title: Pulmonary artery to aorta ratio for the detection of pulmonary hypertension: cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown. In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF.
  
  
  RESULTS
  159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation. By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p < 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p < 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83. Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003).
  
  
  CONCLUSIONS
  PA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.
authors: Acibadem Maslak Hospital, Istanbul, Turkey.
authors: Gültekin
authors: G
authors: Karakus
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Andreas A
authors: AA
authors: Kammerlander
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Stefan
authors: S
authors: Aschauer
authors: Otto Wagner Hospital, Vienna, Austria.
authors: Beatrice A
authors: BA
authors: Marzluf
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Caroline
authors: C
authors: Zotter-Tufaro
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Alina
authors: A
authors: Bachmann
authors: Acibadem Maslak Hospital, Istanbul, Turkey.
authors: Aleks
authors: A
authors: Degirmencioglu
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Franz
authors: F
authors: Duca
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Jamil
authors: J
authors: Babayev
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Stefan
authors: S
authors: Pfaffenberger
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors: Diana
authors: D
authors: Bonderman
authors: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. julia.mascherbauer@meduniwien.ac.at.
authors: Julia
authors: J
authors: Mascherbauer
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology* / Q000503:physiopathology; D019540:Area Under Curve; D062186:Arterial Pressure; D001317:Austria; D006328:Cardiac Catheterization; D004108:Dilatation, Pathologic; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000473:pathology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology* / Q000503:physiopathology; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left