelling in smokers and patients with mild COPD. Eur Respir J. 2002;19:632-8.

Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J. 2008;32:1371-85.

Come CE, Divo MJ, San José Estépar R. NETT Research Group Lung deflation and oxygen pulse in COPD: results from the NETT randomized trial. Respir Med. 2012;106(1):109-19.

Weitzenblum E, Apprill M, Oswald M, Chaouat A, Imbs JL. Pulmonary hemodynamics in patients with chronic obstructive pulmonary disease before and during an episode of peripheral edema. Chest. 1994;105(5):1377-82.

Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE. National Emphysema Treatment Trial (NETT) Group Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med. 2002;166(3):314-22.

Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT. CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD. Chest. 2014;145(4):824-32.

Hale KA, Niewoehner DE, Cosio MG. Morphologic changes in the muscular pulmonary arteries: relationship to cigarette smoking, airway disease, and emphysema. Am Rev Respir Dis. 1980;122:273-8.

Hurst JR, Vestbo J, Anzueto A. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363:1128-38.

Kim V, Han MK, Vance GB. The chronic bronchitic phenotype of COPD: an analysis of the COPD gene study. Chest. 2011;140:626-33.

Han MK, Kazerooni EA, Lynch DA. Chronic obstructive pulmonary disease exacerbations in the COPD gene study: associated radiologic phenotypes. Radiology. 2011;261:274-82.

Blum A, Simsolo C, Sirchan R. Vascular responsiveness in patients with chronic obstructive pulmonary disease (COPD). Eur J Intern Med. 2013;25:370-3.