title: Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  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.
authors.affiliation: Pulmonary & Critical Care Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shin
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: King
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: A Whitney
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Fairfax Radiological Consultants, Falls Church, VA, USA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Albano
authors.affiliation: Fairfax Radiological Consultants, Falls Church, VA, USA.
authors.forename: Melany
authors.initials: M
authors.lastname: Atkins
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sheridan
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Medicine, Division of Critical Care and Hospital Medicine, National Jewish Health, Denver, CO, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Newton
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Nargues
authors.initials: N
authors.lastname: Weir
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Shlobin
authors.affiliation: Advanced Lung Disease and Lung Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: steven.nathan@inova.org.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Nathan
mesh_terms: D001011:Aorta / Q000473:pathology; D062186:Arterial Pressure / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Chronic obstructive pulmonary disease; Pulmonary artery diameter; Pulmonary hypertension; Pulmonary to aortic artery diameter ratio