Abstract
IntroductionPulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD.MethodsCOPD patients evaluated for eligibility for lung transplantation between 2004 and 2015 were retrospectively analyzed. Clinical characteristics, chest CTs, spirometry, and right-sided heart catheterizations (RHC) were studied. Diameters of PA and ascending aorta (A) were measured on CT. Diagnostic properties of different cut-offs of PA diameter and PA:A ratio in diagnosing PH were calculated.ResultsOf 92 included COPD patients, 30 (32.6 %) had PH at RHC (meanPAP > 25 mm Hg). PA:A > 1 had a negative predictive value (NPV) of 77.9 % and a positive predictive value (PPV) of 63.1 % with an odds ratio (OR (CI 95 %)) of 5.60 (2.00–15.63). PA diameter ≥30 mm had a NPV of 78 % and PPV of 64 % with an OR (CI 95 %) of 6.95 (2.51–19.24).ConclusionA small PA diameter and PA:A make the presence of PH unlikely but cannot exclude its presence in end-stage COPD. A large PA diameter and PA:A maybe used to detect PH early.
Highlights
Pulmonary hypertension (PH) in Chronic obstructive pulmonary disease (COPD) is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH
There were no significant differences in age, sex, FEV1, the outcome of the 6-min walk test (6MWT), and body mass index (BMI) between patients with and without PH, see Table 1
We have demonstrated that pulmonary artery (PA):A and PA diameter measured on chest computed tomography (CT) contain substantial diagnostic accuracy for mean pulmonary artery (PA) pressure (meanPAP) at right-sided heart catheterizations (RHC)
Summary
Pulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD. Pulmonary hypertension (PH), defined as a mean pulmonary artery (PA) pressure (meanPAP) of[25 mmHg, is a relatively common and important complication in patients with severe COPD [1,2,3,4]. PH in COPD is mainly associated with degree of hypoxemia which causes pulmonary vascular constriction and increased precapillary vascular pressure with vascular remodeling. Around half of all COPD patients will develop PH and patients with PH tend to have an increased risk on exacerbations, which in turn leads to a greater mortality [9,10,11]. PH is related to a reduced transplant free survival rate [12, 13]
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