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Original Research: COPD |

Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD

J. Michael Wells, MD; Joshua B. Morrison, MD; Surya P. Bhatt, MD; Hrudaya Nath, MD; Mark T. Dransfield, MD
Author and Funding Information

Drs Nath and Dransfield contributed equally to this work.

FUNDING/SUPPORT: The funding for this study came from the National Institutes of Health/National Heart, Lung, and Blood Institute (K08HL123940) and the Walter B. Frommeyer Jr. Fellowship in Investigational Medicine from the University of Alabama at Birmingham (to Dr Wells).

CORRESPONDENCE TO: J. Michael Wells, MD, 1900 University Blvd, THT 422, Birmingham, AL 35294


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):1197-1204. doi:10.1378/chest.15-1504
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Background  Relative pulmonary arterial enlargement, defined by a pulmonary artery to aorta (PA/A) ratio > 1 on CT scanning, predicts hospitalization for acute exacerbations of COPD (AECOPD). However, it is unclear how AECOPD affect the PA/A ratio. We hypothesized that the PA/A ratio would increase at the time of AECOPD and that a ratio > 1 would be associated with worse clinical outcomes.

Methods  Patients discharged with an International Classification of Diseases, Ninth Revision, diagnosis of AECOPD from a single center over a 5-year period were identified. Patients were included who had a CT scan performed during the stable period prior to the index AECOPD episode as well as a CT scan at the time of hospitalization. A subset of patients also underwent postexacerbation CT scans. The pulmonary arterial diameter, ascending aortic diameter, and the PA/A ratio were measured on CT scans. Demographic data, comorbidities, troponin level, and hospital outcome data were analyzed.

Results  A total of 134 patients were included in the study. They had a mean age of 65 ± 10 years, 47% were male, and 69% were white; overall, patients had a mean FEV1 of 47% ± 19%. The PA/A ratio increased from baseline at the time of exacerbation (0.97 ± 0.15 from 0.91 ± 0.17; P < .001). Younger age and known pulmonary hypertension were independently associated with an exacerbation PA/A ratio > 1. Patients with PA/A ratio > 1 had higher troponin values. Those with a PA/A ratio > 1 and troponin levels > 0.01 ng/mL had increased acute respiratory failure, ICU admission, or inpatient mortality compared with those without both factors (P = .0028). The PA/A ratio returned to baseline values following AECOPD.

Conclusions  The PA/A ratio increased at the time of severe AECOPD and a ratio > 1 predicted cardiac injury and a more severe hospital course.

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