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Original Research: Pulmonary Vascular Disease |

Pulmonary Artery Dilatation Correlates With the Risk of Unexpected Death in Chronic Arterial or Thromboembolic Pulmonary HypertensionPulmonary Artery Dilatation and Outcome

Joanna Żyłkowska, MD; Marcin Kurzyna, MD, PhD; Michał Florczyk, MD; Barbara Burakowska, MD, PhD; Franciszek Grzegorczyk, MD; Janusz Burakowski, MD, PhD; Maria Wieteska, MD, PhD; Karina Oniszh, MD, PhD; Andrzej Biederman, MD, PhD; Liliana Wawrzyńska, MD, PhD; Monika Szturmowicz, MD, PhD, FCCP; Anna Fijałkowska, MD, PhD; Adam Torbicki, MD, PhD
Author and Funding Information

From the Department of Pulmonary Circulation and Thromboembolic Diseases (Drs Żyłkowska, Kurzyna, Florczyk, Wieteska, and Torbicki), Medical Center of Postgraduate Education, European Health Centre, Otwock; Department of Radiology (Drs Burakowska, Oniszh, and Fijałkowska), Cardio-Pulmonary Intensive Care Medicine (Dr Burakowski), Department of Chest Medicine (Dr Wawrzyńska), and the I Department of Pneumonology (Dr Szturmowicz), Institute of Tuberculosis and Lung Diseases, Warsaw; the I Chair and Department of Cardiology (Dr Grzegorczyk), Medical University of Warsaw; and the Department of Cardiac Surgery (Dr Biederman), Praski Hospital, Warsaw, Poland.

Correspondence to: Adam Torbicki, MD, PhD, Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Center of Postgraduate Education, ECZ-Otwock, Poland, ul. Borowa 14/18, 05-400 Otwock, Poland; e-mail: adam.torbicki@ecz-otwock.pl


Drs Żyłkowska and Kurzyna contributed equally to this article.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1406-1416. doi:10.1378/chest.11-2794
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Background:  Right ventricular failure does not explain all cases of death in patients with chronic pulmonary hypertension. Searching for alternative explanations, we evaluated the prognostic significance of main pulmonary artery (PA) dilatation in patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH).

Methods:  A retrospective outcome analysis was made of 264 patients (aged 46 ± 17 years; women, 69%; PAH, 82%) who underwent both CT scan measurement of the PA and right-sided heart catheterization (mean PA pressure, 57.6 ± 16.5 mm Hg) at initial evaluation.

Results:  The diameter of the PA ranged from 28 to 120 mm (mean, 39 ± 8.6 mm; median, 38 mm) and was largest in patients with unrepaired congenital defects (42.6 ± 7.6 mm). Pulmonary pulse pressure (P = .04), lower age (P = .03), and duration of symptoms (P < .001) were independently but weakly related to PA diameter. During follow-up (median, 38 months), 99 patients (37%) died. Of these 99 deaths, 73 (74%) were due to heart failure or comorbidities, and 26 (26%) were unexpected deaths (UE-Ds). PA diameter (hazard ratio [HR], 1.06 per 1 mm; 95% CI, 1.03-1.08), heart rate (HR, 1.30 per 10 beats/min; 95% CI, 1.01-1.66), and systolic pulmonary arterial pressure (HR, 1.02 per 1 mm Hg; 95% CI, 1.01-1.04) were the only independent predictors of UE-D and differed from the usual predictors found in the study group for all-cause mortality. PA diameter ≥ 48 mm had 95% specificity and 39% sensitivity and carried 7.5 times higher risk of UE-D (95% CI, 3.4-16.5; P < .0001) during follow-up.

Conclusions:  PA dilatation emerges as an independent risk factor for death unexplained by right ventricular failure or comorbidities in patients with PAH and CTEPH. The possible mechanisms include, but are not limited to, PA compression of the left main coronary artery, PA rupture, or dissection with cardiac tamponade.

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