Pulmonary Artery Diameter Research Articles

467 Prognostic Value Of Main Pulmonary Artery Diameter On Coronary CT Angiography For All-cause Mortality In Patients Without Obstructive Coronary Artery Disease

Introduction: The main pulmonary artery (PA) is visualized in coronary CT angiography (CCTA). In previous studies, increased PA diameter (PAd) or the elevated ratio of PA (rPA) to ascending aorta (AA) on CCTA was associated with pulmonary hypertension (PH) and all-cause mortality (ACM). PH can cause similar symptoms to coronary artery disease (CAD) but is often asymptomatic. The prognostic value of PAd on CCTA for prediction of ACM in patients without obstructive CAD and with and without symptoms has not been studied.

Decreased Pulmonary Artery Bifurcation Angle: A Novel Imaging Criterion for the Diagnosis of Chronic Pulmonary Thromboembolism.

Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE.Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson’s tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant.Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH.Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.

Intermediate risk pulmonary embolism concomitant with or without lung cancer: a wide spectrum of features

ABSTRACT Objectives We aimed to investigate the differences in clinical features between pulmonary embolism (PE) patients concomitant with lung cancer and without lung cancer (LC) and gain further understanding of the impact of lung cancer on pulmonary embolism. Methods This retrospective study sampled 114 patients diagnosed with pulmonary embolism from January 2017 to April 2021 in the First Affiliated Hospital of Soochow University. The patients were categorized into the LC group (n = 22) or non-LC group (n = 92). Myocardial injury, coagulation and blood cell parameters, along with imaging findings, were analyzed for the two groups. The primary outcome measure was the 90-day mortality. Results Of the 114 patients with pulmonary embolism in the present study, the 90 intermediate-risk patients were enrolled for further investigations. Compared to the non-LC group, patients in the LC group had milder myocardial injury, more severe coagulation function disorder, a higher incidence of central PE and a smaller change in diameter of the main pulmonary artery. We found that the occurrence of pericardial effusion created the risk of lung cancer in patients with pulmonary embolism, but there was no increase in the 90-day mortality for non-LC group versus LC group. Conclusion Intermediate risk PE patients concomitant with lung cancer seem to be more likely to present specific clinical features, accordingly, clinicians must pay great attention to PE patients concomitant with lung cancer and implement effective treatments to simultaneously manage the two conditions.

Clinical Effect of Pulmonary Artery Diameter/Ascending Aorta Diameter Ratio on Left Ventricular Reverse Remodeling in Patients With Dilated Cardiomyopathy.

Many patients with dilated cardiomyopathy (DCM) progress to heart failure (HF), although some demonstrate left ventricular (LV) reverse remodeling (LVRR), which is associated with better outcomes. The pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) ratio has been used as a prognostic predictor in patients with HF, although this tool's usefulness in predicting LVRR remains unknown.Methods and Results: Data from a prospective observational study of 211 patients diagnosed in 2000-2020 with DCM were retrospectively analyzed. Sixty-nine patients with New York Heart Association class I or II HF were included. LVRR was observed in 23 patients (33.3%). The mean LV ejection fraction (29%) and LV end-diastolic dimension (64.5 mm) were similar in patients with and without LVRR. The PAD/AoD ratio was significantly lower in patients with LVRR than those without (81.4% vs. 92.4%, respectively; P=0.003). The optimal PAD/AoD cut-off value for detecting LVRR was 0.9 according to the receiver operating characteristic curve analysis. Multivariate analysis identified a PAD/AoD ratio ≥0.9 as an independent predictor of presence/absence of LVRR. Cardiac events were significantly more common in patients with a PAD/AoD ratio ≥0.9 than those with a ratio <0.9, after a median follow up of 2.5 years (log-rank, P=0.007). The PAD/AoD ratio can predict LVRR in patients with DCM.

Low incidence of restenosis after successful balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension.

Balloon pulmonary angioplasty (BPA) is now a treatment option for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the incidence of restenosis and long-term changes in vessel diameters in pulmonary arteries after BPA are unknown. The present study investigated the incidence of restenosis by measuring changes in vessel diameter after BPA. We reviewed 58 patients (168 lesions) with CTEPH who underwent single dilation for the target lesion (type A/B/C lesions) during BPA procedure followed by selective pulmonary angiography more than 6months after the final BPA procedure. The outcomes of BPA were assessed in terms of pulmonary artery diameters. In a median follow-up of 1.9 (1.2-2.7) years, restenosis occurred in only one case with a type C lesion after BPA (0.6%). In type A/B lesions, the minimal lumen diameter was significantly enlarged at follow-up after BPA [3.48 (2.59-4.34) to 4.22 (3.31-4.90) mm]. In type C lesions, the minimal lumen diameter was unchanged at follow-up after BPA [3.15 (1.96-3.64) to 3.28 (2.38-4.61) mm]. The present results revealed that restenosis after BPA rarely occurs in type A/B/C lesions. Minimal lumen diameters for type A/B lesions continually increased and those for type C lesions did not decrease. Stent implantation in type A/B/C lesions would be unnecessary after BPA.

Pulmonary artery obstruction index, pulmonary artery diameter and right ventricle strain as prognostic CT findings in patient with acute pulmonary embolism

ObjectiveThis study was designed to determine predictors of pulmonary hypertension and signs of right heart dysfunction caused by pulmonary embolism (PE) that may lead to early detection of high-risk patients. So the predictive value of pulmonary artery obstruction index (PAOI), measured by pulmonary CT angiography (PCTA) in the acute setting, in predicting the patients susceptible to PE cardiac complications was evaluated. Also two other PCTA indices, pulmonary artery diameter (PAD), and right ventricle (RV) strain, in these patients were investigated and their predictive value for cardiac complications on follow up echocardiography were demonstrated. Materials and methodsIn the study 120 patients with a definite diagnosis of PE were included. The PAOI, PAD and RV strain were measured using PCTA at the time of the initial diagnosis. Transthoracic echocardiography was done 6 months after the diagnosis of PE and RV echocardiographic indices were measured. Pearson correlation was used to investigate correlation between PAOI, PAD, RV strain and signs of right heart dysfunction. ResultsPAOI was strongly correlated with systolic pulmonary artery pressure (SPAP) (r=0.83), RV systolic pressure (r=0.78) and RV wall thickness (r=0.61) in long-term follow up echocardiography. A higher rate of RV dysfunction and RV dilation was detected among the patients with higher PAOI (P<0.001). PAOI≥18 was strongly predictive for development of RV dysfunction. Also developments of pulmonary hypertension, RV systolic hypertension, RV dilation, RV dysfunction, and RV hypertrophy were significantly more common among patients with higher PAD and RV strain (P<0.001). ConclusionsPAOI, PAD and RV strain are sensitive and specific PCTA indices that can predict the development of long-term complications such as pulmonary hypertension and right heart dysfunction, at the time of initial PE diagnosis.

Pulmonary hypertension due to HFpEF in rats

Heart failure with preserved ejection fraction (HFpEF) is frequently complicated by pulmonary hypertension (PH), which underlying mechanism remains largely unknown. When present, it is associated with a worse outcome and there are no therapeutic options for PH due to HFpEF. In this context, we sought to characterize the pulmonary circulation in an experimental model of HFpEF in rats, replicating the characteristics of HFpEF observed in patients. Obesity-prone (OP) and -resistant Sprague-Dawley rats were respectively fed with a high-fat diet or a standard rat chow for 12 months ( n = 10 rats in each group) and evaluated by echocardiography, left (LV) and right ventricular (RV) catheterization, histological and pulmonary artery vasoactive analyses. In OP rats fed with high-fat diet during 12 months, HFpEF was confirmed with preserved LV ejection fraction, LV diastolic dysfunction (assessed by increased LV end-diastolic pressure) associated to concentric LV hypertrophy and fibrosis. In rats with HFpEF, RV systolic pressure was increased (31.6 ± 1.0 versus 26.3 ± 0.5 mmHg, P < 0.001), with no significant changes in pulmonary artery muscularization and inflammatory infiltration. Echocardiography showed an increase in pulmonary artery (PA) diameter and PA-to-aorta diameter ratio associated with an increased RV/LV ratio. Circulating levels of sST2 were increased in rats with HFpEF, while NT-proBNP levels decreased. Ex vivo pulmonary artery contraction to phenylephrine and endothelin-1 was similar in both groups of rats. Our model shows that rats develop HFpEF associated to typical risk factors and present with PH. However, at this early stage of HFpEF, neither pronounced pulmonary structural changes nor RV functional and structural changes were observed, suggesting that other mechanisms are likely involved in the development of pulmonary vascular disease in HFpEF.

The effect of main pulmonary artery diameter on the prognosis of COVID-19 patients in the ICU

Aim: The aim of this study was to examine the effect of main pulmonary artery diameter (MPAD), which is evaluated in patients when first admitted to the intensive care unit due to COVID-19, on mortality.&#x0D; Material and Method: Thoracic computed tomography examinations performed during the initial admission to hospital of patients who were treated in the intensive care unit between October 1, 2020, and June 1, 2021, were evaluated retrospectively. Cox regression analysis was performed with the program R-Project to evaluate the relationship between MPAD and mortality.&#x0D; Results: No significant correlation was found between MPAD and mortality in models used with or without adjusting for age and sex (respectively P: 0.890 and P: 0.920). &#x0D; Conclusion: The MPAD value measured at the initial admission of COVID-19 patients hospitalized in the intensive care unit is not a parameter that can be used to predict mortality.

Immediate and Short-Term Variations in the Echocardiographic Cardiac Hemodynamic Parameters after the Transcatheter Atrial Septal Defect Device Closure and its Procedural Success.

Background and Aims:Transcatheter closure of the secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. We aimed to analyze and compare the changes in cardiac hemodynamics with transthoracic echocardiography (TTE) before, within 48 hours, and after 3 months of ASD closure.&#x0D; Methods: This was a prospective, single-centered study of 43 patients who underwent ASD device closure in the Manmohan Cardiothoracic Vascular and Transplant Center during June 2020 to June 2021 with Amplatzer Septal Occluder under transesophageal and fluoroscopic guidance. The patients were evaluated with TTE before, at 48 hours, and 3 months after the procedure.&#x0D; Results: At 48 hours and 3 months of device closure, the right atrial major dimension, the maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity time integral, and E peak and A peak blood flow velocity at the tricuspid valve orifice were significantly reduced (P &lt; 0.001). At 3 months, the dimensions and ejection fraction of the left ventricle showed significant increment (P &lt; 0.001). Likewise, the right atrial minor dimension and area, right ventricular basal, mid, and longitudinal dimensions, tricuspid annular plane systolic excursion, right ventricular Tei Index, and fractional area change were significantly reduced (P &lt; 0.001). The main pulmonary artery diameter, pulmonary artery systolic and mean pressure, and the pulmonary vascular resistance and index were significantly reduced (p &lt;0.001). The procedural success rate was 97.6%.&#x0D; Conclusion: Echocardiographic evaluation demonstrated that cardiac hemodynamics and loading conditions improved significantly at 3 months after percutaneous closure of ASD. The transcatheter closure of ASD was safe with good short-term outcomes.

Association between Large Arteries Diameter and Heart Function in Subjects Free of Cardiovascular Diseases.

To investigate the association between Aorta (Ao), pulmonary artery (PA) diameters and the PA/Ao ratio with right (RV) and left ventricle (LV) volumetric properties in subjects free of cardiovascular diseases. In the KORA-MRI study, 339 subjects (mean age 56.3 ± 9.1 years; 43.7% female) underwent whole-body 3T-MRI. Ao and PA were measured on DIXON sequences. Cvi42 quantified cardiac functional parameters from a SSFP sequence. The relationship between ascending (AAo), and descending aorta (DAo), as well as PA diameters, and RV and LV function were assessed using linear regression models adjusted for age, sex, and cardiovascular risk factors. AAo and DAo diameter were associated with LV end-diastolic volume (β = 4.52, p = 0.015; ß = 7.1, p ≤ 0.001), LV end-systolic volume (β = 2.37, p = 0.031; ß = 3.66, p = 0.002), while DAo associated with RV end-diastolic volume (β = 6.45, p = 0.006) and RV end-systolic volume (β = 3.9, p = 0.011). PA diameter was associated with LV end-diastolic volume (β = 4.81, p = 0.003). Interestingly, the PA/Ao ratio was only associated with RV end-diastolic and end-systolic volume (β = 4.48, p = 0.029; ß = 2.82, p = 0.037). Furthermore, we found different relationships between men and women. Ao and PA diameter were associated with LV and RV volumetric parameters in subjects free of cardiovascular diseases suggesting that ventricular volumetric performance directly relates to vascular diameter properties.

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital.

Introduction: Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population.Method: In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT’s diagnostic capability and cut-off values.Result: The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p<0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively.Conclusions: The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.

The Main Pulmonary Artery to the Ascending Aorta Diameter Ratio (PA/A) as a Predictor of Worse Outcomes in Hospitalized Patients with AECOPD.

PurposeThe main pulmonary artery (PA) to ascending aorta diameter ratio (PA/A) greater than one is a promising indicator of pulmonary hypertension (PH) in acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) (AECOPD). This study aims to disclose the associations between the PA/A ratio and clinical outcomes in hospitalized patients with AECOPD.Patients and MethodsConsecutive AECOPD patients admitted to the Department of Respiratory Medicine from September 2017 to July 2021 were reviewed. The treatment success of AECOPD patients was defined as improvement in the clinical condition when discharged from the hospital. Conversely, treatment failure was considered to be an event of in-hospital death or deterioration of the clinical condition prior to discharge.ResultsA total of 118 individuals were ultimately reviewed in this study: 74 individuals with a PA/A ratio <1 and 44 individuals with a PA/A ratio ≥1. The outcomes of 21 patients were treatment failure, and 97 patients were considered successes. Patients with a PA/A ratio ≥1 had significantly higher PaCO2, red cell distribution width, brain natriuretic peptide, PA diameters, RICU admission rates, and proportions of treatment failure than patients with PA/A ratios <1 (P < 0.05). The PA diameter and PA/A ratio were significantly increased in the treatment failure group compared with the success group (P < 0.05). A survival analysis indicated that patients with a PA/A ratio ≥1 had worse outcomes than patients with a PA/A ratio <1 during hospitalization (P < 0.05). A multivariate analysis showed that a PA/A ratio ≥1 was an independent risk factor for treatment failure in patients with AECOPD.ConclusionsAECOPD patients with a PA/A ratio ≥1 may have worse outcomes during hospitalization. A PA/A ratio ≥1 may be a promising predictor of treatment failure in patients with AECOPD.

Diagnostic accuracy of an automated artificial intelligence derived right ventricular to left ventricular diameter ratio tool on CT pulmonary angiography to predict pulmonary hypertension at right heart catheterisation

To determine the diagnostic accuracy of an automated artificial intelligence derived right ventricle/left ventricle diameter ratio (RV/LV) computed tomography pulmonary angiography (CTPA) analysis tool to detect pulmonary hypertension (PH) in patients with suspected PH referred to a specialist centre. The present study was a retrospective analysis of a prospectively maintained database of 202 consecutive patients with suspected PH, who underwent CTPA within 12 months of right heart catheterisation (RHC). Automated ventricular segmentation and RV/LV calculation (Imbio LLC, Minneapolis, MN, USA) was undertaken on the CTPA images. PH diagnosis was made using the RHC reference standard. The automated RV/LV correlated more strongly with RHC metrics than main pulmonary artery (MPA) diameter and MPA to ascending aorta diameter ratio (MPA/AA) measured manually (mean pulmonary arterial pressure [mPAP] r=0.535, R2=0.287 p<0.001; pulmonary vascular resistance [PVR] r=0.607, R2=0.369 p<0.001). In the derivation cohort (n=100), the area under the receiver-operating curve for automated RV/LV discriminating PH was 0.752 (95% confidence interval [CI] 0.677-0.827, p<0.001). Using an optimised Youden's Index of ≥1.12 classified from derivation, automated RV/LV ratio analysis was more sensitive for the detection of PH with higher positive predictive value (PPV) when compared with manual MPA and MPA/AA in the validation cohort (n=102). Automated RV/LV compromise (1.12) and specific (1.335) thresholds were strongly predictive of mortality (log-rank 7.401, p=0.007 and log-rank 16.075, p<0.001 respectively). In suspected PH, automated RV/LV diameter thresholds have high sensitivity for PH, outperform manual MPA and MPA/AA and can predict survival.

Pulmonary vascular volume is associated with DLCO and fibrotic score in idiopathic pulmonary fibrosis: an observational study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a disease that primarily occurs in elderly individuals. However, it is difficult to diagnose and has a complex disease course. High-resolution computed tomography (HRCT) and lung function testing are crucial for its diagnosis and follow-up. However, the correlation of HRCT findings with lung function test results has not been extensively investigated.MethodsThis study retrospectively analysed the medical records and images of patients with IPF. Patients with evident emphysema and lung cancer were excluded. The diagnosis of all the included cases was confirmed following a discussion among specialists from multiple disciplines. The correlation of HRCT findings, including fibrotic score, HRCT lung volume, pulmonary artery trunk (PA) diameter and pulmonary vascular volume (PVV), with lung function test parameters, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), was analysed.ResultsA total of 32 patients were included. Higher fibrotic and PVV scores were significantly correlated with lower DLCO (r = − 0.59, p = 0.01; r = − 0.43, p = 0.03, respectively) but not with FVC. Higher PVV score significantly correlated with higher fibrotic score (r = 0.59, p < 0.01) and PA diameter (r = 0.47, p = 0.006).ConclusionOur study demonstrated the structural and functional correlation of IPF. The extent of lung fibrosis (fibrotic score) and PVV score were associated with DLCO but not with FVC. The PA diameter, which reflects the pulmonary artery pressure, was found to be associated with the PVV score.

​​Importance of Right Pulmonary Artery Distensibility Index in the Diagnosis and Management of Pulmonary Arterial Hypertension Secondary to Canine Dilated Cardiomyopathy

Background: The measurement of tricuspid regurgitant velocity is the commonly used non-invasive method for the diagnosis of pulmonary hypertension in dogs. It is anticipated that M-mode echocardiographic measurement of right pulmonary artery distensibility (RPAD) index is simple and provides accurate means for the diagnosis of pulmonary arterial hypertension when tricuspid regurgitant velocity is absent. Hence this study was undertaken to evaluate the importance of RPAD index in the diagnosis and management of pulmonary arterial hypertension secondary to dilated cardiomyopathy. Methods: In the present study, a total of 165 dogs were subjected to echocardiography for diagnosis of pulmonary hypertension secondary to dilated cardiomyopathy. The maximum and minimum internal diameter of the right pulmonary artery during systole and diastole were quantified respectively to determine the right pulmonary artery distensibility (RPAD) index in right parasternal short axis M-mode echocardiogram. The M-mode morphology of right pulmonary artery (anterior dicrotic notch) also recorded. Result: Out of 165 dogs ten dogs had pulmonary arterial hypertension with dilated cardiomyopathy. Dogs with pulmonary hypertension showed a significant decrease in the mean right pulmonary artery distensibility index values and Acceleration time/Ejection time (AT/ET) ratio, while the mean tricuspid regurgitant systolic pressure gradient (TRPG) were significantly elevated when compared to the respective control group. The significant difference was observed in the mean values of tricuspid regurgitant systolic pressure gradient and RPAD index before and after the treatment.

Branch pulmonary artery stent angioplasty in infants less than 10 kg

BackgroundBranch pulmonary artery (PA) Stenting is an established strategy for PA stenosis in older children and adults. Its use in infants is less well established. We describe our experience of branch PA Stenting in infants <10 kg. MethodRetrospective chart review of infants <10 kg who underwent PA Stenting at The Children's Hospital, Westmead between 2010 and 2020. Pre and post-procedural angiograms were reviewed to determine PA size. Technical procedural success was defined as >50% increase in PA diameter. Procedural complications and need for PA re-intervention were ascertained. ResultsForty-one children (age 7.6 months, IQR 2.4–9.8 months, weight 5.9 ± 2.2 kg) had 43 primary Stent implantations (10/43 intraoperative versus 33/43 transcatheter; left pulmonary artery [LPA] 25/43, right pulmonary artery [RPA] 8/43 and bilateral 10/43). Diagnoses were tetralogy of Fallot (27%), hypoplastic left heart syndrome (24%), truncus arteriosus (12%), transposition of the great arteries (7%), other single ventricle (10%) and other biventricular (20%). 40/41 (98%) had undergone a cardiac intervention in the preceding 31 days, [IQR 1–181], with 17/41 having prior branch PA intervention. 14/41 patients had urgent Stenting. There were 2 minor and 1 major complications with no procedural mortality. LPA (LPApre 2.3 ± 1.0 × 2.2 ± 1.2 mm versus LPApost 5.2 ± 1.3 × 5.0 ± 1.7 mm, p < 0.01) and RPA (RPApre 2.5 ± 0.8 × 1.9 ± 0.8 mm versus RPApost 4.9 ± 1.0 × 4.1 ± 1.0 mm, p < 0.01) calibre increased post Stenting. 20/41 required branch PA reintervention (time to reintervention 13.6 months [IQR 8.2–29.3]. ConclusionsBranch PA Stenting is effective and safe in infants <10 kg with expected high rates of reintervention. Urgent PA Stenting provides relief of early post-operative haemodynamic compromise.

Ratio of Pulmonary Artery to Ascending Aortic Diameter Predicts Primary Graft Dysfunction After Cardiac Transplantation

<h3>Purpose</h3> Primary graft dysfunction (PGD) is associated with high mortality rates after heart transplantation. Described risk factors for PGD include pulmonary hypertension. This study aimed to evaluate a noninvasive parameter of pulmonary hemodynamics based on the ratio of pulmonary and aortic diameters (PA/Ao ratio) as a predictive tool for severe PGD <h3>Methods</h3> All adult patients who underwent heart transplantation in our center from January 2011 to December 2020 were included. Measurement of main pulmonary artery and aortic diameters were performed. Primary outcome was the occurence of severe PGD <h3>Endpoints</h3> 46 over 176 included patients had severe PGD (26.1%) with a 30-day mortality of 34.8% compared to 5.4% for patients without severe PGD (p<0.0001). Variables associated with severe PGD in multivariate analysis were redo surgery (OR 2.546 [1.226; 5.289], p=0.012), time between heart failure diagnosis and transplantation (OR 1.046 [1.003; 1.091], p=0.037) and PA/Ao ratio (OR 1.509 [1.062; 2.145], p=0.022). PA/Ao ratio was positively correlated with systolic and mean pulmonary artery pressure (r=0.311, p<0.0001 and r=0.326), pulmonary wedge pressure (r=0.306 <0.0001) and pulmonary vascular resistance (r=0.217, p=0.007). A PA/Ao diameter ratio > 1.06 was associated with severe PGD (OR 2,766 [1,167; 6,558], p=0,021) and achieved a specificity 80 % and sensitivity of 39 %. High PA/Ao diameter ratio is associated with elevated pulmonary pressures and outmatches pulmonary hemodynamic parameters for predicting severe PGD in this cohort. PA/Ao ratio may be a valuable tool to be integrated in predictive scores for PGD.

Meeting abstracts from the 15th international conference on neonatal and childhood pulmonary vascular disease

Meeting abstracts from the 15th international conference on neonatal and childhood pulmonary vascular disease

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

Background: Pulmonary thromboembolism can be easily diagnosed with computed tomography (CT) and pulmonary angiography (CTPA). However, diagnosis is difficult since a contrast agent cannot be used. Several criteria are recommended for the diagnosis of pulmonary embolism (PE) with non-enhanced CT. Objectives: The aim of this study is to investigate the value of the increase in the pulmonary artery diameter (PA-D) and the ratio of the pulmonary artery diameter / ascending aorta diameter (Ao-D) ratio (PA-D/Ao-D) in the diagnosis of PE in the emergency department (ED). Methods: The CTPA of patients diagnosed with PE (n=88) and a control group (n=89) were examined retrospectively. The main PA (MPA), right MPA (RMPA), left MPA (LMPA), and Ao-D were measured. The ratio of PA-D and Ao-D was calculated. Results: Mean age of participants of this study was 67.85±17.03 (Min:18, Max:98) in the PE group and 67.31±20.17 (Min:20, Max:91) in the control group (P=0.272). The PE diagnosis of RMPA, right segmental PA, and right subsegmental PA were found to be more than the left side. Moreover, the mean D-Dimer levels were found to be higher in the PE group (7.31±3.528 mcg/L), compared to the control group (1.52±1.042 mcg/L) (P=0.000). In the PE group, the mean Ao-D (35.14±4.55 mm) was larger, compared to the control group (34.97±5.28 mm); however, it was not statistically significant (P=0,828). In the PE group, the average MPA diameter (MPA-D) (30.45±4.77 mm) was larger than that of the control group (28.35±3.81 mm) and statistically significant (P=0,001). In addition, in the PE group, the average MPA-D/Ao-D ratio (0.87±0.15) was higher in comparison to the control group (0.82±0.13) (P=0,016). Conclusion: The increase in PA-D and PA-D/Ao-D ratio can be used in the diagnosis of PE when contrast agent cannot be given on CT or when thrombus cannot be seen on CT for the diagnosis of PE in the ED.

Pulmonary Artery Remodeling and Advanced Hemodynamics: Magnetic Resonance Imaging Biomarkers of Pulmonary Hypertension

Poorly characterized by non-invasive diagnostic imaging techniques, pulmonary hypertension (PHT) is commonly associated with changes in vascular hemodynamics and remodeling of pulmonary artery architecture. These disease phenotypes represent potential biomarkers of interest in clinical environment. In this retrospective clinical study, 33 patients with pulmonary hypertension and seventeen controls were recruited. Architectural remodeling was characterized using 3D-contrast enhanced angiogram via the measurement of pulmonary artery diameters, bifurcation distances, and angles. Hemodynamics were characterized using 4D-flow magnetic resonance imaging (MRI) via wall shear stress, kinetic energy, vorticity, and directional flow dynamics. Parameters were compared using independent samples student’s t-tests. Correlational analysis was performed using Pearson’s correlation. PHT patients demonstrated dilation in the main and right branch of the pulmonary artery (p &lt; 0.05). Furthermore, these patients also exhibited increases in bifurcation distances in the left and right pulmonary arteries (p &lt; 0.05). Wall shear stress, maximum kinetic energy, and energy loss were decreased in the pulmonary artery (p &lt; 0.001). Correlations were observed between peak velocities and right ventricle ejection fraction (r = 0.527, p &lt; 0.05). These findings suggest that pulmonary artery remodeling and hemodynamic changes may possess clinical utility as MRI biomarkers for PHT.