Main Pulmonary Artery Diameter Research Articles

Prognostic factors of pulmonary hypertension associated with connective tissue disease: pulmonary artery size measured by chest CT

Pulmonary artery enlargement is a common manifestation of chest CT in patients with pulmonary arterial hypertension (PAH). The exact clinical significance of this phenomenon has not been clarified in connective tissue disease (CTD)-associated PAH (CTD-PAH). We aimed to explore the association between the dilatation of pulmonary artery and prognosis of CTD-PAH patients. We retrospectively investigated 140 CTD-PAH patients diagnosed by echocardiography from 2009 to 2018. A chest multi-slice CT was performed on all the patients. Main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), ascending aorta (AAo) and descending aorta (DAo) diameters were measured. The ratios MPA/AAo and MPA/DAo were also calculated. The primary end point was all-cause mortality. During the observational period of 3.44 (0.23) years, 36 patients were followed to death. Cox univariate proportional hazard analysis showed that age, gender, MPA diameter, LPA diameter and RPA diameter were related to the risk of 5-year all-cause mortality in patients with CTD-PAH. In Cox multivariate proportional hazard analysis, MPA diameter and gender were predictors of all-cause mortality in CTD-PAH patients. An all-cause mortality risk prediction model revealed that baseline MPA diameter has the ability to predict 5-year all-cause mortality in CTD-PAH patients. Kaplan-Meier analysis showed that the 5-year survival rate was significantly lower in patients with MPA ≥37.70 mm (P ≤ 0.00012) compared with MPA ≤ 37.70 mm. MPA diameter ≥37.70 mm measured by chest multi-slice CT was a potential independent risk factor of the poor long-term prognosis in Chinese CTD-PAH patients.

Increased main pulmonary artery diameter and main pulmonary artery to ascending aortic diameter ratio in smokers undergoing lung cancer screening

ObjectivesPulmonary hypertension (PH) is a progressive, potentially fatal disease, difficult to diagnose early due to non-specific nature of symptoms. PH is associated with increased morbidity and death in many respiratory and cardiac disorders, and with all-cause mortality, independent of age and cardiopulmonary disease. The main pulmonary artery diameter (MPA), and ratio of MPA to adjacent ascending aorta (AA), MPA:AA, on Chest CT are strong indicators of suspected PH.Our goal was to determine the prevalence of abnormally high values of these indicators of PH in asymptomatic low-dose CT (LDCT) screening participants at risk of lung cancer, and determine the associated risk factors. MethodsWe reviewed consecutive baseline LDCT scans of 1949 smokers in an IRB-approved study. We measured the MPA and AA diameter and calculated MPA:AA ratio. We defined abnormally high values as being more than two standard deviations above the average (MPA ≥ 34 mm and MPA:AA ≥ 1.0). Regression analyses were used to identify risk factors and CT findings of participants associated with high values. ResultsThe prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. Multivariable regression demonstrated that BMI was a significant risk factor, both for MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003). Emphysema was significant in the univariate but not in the multivariate analysis. ConclusionsWe determined that the possible prevalence of PH as defined by abnormally high values of MPA and of MPA:AA was greater than previously described in the general population and that pulmonary consultation be recommended for these participants, in view of the significance of PH.

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension.

BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

Measurement of Main Pulmonary Artery Diameter and its Ratio with Ascending Aorta in Indian Population by Multi Detector Computed Tomography

Introduction: An increase in Pulmonary Artery (PA) pressure is associated with an increase in its diameter. Hence, it is necessary to know the normal range of Main Pulmonary Artery Diameter (MPAD). An attempt has been made to know the same among the Indian population. Aim: To determine the normal range of reference values for diameter of Main Pulmonary Artery (MPA) and its relation with Ascending Aorta (AA) in Indian population. Materials and Methods: A prospective cross-sectional study was conducted between October 2018 and September 2019 ((380 males, 120 females) between the age of 30-65 years). Data from the contrast CT scans of thorax of 500 subjects such as those patients with cough under evaluation, suspected lung nodule, chest wall lesions, primary or secondaries in the lung, etc., who visited the Department of Radio-diagnosis, in the Medical College of South India were analysed. Further, healthy population was also defined as those who were free from chronic cardiopulmonary illness in particular with regard to present study, which would affect the diameter of great vessels including that of PA and aorta. MPA and ascending aortic diameters were measured at the level of pulmonary artery bifurcation, viewed at fixed mediastinal window settings. Statistical Package for Social Sciences (SPSS) version 20, inferential statistics like Unpaired-t test were used to test the significant difference for variables between the two groups (males and females). The level of significance was set at 5%. Results: The MPADs of whole population ranged between 15.6-31.6 mm, with mean diameter of 23.08±2.81 mm. Correlation between age and MPAD was statistically significant (p-value &lt;0.001), while sex-specific MPAD was not significant. The mean AA diameter was 27.15±2.6 mm. The mean AA diameter in males was 27.76±3.2 mm, and 26.67±2.0 mm in females with statistical significance (p-value 0.001) between the groups. The diameter ratio of MPA to AA was 0.85. Conclusion: In present study, the normal ranges of diameter of PA and its ratio with AA were defined among Indians. The diameter ratio of MPA to AA appears to be more important, as it tends to normalise the effects of anthropomorphic factors.

Pulmonary artery aneurysm as a result of group 2 pulmonary artery hypertension in a patient with significant mitral and aortic valve disease - review and case report.

Aneurysms are uncommon, but potentially life-threatening abnormalities of the pulmonary arteries. Aneurysm of the main pulmonary artery (MPA) defined as MPA diameter over 40 mm was reported in 1 : 14 000 autopsies. The most frequent location is the main pulmonary artery (89% of cases), whereas the maximum described diameter is 106–170 mm. Clinical manifestations are usually nonspecific or asymptomatic. Right heart failure symptoms, pulmonary regurgitation, trachea or bronchi compression or pulmonary emboli caused by enlarged MPA are the most commonly described clinical manifestations. Pulmonary artery aneurysm dissection is an uncommon complication but associated with a high mortality rate. Unfortunately, guidelines regulating the optimal time for the surgical intervention still have not been developed. We present the history of 76-year-old patient suffering from an aneurysm of the pulmonary artery (74 × 61 mm), as well as mitral and aortic valve disease, who was successfully operated on in our hospital.

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience.

Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P < .001), repeated runs and long cardiopulmonary bypass time (P < .001), and aortic cross-clamp time (P < .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention.

Diameter of the dilated main pulmonary artery in patients with pulmonary hypertension decreases after lung transplantation.

The pulmonary artery (PA) in patients with pulmonary hypertension (PH) becomes dilated. We analyzed the postoperative changes of the main PA after lung transplantation (LuTx). The subjects of this retrospective study were 68 LuTx recipients, divided into a PH group (n = 36) and a non-PH group (n = 32), based on preoperative right heart catheterization findings. The PA diameter was measured on chest computed tomography. We evaluated the correlation between the mean pulmonary arterial pressure (mPAP) and the main PA diameter and compared the main PA diameters before and 3months after LuTx. The main PA diameter was significantly correlated with the mPAP (r = 0.423, P < 0.001). Preoperatively, the mean main PA diameter in the PH group was significantly greater than that in the non-PH group. However, by 3months after LuTx, the main PA diameter in the PH group had decreased significantly from 32.4 ± 6.7 to 26.9 ± 4.8mm (P < 0.001), while that in the non-PH group had decreased minimally from 28.3 ± 4.9 to 26.4 ± 4.6mm (P < 0.001), resulting in no significant difference in postoperative main PA diameters between the two groups. The main PA diameter in recipients with PH was enlarged and correlated with the mPAP. The dilated main PA diameter in PH patients decreased shortly after LuTx.

P4131Abnormal flow pattern in the main pulmonary artery of Marfan patients is related to local dilation

Abstract Introduction Marfan syndrome (MFS) is a hereditary connective tissue disorder caused by mutation in the FBN1 gene. Main pulmonary artery (MPA) dilation is very prevalent in MFS patients. Indeed, the old Ghent nosology considered main pulmonary artery (MPA) dilation as diagnostic criterion of MFS patients. Although clinical complications related to pulmonary dilation in MFS are rare, this may potentially lead to MPA dissection or be a marker of vascular disease in MFS. Studies regarding potential causes of MPA dilation in MFS patients are very scarce. Purpose Through 4D flow CMR, we aimed to assess whether flow abnormalities exist in the MPA of MFS patients and their relation to local diameter. Methods Fifty-five consecutive Marfan syndrome adults (MFS) and 22 healthy volunteers (HV) were prospectively enrolled. All subjects underwent non-contrast-enhanced 4D flow-MRI, obtaining 4D flow field and a 3D angiography. The MPA was segmented from the 3D angiography, and the segmentation was used to mask 4D velocity data. Four, equidistant analysis planes were placed in the MPA between the pulmonary valve and the pulmonary artery bifurcation. Common descriptors of large arteries hemodynamics were computed at each plane: maximum velocity, systolic flow reversal ratio (a descriptor of the amount of systolic backward flow) and circumferentially-averaged axial and circumferential wall shear stress (WSS). Pulmonary artery diameters were measured on axial images. MPA dilation was defined as a diameter larger than 27 mm in women and 29 mm in men. Systolic (SBP) and diastolic (DBP) systemic blood pressure were measured at the brachial artery with a calibrated cuff immediately after the scan. Results Compared with HV, MFS patients presented similar age, BSA, SBP and maximum blood velocity, but had larger MPA diameter (27.8 vs 25.1 mm, p&lt;0.001) and higher DBP (75.5 vs 66.8 mmHg, p=0.003). According to the used threshold, 45% (27) of MFS patients had MPA dilation. Compared with HV, Marfan patients presented an increased systolic flow reversal ratio in the proximal part of the MPA (Figure 1). In MFS patients axial WSS was reduced in central sections of the MPA, while the circumferential component was not difference with respect to HV. All these flow abnormalities were also present in the subset of 28 MFS patients without pulmonary artery dilation. In multivariable analysis, MPA diameter was independently related to age (B=0.056; p=0.032), sex (B=−2.3; p=0.02) and axial (B=6.4; p=0.039) and circumferential (B=33.9; p&lt;0.001) WSS. Figure 1 Conclusions Dilation of the main pulmonary artery is prevalent in Marfan syndrome patients. Abnormal increase in systolic vortexes and reduction in axial WSS were present in dilated and non-dilated MPA in MFS patients. Axial and circumferential WSS were independently related to MPA diameter. The eventual predictive role of abnormal pulmonary flow pattern in pulmonary artery dilation in MFS patients remain to be established Acknowledgement/Funding Instituto de Salud Carlos III (PI14/0106), La Maratό de TV3 (20151330), CIBERCV and FP7/People (267128)

DIAGNOSIS AND OUTCOMES OF PATIENTS WITH SUPRAVALVULAR PULMONARY STENOSIS TREATED WITH PERCUTANEOUS BALLOON DILATION

Congenital supravalvular pulmonary stenosis (PS) is a rare subtype of PS. Outcomes following percutaneous dilation of the pulmonary artery (PA) and pulmonary valve (PV) seem to be dependent on the presence of a supravalvular component. The aim of this study was to determine the reliability of echocardiography in identifying the origin of the PS and to evaluate the efficacy of percutaneous dilation of supravalvular stenosis. Retrospective study of 109 patients having undergone percutaneous dilation of a native PS between 2006 and 2017 in a tertiary pediatric hospital. Patients were classified as having supravalvular PS or non-supravalvular PS based on angiography. Echocardiographic measurements (main PA and PV diameters) and interventional results (hemodynamic and echocardiographic right ventricular (RV) to PA gradients) were compared between groups. Mean age at intervention was 1.93±4.22 years old. Angiography identified a supravalvular component in 26 patients (24%). Anatomical description of the PV and PA by echocardiography had a sensitivity and a specificity of 58% and 84% respectively. Independently of the coexistence of another type of PS, patients with a supravalvular component had a significantly smaller PA:PV ratio measured by echocardiography: 0.84±0.30 vs 1.47±0.54 (p < 0.001). Based on the PA:PV observation, ROC analysis determined an area under the curve of 0.851 (95%CI 0.739-0.963) and a discriminative cut-off ratio of 1.048 according to Youden’s index; increasing both the sensitivity and specificity to 86%. After dilation, hemodynamic gradients were reduced from 37.35±20.51mmHg to 26.04±12.84mmHg in patients with a supravalvular component compared to a decrease from 39.80±20.47mmHg to 11.75±8.67mmHg in patients without (p < 0.001). The gradient remained significantly higher among patients with a supravalvular PS at the 6-12 month follow-up: 48.94±28.75mmHg compared to 22.54±21.28mmHg (p < 0.001). Of patients with supravalvular stenosis, 19% required a second intervention (percutaneous or surgical) compared to 6% of those without a supravalvular component (p=0.04). Systematic calculation fo the PA:PV ratio significantly improves the accurate determination of the origin of the pulmonary stenosis compared to anatomical description alone. Percutaneous dilation of a supravalvular PS is less effective and patients are more likely to require a second intervention than patients with pulmonary stenosis without a supravalvular component.

Pulmonary Hypertension Parameters Assessment by Electrocardiographically Gated Computed Tomography: Normal Limits by Age, Sex, and Body Surface Area in a Chinese Population.

Pulmonary hypertension (PH) parameters such as pulmonary artery or right ventricular size can be measured easily on computed tomography (CT). However, there are limited data on electrocardiographically (ECG) gated CT. We sought to determine age-specific and sex-specific normal reference values for PH parameters normalized by body surface area (BSA) using ECG-gated cardiac CT in a Chinese population. In total, we enrolled 519 non-PH patients undergoing ECG-gated CT coronary angiography and measured PH parameters, including main pulmonary artery (MPA) and right pulmonary artery (RPA) diameters and distension, the ratio of MPA to ascending aorta (AAO) diameter (MPA/AAO), and the ratio of right ventricular to left ventricular diameter (RV/LV). Maximum MPA and RPA diameters were also normalized to BSA (nMPA, nRPA). Age, sex, BSA, and body mass index (BMI) were variably associated with PH parameters. Age was an independent predictor of all PH parameters. The maximum MPA diameter (26.5±2.7 mm), maximum RPA diameter (20.9±3.0 mm), nMPA (15.8±2.0 mm/m), nRPA (12.4±2.0 mm/m), and RV/LV (0.85±0.11) increased with age. MPA/AAO (0.80±0.10), MPA, and RPA distension (25.4%±7.1%; 23.3%±6.7%) correlated negatively with age. Although absolute MPA and RPA diameters were slightly larger in men, women had significantly larger nMPA and nRPA values. MPA and RPA sizes and RV/LV were correlated positively with BSA and BMI. Using ECG-gated cardiac CT, we determined the normal reference values of PH parameters for non-PH adult Chinese patients, and these values were variably influenced by age, sex, BSA, and BMI.

Association between cardiovascular risk factors and the diameter of the main pulmonary artery in asymptomatic population in the Appalachian region

Pulmonary artery (PA) diameter may be altered in association with cardiovascular (CV) risk factors as noted in aorta in systemic hypertension. The flow of blood from the right ventricle to the PA and all the way to the capillary level depends on the pulmonary vascular resistance and to a lesser extent compliance and impedance of the PA, which are the fundamental conduit for maintenance of the right heart hemodynamics. Our objective is to determine the association between CV risk factors and the main pulmonary artery (MPA) diameter. The study population are asymptomatic individuals with no known diagnosis of CV diseases in central Appalachia (n=1,282). Adults aged 18 years or older were eligible for the screening if they were referred by a physician. For self-referral, only males aged ≥45 years and females aged ≥55 years were eligible. Unadjusted and adjusted linear regression analyses were performed. The mean MPA diameter was significantly higher among males compared to females (27.19±4.20 vs. 24.99±3.91 mm, P<0.0001). Participants with diabetes also had wider MPA diameter (26.79±4.56 mm) compared to those without diabetes (25.93±4.11 mm) (P=0.015). Further, hypertensive (26.42±4.15 vs. 25.71±4.21 mm, P=0.002) and obese (27.25±4.11 vs. 25.28±4.07 mm, P<0.0001) participants had significantly wider MPA diameter compared to non-hypertensive and non-obese participants, respectively. Multivariable model showed that age, sex and body mass index (BMI) were significantly associated with MPA diameter. A 1-year increase in age increased MPA diameter by 0.046 mm (P<0.0001). The diameter of MPA was wider among males by 2.16 mm compared to females (P<0.0001). Finally, with one unit increase in BMI, the MPA diameter increased by 0.16 mm (P<0.0001). MPA diameter was significantly associated with age, sex, and BMI. Further prospective studies are needed to correlate computed tomography (CT) measurement of MPA diameter with pulmonary pressure as assessed by echocardiogram to diagnose pulmonary hypertension (PH).

Main pulmonary artery diameter assessment in a large sample of Indian population: a MDCT based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The gold standard for pulmonary artery pressure measurement is right heart catheterization but its invasive nature precludes its routine use. Main pulmonary arterial trunk calibre increase is a strong indicator of underlying pulmonary arterial hypertension. MDCT can accurately measure the diameter of main pulmonary artery. The objective of the study was to establish the normative values of main pulmonary artery caliber using contrast enhanced CT and try to ascertain any significant difference in main pulmonary artery calibers between two genders and correlation of age and main pulmonary artery diameter.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Contrast enhanced CT images of 462 subjects were analysed on a PACS workstation monitor and widest diameter perpendicular to long axis of the main pulmonary artery as seen on reformatted axial image was measured with electronic caliper tool at the level of the main pulmonary artery bifurcation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean main pulmonary artery diameter in females was 22.54±2.19 mm and 23.34±3.06 mm in males. The mean pulmonary artery diameter in males was larger than females with statistically significant difference seen (p&amp;lt;0.05). The correlation coefficient between age of whole sample and their mean main pulmonary artery was found to be 0.1006 with no statistically significant difference.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is a statistically significant difference in the mean main pulmonary artery calibre between males and females with no strong correlation between the age and mean main pulmonary artery calibre. Further studies are warranted to find the complex interaction between main pulmonary artery diameter and sex, age and body mass index.&lt;/p&gt;

Evaluation of pulmonary artery blood flow and right heart function using phase-contrast magnetic resonance imaging in elderly patients with chronic obstructive pulmonary disease

Objective To investigate the value of phase-contrast magnetic resonance imaging(PC-MRI)in evaluating pulmonary artery blood flow and right ventricular(RV)function in elderly patients with chronic obstructive pulmonary disease(COPD). Methods Twenty-four elderly patients with COPD admitted to Beijing Anzhen Hospital between February 2016 and June 2017 were enrolled in this retrospective study.Based on pulmonary artery pressure evaluated by right heart catheterization, COPD patients were divided into a pulmonary hypertension group(PH group, n=12)and a non-PH group(n=12). Pulmonary artery blood flow velocity and volume, pulmonary arterial compliance and right heart function parameters including ejection fraction, end-diastolic volume, end-systolic volume and cardiac output, and 6-min walking distance evaluated by PC-MRI were compared between the two groups. Results There were significant differences in peak flow velocity[(88.1±16.0)cm/s vs.(59.8±13.8)cm/s, P=0.005], flow volume[(80.7±22.0)ml/s vs.(53.2±26.7)ml/s, P=0.012], main pulmonary artery compliance[(42.3±14.6)vs.(22.7±10.8), P=0.001], right ventricular ejection fraction[(48.4±13.4)% vs.(37.6±11.1)%, P=0.000], end-diastolic volume[(64.6±22.5)ml vs.(72.5±22.8)ml, P=0.030]and end-systolic volume[(50.6±33.1)ml vs.(41.7±33.1)ml, P=0.040]between the non-PH and PH groups, while there was no significant difference in cardiac output between the non-PH and PH groups[(34.2±10.8)ml vs.(34.4±8.3)ml, P=0.080]. Pearson's correlation analysis showed that 6-minute walking distance had good correlations with right ventricular ejection fraction(r=0.49), forced expiratory volume in 1 s(FEV1)(r=0.60)and main pulmonary artery diameter(r=-0.61). Conclusions PC-MRI is a noninvasive imaging method for quantitative analysis of pulmonary artery dynamics and right heart function for the elderly with COPD, and it can provide information for evaluating therapeutic effects and prognosis. Key words: Magnetic resonance imaging; Pulmonary disease, chronic obstructive; Pulmonary artery; Ventricular function

Analysis of sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome

Objective: To investigate the sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome(OSAHS). Method: We summarized the characteristics of 250 children withsevere OSAHS diagnosed by polysomnography（PSG）in our hospital from January 1, 2017 to December 31, 2017. According to AHI, the patients were divided into three groups, 159 in group A with 20 < AHI≤0, 57 in group B with 40 < AHI≤60, and 34 in group C with AHI > 60. We collected the basic data, sleep parameters (sleep efficiency, latency, sleep stage, sleep index, etc.), preoperative arterial blood gas test results (awake and postsleep state), echocardiographic findings of the three groups. Statistical comparisons between groups were performed with SPSS19.0. Result: BMI, AHI, OAHI, LSaO₂ was significantly different with among the three groups (all P<0.01), and there was a linear correlation between BMI and AHI (r=0.251). There was significant differences in sleep efficiency (SE), sleep latency (SO), and rapid eye movement (REM) latency among the three groups. Compared with group A, the proportion of sleep in stage 1 increased by 38%, the proportion of sleep in stage 3+4 was decreased by 19%, and the proportion of REM was decreased by 14% in group C. There was no significant difference between group A and B. There was a significant linear correlation between AHI and ODI in NREM and REM, respectively (r¹=0.663, r₂=0.499, P< 0.001), and the ODI in REM (63.8±35.0) was significantly higher than that in NREM (29.7±36.0), accounting for 68% of the sleep. Sixty-five children had received preoperative arterial blood gas test (awake and post-sleep state). There was a significant negative correlation between AHI and SaO₂ after sleep (r=-0.444, P=0.000), and no significant correlation in awake state. Forty-four patients underwent preoperative echocardiographic examination. There was significant differences between group A and C in interventricular septum thickness, left ventricular diameter, and main pulmonary artery diameter (P<0.05). There was no significant difference between group A and B. There were no significant differences in aortic annulus diameter, left atrial diameter, left ventricular end diastolic dimension (LVEDD), ejection fraction(EF), and right ventricular anteroposterior diameter among the groups (P>0.05). Conclusion: Obesity is an important factor affecting the severity of OSAHS. As the severity of disease increased, the proportion of awakening time and stage 1 of sleep increased, but stage 3, 4 and REM decreased significantly. The SE, SO, and REM latency were significantly associated with the severity of OSAHS. The severity of hypoxemia is significantly related to AHI, and mainly occur in REM stage. Severe OSAHS is risk factor for cardiovascular complications.

Endogenous circulating testosterone and sex hormone-binding globulin levels and measures of myocardial structure and function: the Framingham Heart Study.

The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean=59.6years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p=0.009), left ventricular mass index (p=0.006), cardiac output (p=0.001), and main pulmonary artery diameter (p=0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p=0.002), left ventricular mass index (p=0.004), cardiac output (p=0.003), left ventricular ejection fraction (p=0.039), and main pulmonary artery diameter (p=0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.

Prediction of COPD Using CT Measurements of Pulmonary Artery and Aortic Diameter

Introduction: Chronic obstructive pulmonary disease (COPD) is group of progressive lung disease which commonly includes emphysema and chronic bronchitis. Among non-communicable disease, COPD is estimated to be second largest cause of death in India. Computed Tomography (CT) of chest and measurements of arteries could be simple and effective modality for diagnostic evaluation of COPD.Aim: To determine whether CT measurements such as Pulmonary artery and aortic artery diameters are useful in predicting COPD.Materials and Method: A total of 291 patients was included in this retrospective study who had underwent CT thorax from April 2016 to April 2018. 194 patients with COPD were taken as cases and 97 patients without any history of COPD were taken as controls. Diameters such as Main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), ascending aorta (AAo) and descending aorta (DAo) was measured on an axial CT thorax image. Ratios of MPA/AAo and MPA/DAo were also calculated. Mann Whitney U test was used to compare CT measurements between two groups. Receiver operating characteristic (ROC) curve was used to find sensitivity and specificity of CT measurements in predicting COPD.Results: The sensitivity and specificity for MPA, RPA, LPA, AAo, DAo, MPA/AAo and MPA/DAo was 77.3% & 83%, 74.8% & 79.5%, 71.8 & 78.8, 56.7% & 42.6%, 30.1 & 60.3, 17.3% & 33.8%, 18.9% & 33.8% respectively. There was significant difference in diameters such as MPA, RPA, LPA, AAo and DAo among two groups (p value 0.001).Conclusion: In present study, we found significant increase in MPA, RPA and LPA diameters in COPD patients compared to controls. Henceforth, our study concludes that MPA, RPA and LPA diameters could be useful as reliable indicators in predicting COPD

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test.

PurposePulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality.Material and methodsThe study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors.ResultsBased on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not.ConclusionsRV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.

Effect of Tai Chi on Cardiac and Static Pulmonary Function in Older Community-Dwelling Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial.

To evaluate the effect of tai chi exercise on cardiac and static lung function for older community-dwelling adults at risk of ischemic stroke. A total of 170 older community-dwelling adults (aged 55-75 years old) at risk of ischemic stroke were allocated to either tai chi training group (85 cases, five 60-min sessions of tai chi training per week for 12 weeks) or control group (85 cases, usual pbysical activity for 12 weeks) using a computer-generated randomization. The echocardiographic parameters of cardiac structure, cardiac function and static lung function were measured at baseline, after 12 weeks of intervention and additional 12-week follow-up period by a blinded professional staffmember using a color Doppler ultrasound imaging device or a cardiopulmonary function instrument. The t test and linear mixed model based on the intentionto-treat analysis principle was used to calculate the effect. The adverse effect was observed. Most of echocardiographic parameters on the cardiac structure, cardiac function and static lung function between the tai chi group and control group did not have a significant difference either post 12-week intervention or additional 12-week follow-up period. Only three parameters involving in right ventricular diameter (P=0.024), main pulmonary artery diameter (P=0.002) and vital capacity maximum (P=0.036) were beneficial to be improved in the tai chi group compared to the control group by the analysis of mixed linear model. No adverse effects were found during the intervention period. The 12-week tai chi exercise did not have an obvious beneficial effect on cardiac structure, cardiac function and static lung function in older community-dwelling adults at risk of ischemic stroke. The study with a longer duration of intervention should be necessary. (Trial registration No. ChiCTR-TRC-13003601).

Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot.

The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6months; 7.5 ± 1.3kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> - 3.83) with either PAI (> 0.73) or PA z score (> - 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.

Ratio of pulmonary artery diameter to ascending aortic diameter and severity of heart failure.

Treatment decisions in dilated cardiomyopathy (DCM) patients with severe heart failure (HF) and short clinical history are challenging because of the difficulty of determining HF stage or prognosis in the acute HF phase. We hypothesized that persistent decreased systemic or increased pulmonary arterial pressure, including in the sub-clinical phase, might affect the main pulmonary artery diameter (PAD), ascending aortic diameter (AoD), and their ratio (PAD/AoD). This study assessed AoD, PAD, and PAD/AoD by non-contrast computed tomography scans in DCM patients in the acute phase of HF and examined the association of these parameters with their clinical course. Of 261 screened individuals, we studied 110 consecutive hospitalized patients with DCM suspected of being in advanced stage of HF and 45 age-matched controls, assessing clinical data and later events (cardiac death or left ventricular assist device implantation). Compared with controls, DCM patients had smaller AoD (26.6 ± 4.4 vs 30.6 ± 2.7 mm) and larger PAD (27.7 ± 3.5 vs 25.4 ± 2.8 mm) and PAD/AoD (1.05 ± 0.14 vs 0.83 ± 0.08; all p < 0.01). DCM patients with high PAD/AoD (median, > 1.05) had more frequent past HF hospitalizations, lower blood pressure, stroke volume, and ejection fraction, higher brain natriuretic peptide levels, smaller AoD, and similar PAD compared with patients with a low PAD/AoD. A higher PAD/AoD was associated with poorer outcomes even after adjusting for age, blood pressure, ejection fraction, or number of hospitalizations. Assessment of AoD and PAD may have important clinical implications in determining whether DCM patients are in an advanced stage of HF with a poorer prognosis.