Pulmonary Vascular Disease |

Pulmonary Vascular Dimensions as an Indicator of Pulmonary Hypertension in Scleroderma FREE TO VIEW

Julianne Nichols, DO; Raymond Foley, DO; D. Datta, MD
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University of Connecticut Health Center, Farmington, CT

Chest. 2014;146(4_MeetingAbstracts):847A. doi:10.1378/chest.1977475
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters IV

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary artery diameter (dPA) on chest Computed Tomogram (CT) > 2.9cm and dPA/ dAo (Aorta diameter) >1 has been reported to indicate pulmonary arterial hypertension (PAH) but results are variable with pulmonary fibrosis. Limited information is available on the relation of dPA and dPA/dAo with mean Pulmonary Artery Pressure (mPAP) in patients with PAH associated with Scleroderma (Scl-PAH), many of whom have concomitant pulmonary fibrosis. The objective of this study was to determine (i) if mPAP and Pulmonary Vascular Resistance (PVR) in patients with Scl-PAH correlates with dPA and dPA/dAo and (ii) if there is a significant difference in the dPA and dPA/dAo in Scleroderma patients with and without PAH.

METHODS: We reviewed the records of 31 patients with Scl-PAH and 10 patients with Scleroderma without PAH (SCl-NoPAH). Patient demographics, mPAP, and PVR on initial right heart catheterization (RHC) were obtained. Initial CT scans were reviewed with a radiologist who measured the dPA, in the axial sections on mediastinal window, 1cm above level of the bifurcation, using electronic calipers. dAo was measured at the same level as dPA. Correlation between mPAP and dPA and dPA/dAo respectively in Scl-PAH was determined by Pearson’s test for linear correlation. Linear regression was used to compare mPA, PVR, dPA and dPA/dAo in Scl-PAH and Scl-NoPAH.

RESULTS: In patients with Scl-PAH, dPA correlated with mPAP (r= 0.39; p=0.02) but not with PVR(r= 0.23; p=0.22); dPA/dAo did not show a significant correlation with mPAP (r=0.04, p=0.8) and PVR (r=0.033, p=0.8). mPAP in Scl-PAH was 36.3±10 mmHg, and 18.7±5 in Scl-NoPAH (p<0.0001). dPA in Scl-PAH was 3.4±0.5cm; in Scl-NoPAH was 2.6±0.2 cm (p<0.0001). dPA/dAo in Scl-PAH was 1.14±0.1 cm; in Scl-NoPAH was 0.88±0.07 cm (p<0.0001). dPA and dPA/dAo was significantly higher in Scl-PAH.

CONCLUSIONS: In patients with Scl-PAH, dPA on chest CT correlates with mPAP and is also significantly higher than in Scl-No PAH.

CLINICAL IMPLICATIONS: Whether dPA can be used to identify which Scleroderma patients have PAH and should be referred for a RHC should be confirmed in larger studies.

DISCLOSURE: The following authors have nothing to disclose: Julianne Nichols, Raymond Foley, D. Datta

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