Progressive dilatation of the main pulmonary artery is a characteristic of pulmonary arterial hypertension and is not related to changes in pressure.
BACKGROUND
Pulmonary artery (PA) dilatation is one of the consequences of pulmonary arterial hypertension (PAH) and is used for noninvasive detection. However, it is unclear how the size of the PA behaves over time and whether it is related to pressure changes. The aim of this study was to evaluate PA size during follow-up in treated patients with PAH and whether it reflects pulmonary vascular hemodynamics.


METHODS
Fifty-one patients with PAH who underwent at least two right-sided heart catheterizations (RHCs) together with cardiac MRI (CMR) were included in this study. Another 18 patients who had normal pressure at RHC were included for comparison at baseline. From RHC, we derived PA pressures and cardiac output. From the CMR images we derived PA diameter (PAD) and the ratio of the PAD and ascending aorta diameter.


RESULTS
The PAD was significantly larger in patients with PAH than in patients without PAH (P < .001). A ratio of the PAD and ascending aorta diameter > 1 had a positive predictive value of 92% for PAH. Mean follow-up time was 942 days, and there was a significant dilatation during this period (P < .001). The change of the PAD did not correlate with the changes in pressure or cardiac output. A moderate correlation with follow-up time was found (r = 0.56; P < .001).


CONCLUSIONS
A dilatated PA is useful for identifying patients with PAH. However, during patient follow-up, progressive dilatation of the PA is independent of the change in PA pressure and cardiac output and might become independent from hemodynamics.
Boerrigter
Bart
B
VU University Medical Center, Amsterdam, The Netherlands.
Mauritz
Gert-Jan
GJ
Marcus
J Tim
JT
Helderman
Frank
F
Postmus
Pieter E
PE
Westerhof
Nico
N
Vonk-Noordegraaf
Anton
A
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D006328:Cardiac Catheterization / Q000379:methods; D002302:Cardiac Output; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D000959:Antihypertensive Agents