title: Mortality risk as a function of the ratio of pulmonary trunk to ascending aorta diameter in patients with suspected coronary artery disease.
abstract: Although an increased pulmonary trunk (PT) diameter to ascending aorta (AA) diameter ratio (PT/AA ratio) is associated with pulmonary hypertension, the prognostic utility of this metric remains unexamined. We investigated whether an increase in the PT/AA ratio, as measured using coronary computed tomographic angiography, is associated with the risk of all-cause death. We identified 1,326 consecutive patients (mean age 61 ± 13 years; 60% men) without known coronary artery disease who underwent coronary computed tomographic angiography. Patients with a history of congenital or valvular heart disease or aortic enlargement (≥4 cm) were excluded. The PT and AA diameters were measured at the PT bifurcation level. The patients were categorized by PT/AA deciles, with the ≥90th percentile (PT/AA ratio 0.9) considered elevated. All-cause death associated with a PT/AA ratio <0.9 versus ≥0.9 was evaluated using multivariate Cox proportional hazard models. During 2.9 ± 1.0 years of follow-up, 58 patients died. Patients with a PT/AA ratio ≥0.9 experienced 2.5-fold greater annualized mortality compared to those with <0.9 (3.1% vs 1.3%, p = 0.004). Adjusting for age, gender, heart rate, dyslipidemia, smoking, and coronary artery disease extent, the patients with a PT/AA ratio ≥0.9 experienced a greater mortality risk compared to patients with PT/AA ratio <0.9 (hazard ratio 3.2, 95% confidence interval 1.6 to 6.6, p = 0.001). In the 1,059 patients with left ventricular ejection fraction measurements, a lower left ventricular ejection fraction was observed in the PT/AA ratio ≥0.9 group (p <0.05). In conclusion, incrementally and independent of the traditional coronary artery disease risk factors, an elevated PT/AA ratio was associated with increased mortality risk in patients without known coronary artery disease undergoing coronary computed tomographic angiography.
authors: Department of Imaging, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors: Rine
authors: R
authors: Nakanishi
authors: Jamal S
authors: JS
authors: Rana
authors: Aryeh
authors: A
authors: Shalev
authors: Heidi
authors: H
authors: Gransar
authors: Sean W
authors: SW
authors: Hayes
authors: Troy M
authors: TM
authors: Labounty
authors: Damini
authors: D
authors: Dey
authors: Romalisa
authors: R
authors: Miranda-Peats
authors: Louise E J
authors: LE
authors: Thomson
authors: John D
authors: JD
authors: Friedman
authors: Aiden
authors: A
authors: Abidov
authors: James K
authors: JK
authors: Min
authors: Daniel S
authors: DS
authors: Berman
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D001794:Blood Pressure; D002423:Cause of Death; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology