CT-Derived Pulmonary Artery Diameters to Preselect for Echocardiography in COPD Patients Eligible for Bronchoscopic Treatments

Abstract

<b><i>Background:</i></b> Currently, patients with COPD who are evaluated for bronchoscopic treatments are routinely screened for pulmonary hypertension (PH) and systolic left ventricle dysfunction by echocardiography. <b><i>Objectives:</i></b> We evaluated the prevalence of PH and systolic left ventricle dysfunction in this patient group and investigated if the previously proposed CT-derived pulmonary artery to aorta (PA:A) ratio &#x3e;1 and PA diameter measurements can be used as alternative screening tools for PH. <b><i>Methods:</i></b> Two hundred fifty-five patients were included in this retrospective analysis (FEV₁ 25%pred, RV 237%pred). All patients received transthoracic echocardiography and chest CT scans on which diameters of the aorta and pulmonary artery were measured at the bifurcation and proximal to the bifurcation. <b><i>Results:</i></b> Following echocardiography, 3 patients (1.2%) had PH and 1 (0.4%) had systolic left ventricle dysfunction. Using a PA:A ratio &#x3e;1, only 10.3% of the patients with a right ventricular systolic pressure (RVSP) ≥35 mm Hg were detected and none of the patients with an RVSP &#x3e;50 mm Hg were detected. Patients with an RVSP ≥35 mm Hg had significantly higher PA diameters (29.5 vs. 27.5 mm; <i>p</i> = 0.02) but no significantly different PA:A ratios. All patients with an RVSP &#x3e;50 mm Hg had PA diameters &#x3e;30 mm. <b><i>Conclusions:</i></b> The prevalence of PH and systolic left ventricle dysfunction is low in this preselected cohort of patients with severe COPD. In this population, a PA:A ratio &#x3e;1 is not a useful cardiac screening tool for PH. A PA diameter &#x3e;30 mm could substitute for routinely performed echocardiography in the screening for PH in this patient group.