Pulmonary Artery Diameter Research Articles

COVID-19 Pnömonili Hastaların Taburculuk Sonrası Sağ Ventrikül Fonksiyonunun Sağ Ventriküler Erken Giriş-Çıkış İndeksi ile Değerlendirilmesi

Aim
 The coronavirus disease 2019 (COVID-19) causes many cardiovascular complications. In patients with comorbidities, COVID-19 infection has a more severe course. Although some patients who do not have comorbidities, severe infection and death may occur. In studies, many echocardiographic parameters were found to be impaired in patients with COVID-19 pneumonia. The right ventricular premature inflow-output flow (RVEIO) index is a possible and indirect predictor of the severity of right ventricular dysfunction. The aim of our study is to evaluate the RVEIO index after discharge in patients with moderate-to-severe COVID-19 pneumonia without comorbidities.
 Methods
 The study was conducted in a single center, prospectively. One month after discharge, echocardiography and biochemical tests were performed in 57 patients with moderate-to-severe COVID-19 pneumonia without comorbidities.
 Results
 Pulmonary artery diameter was found to be significantly larger in the severe group [1.9 (1.8-2) vs. 2 (1.9-2.1); p=0.014]. Pulmonary artery acceleration time [140.92±11.70 vs 114.58±12.03; p=0.001)] and RVOT VTI [23.48±1.96 vs 19.18±2.2; p

Left main coronary artery compression by dilated pulmonary artery in pulmonary arterial hypertension: a systematic review and meta-analysis.

Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A meta-analysis of LMCo cases could fill the knowledge gaps in this topic. Electronic databases were searched for all LMCo/PAH studies, abstracts and case reports including pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis was used to evaluate LMCo-associated factors. Specificity, sensitivity and accuracy of PA size thresholds for diagnosis of LMCo were calculated. Treatment options and outcomes were summarized. A total of five case-control cohorts and 64 case reports/series (196 LMCo and 438 controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46 [1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA pressure or vascular resistance. A 40mm cut-off for the PA diameter had balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for LMCo diagnosis, while a value of 44mm had higher accuracy (81.7%), higher specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after non-conservative treatment (n = 150, predominantly stenting) was 2.7% at up to 22months of mean follow-up, with 83% survivors having no angina at follow-up. PA diameter, PA/aorta ratio and CHD are associated with LMCo, while hemodynamic parameters are not. Data from this study support that a PA diameter cut-off between 40 and 44mm can offer optimal accuracy for LMCo screening. Preferred treatment was coronary stenting, associated with low mid-term mortality and symptom relief. Diagnosis and management of left main coronary artery compression (LMCo) in patients with pulmonary arterial hypertension (PAH).

The effect of clinical, laboratory findings and parenchymal infiltration features on the diameter of the main pulmonary artery in COVID-19 pneumonia.

Purpose: The main pulmonary artery diameter is an indirect indicator of pulmonary vascular bed resistance. In this study, it was aimed to reveal which parameters are associated with respiratory distress by evaluating the parameters affecting the diameter of the main pulmonary artery in cases with COVID-19 pneumonia. Methods: The relationship between comorbid diseases, clinical findings, laboratory values, pulmonary infiltration features, and main pulmonary artery diameter (MPAD) was statistically evaluated. Results: When MPAD 27.5 mm was considered as enlargement; it was significantly wider in smokers in COVID-19 pneumonia (p<0.05). It was statistically shown that there was not association with diabetes, hypertension, asthma, or COPD and MPAD (p>0.05). It was observed that MPAD was associated with shortness of breath (p=0.039; p<0.05) but not with cough and fever (p>0.05). Also, it was found that MPAD was significantly wider in cases with high CRP and LDH values (p=0.008; p<0.01, p=0.011; p<0.05, respectively). While MPAD did not differ significantly in those with ground-glass infiltration; MPAD was significantly larger in those with infiltration in the form of crazy-paving or consolidation (p<0.05). While there is no significant variation in MPAD in those with periferobasal involvement; MPAD was significantly wider in cases with central or mixed infiltration (p<0.05). Conclusion: It is possible to indirectly predict respiratory distress in COVID-19 patients by measuring MPAD, which is associated with respiratory distress. Smoking, CRP and LDH values, central infiltration in the pattern of crazy-paving or consolidation are related with increased MPAD in COVID-19 pneumonia.

Early postmortem changes in the pulmonary artery and veins: An antemortem and postmortem computed tomography study

• Postmortem changes in the pulmonary artery and veins were unclear. • The diameter of the pulmonary artery and veins was measured at five points both on the antemortem and postmortem CT of the same patient. Two patient groups were enrolled: the control group and the died-of-congestive heart failure group. • In both groups, the main pulmonary artery diameter decreased after death. • Congestive heart failure caused a greater decrease in pulmonary vein diameter compared to the control group. To compare the diameter of pulmonary vessels on antemortem (AMCT) and postmortem computed tomography (PMCT). This retrospective case–control study included 641 patients who underwent AMCT within 30 days before death, died in the hospital, and underwent PMCT and conventional autopsy, as a reference standard, soon after death between 2009 and 2020 at a university hospital. The control group comprised 8 patients without lung and pulmonary vessel abnormalities, whereas the heart failure group comprised 16 patients who died of congestive heart failure. The diameters of the main pulmonary artery and bilateral superior and inferior pulmonary veins were measured on AMCT and PMCT images and statistically analyzed (240 vessels in total). In both groups, PMCT resulted in significantly smaller main pulmonary artery diameters compared to AMCT. The control group had greater pulmonary vein diameters compared to the heart failure group after death, although the difference did not reach statistical significance. Comparison between the groups revealed that the heart failure group had significantly greater tendency for postmortem decrease in the pulmonary vein diameters compared to the control group. Our findings showed that the main pulmonary artery diameter decreases after death. Moreover, patients who died of congestive heart failure had a greater tendency for decreased pulmonary vein diameter compared to those who died without cardiopulmonary abnormalities. Five measuring points of the pulmonary vessels.

Larger pulmonary artery to ascending aorta ratios are associated with decreased survival of patients undergoing pulmonary endarterectomy

ObjectivesThe ratio of pulmonary artery (PA) and ascending aorta (AA) diameters has recently been shown to be a useful indicator for disease severity and predictor of outcome in patients with pulmonary hypertension and heart failure. This study aimed at evaluating the applicability of this ratio for perioperative risk assessment of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. MethodsIn this retrospective cohort study on 149 patients undergoing pulmonary endarterectomy between 2013 and 2020, the preoperative PA to AA ratio was analyzed on axial computed tomography. Variables of pulmonary hemodynamic status were assessed during preoperative right heart catheterization and postoperative Swan-Ganz catheter measurements. Perioperative survival was analyzed by Kaplan-Meier method and log-rank tests. ResultsPreoperative computed tomography measurements showed a median AA diameter of 31 mm (range, 19-47 mm), and a median PA diameter of 36 mm (range, 25-55 mm). The calculated median PA to AA ratio was 1.13 (range, 0.79-1.80). PA to AA ratio correlated positively with PA pressure (systolic, r = 0.352 [P < .001]; diastolic, r = 0.406 [P < .001]; mean, r = 0.318 [P < .001]) and inversely with age (r = −0.484 [P < .001]). Univariable Cox regression analysis identified PA diameter (P = .008) as a preoperative parameter predictive of survival. There was a significant difference (log-rank P = .037) in 30-day survival probability for patients with lower PA to AA ratios (<1.136; survival probability, 97.4%) compared with patients with higher ratios (>1.136; survival probability, 88.9%). ConclusionsPA to AA ratio shows a correlation with other variables associated with pulmonary hypertension. In addition, patients with higher PA to AA ratios have lower survival probabilities after PEA. Further analysis of PA to AA ratio on the selection of chronic thromboembolic pulmonary hypertension for different treatment modalities—pulmonary endarterectomy, medical therapy, and or balloon pulmonary angioplasty—is warranted.

Computed tomographic assessment of right ventricular long axis strain for prognosis after transcatheter aortic valve replacement

ObjectivesTo investigate the predictive value of right ventricular long axis strain (RV-LAS) derived by cardiac computed tomography angiography (CCTA) for mortality in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). MethodsWe retrospectively included patients with severe AS undergoing TAVR (n = 168, median 79 years). Parameters of RV function including RV-LAS and RV ejection fraction (RVEF) were assessed using pre-procedural systolic and diastolic CCTA series. The tricuspid annulus diameter (TAD) and diameter of the main pulmonary artery (mPA) were also assessed. All-cause mortality was recorded post-TAVR. Cox regression was used and results are presented with hazard ratio (HR) and 95% confidence interval (CI). Harrell's c-index was used to assess the performance of different models and the likelihood ratio test was used to compare nested models. ResultsThirty-eight deaths (22.6%) occurred over a median follow-up of 21 months. RV-LAS > -11.42% (HR 2.86, 95% CI 1.44–5.67, p = 0.003), LVEF (HR 0.98, 95% CI 0.96–0.996; p = 0.02), TAD (HR 1.05, 95% CI 1.01–1.10, p = 0.02) and mPA diameter (HR 1.09, 95% CI 1.02–1.16, p = 0.01) were associated with mortality on univariable analysis. In a multivariable model, only RV-LAS (HR 2.36, 95% CI 1.04–5.36, p = 0.04) remained as an independent predictor of all-cause mortality. RV-LAS significantly improved the predictive power of the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (c-index 0.700 vs 0.637; p = 0.01). ConclusionRV-LAS was an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR, outperformed anatomical markers such as TAD and mPA diameter, and could potentially improve the current risk-stratifying tool.

Exploring the feasibility of the aorta to pulmonary artery ratio as novel risk marker of acute aortic syndromes in dilated aorta without conventional criteria for surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Based on current guidelines, surgery indication of thoracic ascending aortic aneurysm (TAAA) is mainly driven by the aortic diameter. However, most cases of TAAA acute complications occur in patients who did not previously meet the 55 mm criteria for preventive surgical replacement (1). Both aorta indexed to height and to body surface area have been proposed as possible solution but indexed diameters of healthy aortas widely vary (2). Accordingly, new individualized biomarkers to improve the risk stratification of dilated aorta without a conventional criteria for surgery remain an unmet clinical need. Since aorta and pulmonary artery have an established ratio in general population (upper normal ratio of 1.2) (3), the aorta-to-pulmonary-artery ratio (A:PA) may better define the wall stress in a dilated aorta, overcoming the individual limitations of conventional size criteria. Purpose The aim of our study is to find a novel aortic indexed diameter with better prognostic performance. Therefore, we aimed to explore the feasibility of using the A:PA as risk predictor in TAAA with aortic diameter &amp;lt; 55 mm. Methods All consecutive patients with an acute aortic syndrome (AAS), diagnosed by CT scan in our tertiary hospital between January 2010 and June 2021 undergoing surgical repair, were retrospectively analyzed. Patients with pulmonary hypertension were excluded to prevent distortions in the pulmonary artery diameter. Basic clinical characteristics regarding indications of surgery were collected along with measurements of the aortic maximum diameter and pulmonary artery maximum diameter, obtained by multiplane reconstruction (Figure, Panels A, B). Patients were categorized into three groups based on aortic diameter terciles: group A included patients with &amp;lt; 47 mm, group B ≥ 47 mm but &amp;lt; 55 mm and group C ≥ 55 mm. Considering a high risk of concomitant confounding factors the lower tercile was subsequently excluded of the analysis. Results A total 48 patients were included. 69% of the patients had an aortic diameter that would have not fulfilled a preventive surgery indication. Two patients had bicuspid aortic valve, both of them with aortic aneurysms &amp;gt; 55 mm. None had high risk connective tissue disorders. There were no significant differences in baseline characteristics between the groups (Table 1). A PA ratio was similar in group B and C [1.91 (0.41) versus 2.11(0.45); p = 0.251], suggesting a similar aortic wall stress between aortas despite the difference in aortic diameters [49.5 mm (5.0) versus 58 mm (4.7); p &amp;lt; 0.001] (Figure 1, Panels C, D). Conclusions: Our findings suggest that the A PA ratio may be a promising risk stratification biomarker for TAAA without a conventional criteria for preventive surgery. This novel parameter should be prospectively tested in cohorts of TAAA. To the best of our knowledge, this is the first attempt to describe the usefulness of this parameter. Abstract FIGURE 1 Abstract TABLE 1

Investigation on the Association of Cardiovascular Markers with Severity of Chronic Pyelonephritis.

Chronic kidney disease (CKD) is an established independent risk factor for cardiovascular disease (CVD) and is caused by chronic pyelonephritis (CP). This study aimed to investigate the effect of the association of cardiovascular markers with the course of CP on the comorbidity of CP with ischemic heart disease. The study participants included 125 patients with CP without symptoms of urinary tract obstruction who were divided into three groups. The first group (n=45) consisted of patients with recurrent CP (CPr) three or more times per year. The second group (n=42) included patients with active phase pyelonephritis (CPa), with a frequency of two times or less per year, with concomitant pathology (stable coronary artery disease, functional class I - II), and the third group (n=38) included patients with an inactive phase of the disease (CPi), with a history of pyelonephritis of at least five years. The patients' carotid artery augmentation index (AI %) and the change in the diameter of the brachial artery (D %) in CPi, CPa, and CPr groups were 8.44±1.76, 15.47±4.00, 11.71±1.70, 13.81±3.06, 12.75±2.55 and 6.54±3.27, respectively. The left ventricular ejection fraction (EF) index in the three study groups was estimated to be 68.92±3.76, 64.76±2.75, and 66.28±3.45%, respectively. An analysis of the results showed the most significant changes in the parameters of the cardiovascular system in patients with a comorbid and relapsing course of CP. The results showed a significant increase in pulmonary artery diameter, EF, left ventricular pressure and volume, pulse wave velocity in the aorta, and vascular resistance index.

Right ventricular end-systolic remodeling index on cardiac magnetic resonance imaging: comparison with other functional markers in patients with chronic thromboembolic pulmonary hypertension.

Cardiac magnetic resonance imaging (CMR) can provide important metrics of pulmonary hypertension. In the current study, we investigated whether the CMR-derived right ventricular end-systolic remodeling index (RVESRI) could be a metric in assessing the function and hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH). A total of 64 patients (45±14 years, 37 males), including 46 patients with CTEPH and 18 patients with chronic pulmonary thromboembolism (CTE), were retrospectively enrolled. All patients underwent right heart catheterization and CMR within 7 days. RVESRI, right ventricular eccentricity index, right ventricular end-diastolic and end-systolic volume index, right ventricular ejection fraction, right ventricular cardiac output, and strain were analyzed on cine images of CMR. Hemodynamic parameters including mean pulmonary arterial pressure, pulmonary vascular resistance, and cardiac output were obtained from right heart catheterization. RVESRI of all patients was 1.50 (IQR, 1.26-1.90). Compared with CTE patients, RVESRI in patients with CTEPH was significantly increased (U=27.5, P<0.001). The interclass correlation coefficients of intra-observer reproducibility and inter-observer reproducibility for RVESRI measurement were 0.96 (95% CI, 0.93-0.97) and 0.99 (95% CI, 0.98-0.99), respectively. RVESRI positively correlated with right ventricular end-diastolic and end-systolic volume index and right ventricular global longitudinal strain (r=0.79, 0.83, 0.62, P<0.001), while it was negatively correlated with right ventricular ejection fraction (r=-0.64, P<0.001), right ventricular cardiac output (r=-0.50, P<0.001), and right ventricular eccentricity index (r=-0.81, P<0.001). RVESRI had a positive correlation with mean pulmonary arterial pressure (r=0.65, P<0.001) and pulmonary vascular resistance (r=0.69, P<0.001), while it was negatively correlated with cardiac output (r=-0.64, P<0.001). The receiver operating characteristic curve indicated that RVESRI >1.35 had a sensitivity of 97.8% and specificity of 83.3% in predicting mean pulmonary arterial pressure ≥25 mmHg, and its area under the curve (AUC) was 0.96±0.02. Meanwhile, the AUC of RVESRI was similar to RVEI (Z=1.635, P=0.102) and was more than the diameter of the main pulmonary artery (MPA) (Z=2.26, P=0.02) and the ratio of the MPA and ascending aorta diameter (MPA/AAo) (Z=3.826, P<0.001) in predicting mean pulmonary arterial pressure ≥25 mmHg. RVESRI measured on CMR is a simple and reproducible metric in assessing right ventricular function and hemodynamics in CTEPH patients.

Fontan Geometry and Hemodynamics Are Associated With Quality of Life in Adolescents and Young Adults

BackgroundDespite favorable short-term outcomes, Fontan palliation is associated with comorbidities and diminished quality of life (QOL) in the years after completion. We hypothesized that poor Fontan hemodynamics and ventricular function are associated with worse QOL. MethodsThis was a single-center study of Fontan survivors aged more than 12 years. Subjects completed a cardiac magnetic resonance scan and QOL questionnaire. Cardiac magnetic resonance-derived variables included Fontan geometry, and hemodynamics. Computational fluid dynamics simulations quantified power loss, pressure drop, and total cavopulmonary connection resistance across the Fontan. Quality of life was assessed by completion of the Pediatric Quality of Life Inventory. Longitudinal and cross-sectional comparisons were made between cardiac magnetic resonance and computational fluid dynamics parameters with patient-reported QOL. ResultsWe studied 77 Fontan patients, median age 19.7 years (interquartile range, 17.1 to 23.6), median time from Fontan completion 16 years (interquartile range, 13 to 20). Longitudinal data were available for 48 patients; median time between cardiac magnetic resonance and QOL was 8.1 years (interquartile range, 7 to 9.4). Median patient-reported Pediatric Quality of Life Inventory total score was 80 (interquartile range, 67.4 to 88). Greater power loss and smaller left pulmonary artery diameter at baseline were associated with worse QOL at follow-up. Greater pressure drop was associated with worse QOL at the same time point. ConclusionsFor Fontan survivors, measures of computational fluid dynamics hemodynamics and geometry are associated with worse QOL. Interventional strategies targeted at optimizing the Fontan may improve QOL.

Bronchiectasis: Retrospective Analysis of Clinical and Pathological Findings in a Tertiary-Care Hospital.

Background Bronchiectasis is still a challenging chronic lung disease in developing countries. Patients with bronchiectasis can also have pulmonary hypertension. There are sparse data on the prevalence of pulmonary hypertension in patients with bronchiectasis. Materials and methods. Archived H&E-stained slides of 141 patients histopathologically diagnosed with bronchiectasis were reevaluated. Cases were categorized into 4 subgroups based on histology: tubular, varicose, follicular, and cystic. In addition, concomitant histopathological changes were also reevaluated. For patients with available CT sections, main, right, and left pulmonary artery (PA) diameters and PA/aorta ratio were measured with regard to pulmonary hypertension. Results Of the cases, 70% (n = 89) were female and 30% (n = 52) were male, with a mean age of 36.58 in females and 33.84 in males. Histopathologically, 43% (n = 68) of the cases showed follicular, 37% (n = 59) showed varicose, 35% (n = 56) showed tubular, and 28% (n = 45) showed cystic bronchiectasis morphology. All cases showed chronic inflammation, fibrosis, muscle destruction, and cartilage destruction. Aspergillus were present in 11% of the cases showing cystic morphology. Approximately 17% of the cases (n = 24) were found to have neuroendocrine cell proliferations. In cases with medial hypertrophy, a statistically significant increase in the left pulmonary artery diameter was radiologically determined. Conclusions Medial hypertrophy was found to be significant with regard to indicating a radiological increase in left pulmonary artery diameter. Vascular changes observed in bronchiectasis cases and the presence of neuroendocrine cell proliferations should be specified in pathology reports, and aspergilloma should be carefully investigated in cases with predominant cystic morphology.

Shunt resistance is associated with clinically important outcomes after the Norwood operation

BackgroundIn single-ventricle physiology, focus on pulmonary vascular resistance neglects the resistance in the conduit supplying the pulmonary inflow. MethodsConduit length and diameter, which can approximate conduit resistance, are available in the public dataset of Single Ventricle Reconstruction (SVR) trial. Conduit resistance was then calculated for SVR trial participants and the relationship with clinically important variables (death or transplant at 1 year, pulmonary artery size at second-stage palliation, pulmonary-to-systemic blood flow ratio, and supplemental oxygen requirement) was explored. To validate this calculated resistance, calculated resistance was compared with catheterization measurements at a single institution (not included in the SVR trial). ResultsIn the institutional dataset, calculated and measured resistances had an intraclass correlation of 0.78 for modified Blalock–Taussig shunts (MBTS). Within the SVR trial, transplant-free survivors had a lower MBTS resistance (median, 8.3 Woods Units [WU]. interquartile range [IQR], 6.5-11.1 WU) than patients who died or required transplantation (median, 13.0 WU; IQR, 9.4-16.6 WU, P = .0001). When we controlled for left pulmonary artery diameter after the Norwood procedure in the SVR trial, for each unit increase in MBTS resistance, the left pulmonary artery diameter at stage II decreased (–0.006 ± 0.002 cm, P = .005). When we controlled for pulmonary vascular resistance, greater MBTS resistance was associated with a decrease in log pulmonary-to-systemic blood flow ratio (–0.04 ± 0.015, P = .0048) in the SVR trial. Patients in the SVR trial requiring supplemental oxygen on admission for stage II palliation had greater MBTS resistance (median. 11.1 WU; IQR, 6.6-16.6 WU) than patients not requiring oxygen (median 8.3, WU; IQR, 6.5-11.1 WU, P = .015). ConclusionsConduit resistance is associated with important clinical outcomes after Norwood; however, further studies are required to guide conduit resistance optimization.

Echocardiographic Predictors of Ductal Tissue-Related Branch Pulmonary Artery Stenosis in Pulmonary Atresia.

Branch pulmonary artery (PA) stenosis due to ductus arteriosus (DA) tissue (DA-PS) contributes to the morbidity associated with pulmonary atresia (PAtr). We sought to identify preoperative echocardiographic features predictive of DA-PS. Patients consecutively encountered with PAtr and a DA-dependent pulmonary circulation at birth who underwent intervention in our program over a 5-year period were identified and records reviewed. Preoperative echocardiograms were reviewed to identify features that predicted postoperative DA-PS. Seventy patients with PAtr met inclusion criteria and 36 (51%) had DA-PS. At preoperative echocardiography, the proximal diameter of the PA ipsilateral to the DA was smaller in those with versus without DA-PS (Z-score - 4.8 ± 1.7 vs - 1.1 ± 1.7, respectively p < 0.001). PA origins could not be imaged on the same axial plane in 21/36 (58%) with versus 2/34 (6%) without DA-PS. Patients with DA-PS had an obtuse posterior angle of the PA bifurcation compared to those without (128 ± 17° and 87 ± 21°, p < 0.001), and a posterior angle of > 100° best predicted DA-PS with a sensitivity of 97% and specificity of 76%. An abnormal PA relationship and/or an obtuse posterior bifurcation angle had a sensitivity, specificity, positive and negative predictive value for DA-PS of 78%, 94%, 90% and 86%, respectively. Finally, DA insertion was into the ipsilateral PA in 26/36 (72%) of cases with DA-PS. A smaller proximal ipsilateral PA diameter, inability to image the PAs in the same plane, a posterior PA bifurcation angle of > 100°, and insertion of the DA in the ipsilateral PA demonstrated by echo are useful in identifying patients at risk for DA-PS.

Echocardiographic probability of pulmonary hypertension: a validation study.

According to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterisation (RHC). How echocardiography predicts PH recently redefined by mean pulmonary arterial pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by pulmonary vascular resistance (PVR) ≥3 or >2 WU has not been established. A total of 278 patients referred for PH underwent comprehensive echocardiography followed by RHC. 15 patients (5.4%) were excluded because of insufficient quality echocardiography. With PH defined by mPAP >20 mmHg, 23 patients had no PH, 146 had pre-capillary PH and 94 had post-capillary PH. At univariate analysis, maximum tricuspid regurgitation velocity (TRV) 2.9-3.4 m·s-1, left ventricle (LV) eccentricity index >1.1, right ventricle outflow tract acceleration time (RVOT-AT) <105 ms or notching, RV/LV basal diameter >1 and pulmonary artery diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m·s-1 independently predicted PH. Additional independent prediction of PVR ≥3 WU was offered by LV eccentricity index >1.1, and RVOT-AT <105 ms and/or notching, but with no improvement of optimal combination of specificity and sensitivity or positive prediction. Echocardiography as recommended in current guidelines can be used to assess the probability of redefined PH in a referral centre. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.

Evaluation of the relationship between chronic small airway diseases and pulmonary artery diameter on computed tomography

Purpose: To study that how the non-asthma chronic obstructive pulmonary diseases (non-asthma-COPD) affect pulmonary artery diameters. Methods: The main pulmonary artery diameter (MPAD), right and left main pulmonary artery diameter (RPAD-LPAD), and the ratio of MPAD to ascending aorta diameter (AAD) (MPAD/AAD) in all subjects of the sample were assessed. Cases with non-asthma-COPD were classified as Group 1; those who were not was categorized into Group 2. The link between non-asthma-COPD and diameters of pulmonary artery and also the ratio of MPAD/AAD was evaluated statistically according to the groups. Results: In the study in which a total of 905 cases were evaluated, 138 in Group 1; 767 in Group 2. The patients' average age was 44.82 ± 16.53 (18-82). It was discovered that there is a statistically significant relationship between MPAD, RPAD and LPAD values and non-asthma-COPD, and it was higher in Group 1 (p=0.049, p=0.011, p=0.022; p<0,05, respectively). The MPAD/AAD value of the cases in Group 1 was discovered to be slightly higher than Group 2 (p=0.006; p<0,01). While the cut-off value for MPAD is ≥23.5 mm, the odds ratio was 1.573 (95% CI: 1.092-2.267); while the cut-off value for MPAD/AAD was ≥0.88, the odds ratio was 1.918 (95% CI: 1.253-2.938). According to ROC analysis, MPAD values were more specific for non-asthma-COPD than MPAD/AAD ratio, but MPAD/AAD ratio was more sensitive. Conclusion: Although there is a relationship between non-asthma-COPD and MPAD, RPAD, LPAD; the ratio of MPAD /AAD is more sensitive for the presence of non-asthma-COPD.

Dijametar plućne arterije na CT-u grudnog koša kao prediktor mortaliteta hospitalizovanih pacijenata sa COVID-19 pneumonijom

Background: Enlargement of the pulmonary artery (PA) could be helpful in risk stratification by the chest CT on the admission of COVID-19 patients. Methods: This study aimed to associate PA diameter and overall mortality in COVID-19 pneumonia. We designed a retrospective study between January 2021 and May 2021 in tertiary-level hospitals in Gebze, Turkey. Subjects were evaluated in two groups according to their survivor status (survivors and non-survivors). Then biochemical, demographic, and clinical values were compared via the groups to define the predictive value of PA diameter on chest CT images. Results: In the enrolled 594 COVID-19 in-hospital patients (median age was 45 (34-58) years, 263patients (44.3%) were female. 44 patients (7.4%) died during hospitalization. Multivariate Cox-proportion regression model yielded main PA ≥ 29 mm on admission showed that as independent predictors of death (long rank &lt;0.001, median survival time 28 days). Cumulative survival rates were MPAD ≥ 29 mm 45% and &lt; 29 mm 90% yielded (p &lt; 0.001) Conclusions: PA dilatation is strongly linked with in-hospital mortality in hospitalized patients with COVID-19 infection. Thus increased PA diameter on chest CT at admission may guide rapid and early diagnosis of high-risk patients.

Early warning triad for pulmonary microemboli in COVID-19 pneumonia: Pulmonary artery diameter, D-dimer and NT-proBNP

Early warning triad for pulmonary microemboli in COVID-19 pneumonia: Pulmonary artery diameter, D-dimer and NT-proBNP

Evaluation of cardiovascular changes in patients with gastric wall fat halo sign.

This study aims to investigate the relationship between gastric wall fat halo sign and potentially associated cardiovascular disease (CVD) in thoracic computed tomography (CT). Between October 2020 and January 2021, 62 patients with gastric wall fat halo sign and 62 controls were evaluated with thorax CT. Patient's height, weight, body mass index (BMI), sex, age, comorbidities, laboratory parameters, diameters of cardiac axes, aorta and pulmonary artery; aorta and coronary artery calcium scores were recorded for the two groups. No significant differences were found in sex, age, height, body weight or BMI between the two groups (p > 0.124). Patients with gastric wall fat halo sign had significantly larger diameters of the ascending aorta, the descending aorta, the main pulmonary artery, the right and left pulmonary arteries, and the short and long cardiac axes and a higher cardiothoracic ratio (CTR) than the control group (p < 0.001). Additionally, the calcium scores of the ascending, arcus, and descending aortas and the coronary arteries were significantly higher detected in patients group (p < 0.001). Patient group had significantly higher lipid profile, frequencies of diabetes mellitus (DM) and hypertension (HT) than control group (p<0.026). Patients with a gastric wall fat halo may show higher cardiovascular risk because of increased visceral fat tissue, vascular diameters, CTR, heart sizes, presence of DM, HT, increased lipid profile and calcium scores.

Inferior vena cava and pulmonary artery diameters for prognosis of Coronavirus disease

Inferior vena cava and pulmonary artery diameters for prognosis of Coronavirus disease

Preoperative Thoracic CT Findings Associated With Postoperative Mechanical Ventilation in Patients Undergoing Major Abdominal or Pelvic Surgery: A Matched Case-Control Study.

BACKGROUND. Postoperative prolonged mechanical ventilation is associated with increased morbidity and mortality. Reliable predictors of the need for postoperative mechanical ventilation after abdominal or pelvic surgeries are lacking. OBJECTIVE. The purpose of this study was to explore associations between preoperative thoracic CT findings and the need for postoperative mechanical ventilation after major abdominal or pelvic surgeries. METHODS. This retrospective case-control study included patients who underwent abdominal or pelvic surgeries during the period from January 1, 2014, through December 31, 2018, and had undergone preoperative thoracic CT. Case patients were patients who required postoperative mechanical ventilation. Control patients and case patients were matched at a 3:1 ratio on the basis of age, sex, body mass index, chronic obstructive pulmonary disease, smoking status, and surgery type. Two radiologists (readers 1 and 2) reviewed the CT images. Findings were compared between groups. RESULTS. The study included 165 patients (70 women, 95 men; mean age, 67.0 ± 9.7 [SD] years; 42 case patients and 123 matched control patients). Bronchial wall thickening and pericardial effusion were more frequent in case patients than control patients for reader 2 (10% vs 2%, p = .03; 17% vs 5%, p = .01) but not for reader 1. Pulmonary artery diameter (mean ± SD) was greater in case patients than control patients for reader 2 (2.9 ± 0.5 cm vs 2.8 ± 0.5 cm, p = .045) but not reader 1. Right lung height was lower in case patients than control patients for reader 1 (18.4 ± 2.9 cm vs 19.9 ± 2.7 cm, p = .01) and reader 2 (18.3 ± 2.9 cm vs 19.8 ± 2.7 cm, p = .01). Left lung height was lower in case patients than control patients for reader 1 (19.5 ± 3.1 cm vs 21.1 ± 2.6 cm, p = .01) and reader 2 (19.6 ± 2.4 cm vs 20.9 ± 2.6 cm, p = .01). Anteroposterior (AP) chest diameter was greater for case patients than control patients for reader 1 (14.0 ± 2.3 cm vs 12.9 ± 3.7 cm, p = .02) and reader 2 (14.2 ± 2.2 cm vs 13.2 ± 3.6 cm, p = .04). In a multivariable regression model using pooled reader data, bronchial wall thickening exhibited an odds ratio (OR) of 4.6 (95% CI, 1.3-16.5; p = .02); pericardial effusion, an OR of 5.1 (95% CI, 1.7-15.5; p = .004); pulmonary artery diameter, an OR of 1.4 per 1-cm increase (95% CI, 0.7-3.0; p = .32); mean lung height, an OR of 0.8 per 1-cm increase (95% CI, 0.7-1.001; p = .05); and AP chest diameter, an OR of 1.2 per 1-cm increase (95% CI, 1.013-1.4; p = .03). CONCLUSION. CT features are associated with the need for postoperative mechanical ventilation after abdominal or pelvic surgery. CLINICAL IMPACT. Many patients undergo thoracic CT before abdominal or pelvic surgery; the CT findings may complement preoperative clinical risk factors.