Main pulmonary artery diameter on lung cancer screening CT was significantly correlated with mean pulmonary artery pressure (ρ=0.41; p<0.01), whereas the bronchoarterial ratio showed a weak negative correlation.
Cohort (n=48)
No
Do lung cancer screening chest CT metrics (BA ratio and PA diameter) correlate with pulmonary hypertension hemodynamics in tobacco-exposed Veterans?
Lung cancer screening chest CT metrics, such as main pulmonary artery diameter, correlate with invasive pulmonary hemodynamics and may aid in the early detection of pulmonary hypertension in high-risk patients.
Effect estimate: ρ = 0.41 (PA diameter and mPAP)
p-value: p=<0.01
Abstract Introduction Pulmonary hypertension (PH) is associated with high morbidity and mortality and invasive confirmatory testing with right heart catheterization (RHC) is underperformed. Non-invasive diagnostics to inform earlier diagnosis are imperative. Lung cancer screening chest computed tomography (LCS CT) may represent an underutilized tool to enhance early PH detection. Presently, few vascular features, including pulmonary artery (PA) diameter, are routinely reported. We hypothesized that additional metrics such as the segmental bronchial lumen to pulmonary artery ratio (BA) ratio may be informative for PH assessment. Methods Retrospective cohort study of tobacco-exposed Veterans from the Boston Veteran Affairs Hospital undergoing standardized LCS from 2015 to present with available RHC data. Echocardiographic, pulmonary function test, hemodynamic and imaging data were manually extracted. For each LCS CT, main PA diameter and BA are reported; PA was measured at the level of bifurcation and BA was assessed as the inner bronchus diameter divided by the corresponding artery diameter at the segmental level for each lobe plus the lingula. Descriptive statistics, spearman correlations and logistic regression were performed. Results Forty-eight Veterans with LCS CTs and RHC data available were included in this pilot analysis; the median days between studies was 10 -153,141. The mean FEV1/FVC ratio was consistent with mild obstruction (0.61 (0.14)) with mean FEV1 70 (19) % predicted. Twenty-nine (60.4%) Veterans had PH defined as a mean pulmonary artery pressure (mPAP) 20mmHg; disease was mixed pre- and post-capillary with median IQR mPAP 27 7, pulmonary capillary wedge pressure (PCWP) 18 14 and pulmonary vascular resistance (PVR) 2.1 1.8. The median PA diameter was elevated (32 8.1 mm). The mean segmental PA and bronchus diameters were 6.4 (0.8) and 3.8 (0.6), respectively. The average BA (0.61 (0.08)) was below reported non-smoking normal controls. Main pulmonary artery diameter was significantly correlated with mPAP (ρ = 0.41; p 0.01); there was a weak negative correlation between average BA and mPAP (ρ=-0.17; p = 0.25). There was a negative relationship between average BA and PCWP (ρ=-0.26; p = 0.08); BA and PVR were positively associated (ρ = 0.17; p = 0.28). In those with available echocardiography diastolic function data (n = 21), there was a trend towards lower BA in Veterans with diastolic dysfunction (β= -0.07±0.06; p = 0.23). Conclusions Lung cancer screening images provide insight into subjects’ pulmonary vascular disease state that is presently underutilized and may inform earlier PH diagnosis. In this population enriched for smokers with cardiopulmonary comorbidities, BA may reflect increased left-sided filling pressures due to post-capillary PH. This abstract is funded by: US Department of Veteran Affairs Merit Award CX002193, NIH/NHLBI K23HL179493-01
Rai et al. (Fri,) conducted a cohort in Pulmonary hypertension (n=48). Lung cancer screening chest computed tomography metrics (PA diameter and BA ratio) was evaluated on Correlation between main pulmonary artery diameter / bronchoarterial ratio and mean pulmonary artery pressure (ρ = 0.41 (PA diameter and mPAP), p=<0.01). Main pulmonary artery diameter on lung cancer screening CT was significantly correlated with mean pulmonary artery pressure (ρ=0.41; p<0.01), whereas the bronchoarterial ratio showed a weak negative correlation.