Correlation between different ultrasound pulmonary artery systolic pressure and high-resolution CT pulmonary artery width in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

FU Xiaoyin , ZENG Xiaoli , BAO Hairong ,  LIU Xiaoju

Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

LIU Xiaoju, Email: liuxiaoju835@126.com

Keywords：

Chronic obstructive pulmonary disease; Pulmonary artery systolic pressure; Pulmonary artery width; Lung function; Hypoxemia; Hypercapnia

DOI：

10.7507/1671-6205.202107017

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Objective To explore the correlation between different ultrasound pulmonary artery systolic pressure (PASP) and high-resolution CT (HRCT) pulmonary artery width (PAD) in patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was conducted on 473 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in the First Hospital of Lanzhou University from January 2016 to December 2020. They were divided into four groups according to the degree of PASP elevation: PASP normal group: PASP≤36 mm Hg, 182 cases; mildly elevated group: PASP 37 to 50 mm Hg, 164 cases; moderately elevated group: PASP 51 to 70 mm Hg, 89 cases; severely elevated group: PASP>70 mm Hg, 38 cases. The PAD of chest HRCT and the width of the ascending aorta (AAD) on the same plane were measured, and the ratio of PAD to AAD (PAD/AAD) was calculated. The differences of PAD, AAD, PAD/AAD in different PASP groups of COPD were compared. The correlations between PASP, lung function, blood gas analysis and PAD, PAD/AAD were analyzed. Results With the decrease of FEV₁%pred, FVC%pred, FEV₁/FVC, PaO₂ and SaO₂ in the patients, PaCO₂ increased, PASP gradually increased, PAD and PAD/AAD gradually increased. PAD and PAD/AAD were significantly different between the severely elevated PASP group and the other three groups, and there were significant differences between the moderately elevated group and the normal group, and between the moderately elevated group and the mildly elevated group. PASP and PaCO₂ were positively correlated with PAD and PAD/AAD, and FEV₁%pred, FVC%pred, FEV₁/FVC, PaO₂, SaO₂ were negatively correlated with PAD and PAD/AAD. Multivariate logistic regression analysis showed that after adjusting for confounding factors, decreased FEV₁%pred was an independent risk factor for PAD/AAD>1 in COPD patients. The receiver operating characteristic curve showed that the width of PAD and PAD/AAD had certain predictive value for PASP. Conclusions There is a significant positive correlation between different degrees of ultrasound PASP and PAD and PAD/AAD in patients with COPD. HRCT PAD has certain predictive value for PASP. The heavier the hypoxia and carbon dioxide retention, the worse the pulmonary ventilation function, the higher the pulmonary artery pressure, the greater the possibility of PAD and PAD/AAD.

Citation： FU Xiaoyin, ZENG Xiaoli, BAO Hairong, LIU Xiaoju. Correlation between different ultrasound pulmonary artery systolic pressure and high-resolution CT pulmonary artery width in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(11): 768-773. doi: 10.7507/1671-6205.202107017 Copy

1.	Brassington K, Selemidis S, Bozinovski S, et al. New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease. Clin Sci (Lond), 2019, 133(7): 885-904.
2.	Cuttica MJ. Pulmonary hypertension associated with lung diseases and hypoxemia. Heart Fail Rev, 2016, 21(3): 299-308.
3.	Blanco I, Tura-Ceide O, Peinado VI, et al. Updated perspectives on pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis, 2020, 15: 1315-1324.
4.	Scharf SM, Iqbal M, Keller C, et al. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med, 2002, 166(3): 314-322.
5.	Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
6.	Cuttica MJ, Bhatt SP, Rosenberg SR, et al. Pulmonary artery to aorta ratio is associated with cardiac structure and functional changes in mild-to-moderate COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1439-1446.
7.	Coste F, Benlala I, Dournes G, et al. Assessing pulmonary hypertension in COPD. Is there a role for computed tomography?. Int J Chron Obstruct Pulmon Dis, 2019, 14: 2065-2079.
8.	Wells JM, Washko GR, Han MK, et al. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med, 2012, 367(10): 913-921.
9.	Terzikhan N, Bos D, Lahousse L, et al. Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study. Eur Respir J, 2017, 49(6): 1602168.
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12.	肺动脉高压筛查诊断与治疗专家共识. 中华心血管病杂志, 2007, 35(11): 979-987.
13.	滑少华, 尹静, 孙梦娇, 等. 实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值. 中华超声影像学杂志, 2017, 26(5): 393-397.
14.	Skjørten I, Hilde JM, Melsom MN, et al. Pulmonary artery pressure and PaO₂ in chronic obstructive pulmonary disease. Respir Med, 2013, 107(8): 1271-1279.
15.	Hayes D Jr, Black SM, Tobias JD, et al. Prevalence of pulmonary hypertension and its influence on survival in patients with advanced chronic obstructive pulmonary disease prior to lung transplantation. COPD, 2016, 13(1): 50-56.
16.	Rodríguez-Roisin R, Drakulovic M, Rodríguez DA, et al. Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol (1985), 2009, 106(6): 1902-1908.
17.	Saure EW, Eagan TM, Jensen RL, et al. Predictors for PaO₂ and hypoxemic respiratory failure in COPD-A three-year follow-up. COPD, 2014, 11(5): 531-538.
18.	De-Torres JP, Ezponda A, Alcaide AB, et al. Pulmonary arterial enlargement predicts long-term survival in COPD patients. PLoS One, 2018, 13(4): e195640.
19.	Yang T, Chen C, Chen Z, et al. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med, 2021, 21(1): 34.
20.	Hahm CR, Lim MN, Kim HY, et al. Implications of the pulmonary artery to ascending aortic ratio in patients with relatively mild chronic obstructive pulmonary disease. J Thorac Dis, 2016, 8(7): 1524-1531.
21.	Schneider M, Ran H, Pistritto AM, et al. Pulmonary artery to ascending aorta ratio by echocardiography: a strong predictor for presence and severity of pulmonary hypertension. PLoS One, 2020, 15(7): e235716.
22.	Johns CS, Rajaram S, Capener DA, et al. Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging. Eur Radiol, 2018, 28(4): 1438-1448.
23.	Shin S, King CS, Brown AW, et al. Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease. Respir Med, 2014, 108(11): 1626-1632.
24.	Chen X, Liu K, Wang Z, et al. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension. Int J Chron Obstruct Pulmon Dis, 2015, 10: 2525-2533.
25.	Nakayama S, Chubachi S, Sakurai K, et al. Characteristics of chronic obstructive pulmonary disease patients with pulmonary hypertension assessed by echocardiography in a three-year observational cohort study. Int J Chron Obstruct Pulmon Dis, 2020, 15: 487-499.
26.	李爱莉, 翟亚楠, 陶新曹, 等. 多普勒超声心动图筛查肺动脉高压的截断值及准确度比较. 中国超声医学杂志, 2021, 37(10): 1116-1119.

1. Brassington K, Selemidis S, Bozinovski S, et al. New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease. Clin Sci (Lond), 2019, 133(7): 885-904.
2. Cuttica MJ. Pulmonary hypertension associated with lung diseases and hypoxemia. Heart Fail Rev, 2016, 21(3): 299-308.
3. Blanco I, Tura-Ceide O, Peinado VI, et al. Updated perspectives on pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis, 2020, 15: 1315-1324.
4. Scharf SM, Iqbal M, Keller C, et al. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med, 2002, 166(3): 314-322.
5. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
6. Cuttica MJ, Bhatt SP, Rosenberg SR, et al. Pulmonary artery to aorta ratio is associated with cardiac structure and functional changes in mild-to-moderate COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1439-1446.
7. Coste F, Benlala I, Dournes G, et al. Assessing pulmonary hypertension in COPD. Is there a role for computed tomography?. Int J Chron Obstruct Pulmon Dis, 2019, 14: 2065-2079.
8. Wells JM, Washko GR, Han MK, et al. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med, 2012, 367(10): 913-921.
9. Terzikhan N, Bos D, Lahousse L, et al. Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study. Eur Respir J, 2017, 49(6): 1602168.
10. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease (2021 Report) [EB/OL]. https://goldcopd. org/.
11. Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Eur Respir J, 2009, 34(6): 1219-1263.
12. 肺动脉高压筛查诊断与治疗专家共识. 中华心血管病杂志, 2007, 35(11): 979-987.
13. 滑少华, 尹静, 孙梦娇, 等. 实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值. 中华超声影像学杂志, 2017, 26(5): 393-397.
14. Skjørten I, Hilde JM, Melsom MN, et al. Pulmonary artery pressure and PaO₂ in chronic obstructive pulmonary disease. Respir Med, 2013, 107(8): 1271-1279.
15. Hayes D Jr, Black SM, Tobias JD, et al. Prevalence of pulmonary hypertension and its influence on survival in patients with advanced chronic obstructive pulmonary disease prior to lung transplantation. COPD, 2016, 13(1): 50-56.
16. Rodríguez-Roisin R, Drakulovic M, Rodríguez DA, et al. Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol (1985), 2009, 106(6): 1902-1908.
17. Saure EW, Eagan TM, Jensen RL, et al. Predictors for PaO₂ and hypoxemic respiratory failure in COPD-A three-year follow-up. COPD, 2014, 11(5): 531-538.
18. De-Torres JP, Ezponda A, Alcaide AB, et al. Pulmonary arterial enlargement predicts long-term survival in COPD patients. PLoS One, 2018, 13(4): e195640.
19. Yang T, Chen C, Chen Z, et al. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med, 2021, 21(1): 34.
20. Hahm CR, Lim MN, Kim HY, et al. Implications of the pulmonary artery to ascending aortic ratio in patients with relatively mild chronic obstructive pulmonary disease. J Thorac Dis, 2016, 8(7): 1524-1531.
21. Schneider M, Ran H, Pistritto AM, et al. Pulmonary artery to ascending aorta ratio by echocardiography: a strong predictor for presence and severity of pulmonary hypertension. PLoS One, 2020, 15(7): e235716.
22. Johns CS, Rajaram S, Capener DA, et al. Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging. Eur Radiol, 2018, 28(4): 1438-1448.
23. Shin S, King CS, Brown AW, et al. Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease. Respir Med, 2014, 108(11): 1626-1632.
24. Chen X, Liu K, Wang Z, et al. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension. Int J Chron Obstruct Pulmon Dis, 2015, 10: 2525-2533.
25. Nakayama S, Chubachi S, Sakurai K, et al. Characteristics of chronic obstructive pulmonary disease patients with pulmonary hypertension assessed by echocardiography in a three-year observational cohort study. Int J Chron Obstruct Pulmon Dis, 2020, 15: 487-499.
26. 李爱莉, 翟亚楠, 陶新曹, 等. 多普勒超声心动图筛查肺动脉高压的截断值及准确度比较. 中国超声医学杂志, 2021, 37(10): 1116-1119.

Chinese Journal of Respiratory and Critical Care Medicine

Correlation between different ultrasound pulmonary artery systolic pressure and high-resolution CT pulmonary artery width in patients with chronic obstructive pulmonary disease

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