Evaluation Of Pulmonary Arterial Hypertension In Chronic Obstructive Pulmonary Disease By Chest CT

Objective To investigate the role of chest CT in the measurement of cardiac diameter and diameter of left and right ventricular in the diagnosis and prognosis of patients with chronic obstructive pulmonary disease and PAH.Methods Retrospectively collected 174 patients with stable COPD and PAH who were hospitalized in the Department of Respiratory and Critical Care Medicine of Ningxia University from January to February 2018,195 patients with COPD and 203 patients with healthy control,named Group A,Group B and Group C.Collecting the above three groups of patients separately(1)General information: including gender,age,smoking index,BMI,diabetes,blood pressure,BNP,PaCO2,FEV1,FVC;(2)chest CT measurements: including main pulmonary artery diameter(mPA),ascending aorta diameter(AAD),descending aorta diameter(DAD),right ventricular diameter(RV),left ventricular diameter(LV),and calculating the ratio of main pulmonary artery to ascending aorta diameter(rPA),the ratio of main pulmonary artery to descending aorta diameter(rPD),and the ratio of right ventricular to left ventricular diameter(RV/LV);(3)Pulmonary systolic pressure(PASP)measured by echocardiography in patients with COPD comlicated with pulmonary hypertension.To compare the differences between the general data of the three groups of patients,chest CT aorta and ventricular measurements.136 patients with COPD were followed up for two years to observe the relationship between different sizes of mPA,rPA,rPD,RV/LV and the number of acute exacerbations and the mortality.120 patients with COPD complicated withpulmonary hypertension were followed up for two years.,to Observe he effects of different mPA,rPA,rPD and RV/LV on mortality.Results(1)There was no significant difference in age and BMI between the three groups(p>0.05),but the difference between hospitalization duration and smoking index was statistically significant(p<0.05).Compared with group B,group A had significantly lower PO2,FEV1/FVC and Fev1% than group B,and the difference was statistically significant(p<0.05).The results of mPA,AAD and RV in the three groups showed statistically significant differences(p<0.05),and the degree of MPA,AAD and RV broadening was group A > group B > C.Among the two measures of DAD and LV,the difference between group A and group C was statistically significant(p<0.05).There was no significant difference between group A and group B,group B and group C(p>0.05).(2)There were significant differences in rPA and rPD between the three groups(p<0.05).The sizes of rPA and rPD were:group A > group B > group C.(3)According to the pulmonary artery pressure measured by cardiac color Doppler ultrasound,40PASP50 mmHg was mild group,50<PASP70mmHg was moderate group,PASP>70mmHg was severe group.Statistical analysis showed mPA,rPA,rPD of patients with different degrees of PAH.There was a statistical difference(p<0.05),the degree of mPA broadening,and the order of rPA and rPD were: mild group <moderate group< severe group.There were statistical differences between the mild and severe(R<0.05),and there was no statistical difference between mild and moderate,moderate and severe(p>0.05).There was no significant difference in AAD,DAD,and RV/LV between the three groups(p>0.05).(4)The sperman correlation coefficient between the PASP measured by cardiac ultrasonography and the mPA measured by chest CT in COPD patients with pulmonary hypertension was r=0.392.The correlation coefficient between PASP and rPA is r = 0.510.The correlation coefficient between PASP and rPD is r = 0.350.The correlation coefficient between PASP and RV/LV is r=0.084.It indicates that there is a positive correlation betweenmPA,rPA,rPD,RV and PASP,and the correlation is relatively close,but the correlation between PASP and RV/LV is weak.(5)As the rPA value increases,the patient's survival rate decreases and the mortality rate gradually increases.(6)136 patients with COPD were followed up for two years.The results showed that the ratio of rPA was not significantly correlated with the number of acute exacerbations of COPD.(7)Using the ROC curve to analyze the diagnostic performance of mPA,RV,rPA,rPD,the results showed that when mPA32.36 mm,the sensitivity of diagnosis was 87%,the specificity was 73%,and the area under the curve was 0.857.When RV45.23 mm,the sensitivity is 52%,the specificity is 72%,and the area under the curve is 0.644.When rPA0.95,the sensitivity was 73%,the specificity was 76%,and the area under the curve was 0.811.Finally,when rPD1.23,the sensitivity is79%,the specificity is 73%,and the area under the curve is 0.808.Conclusion 1.mPA,rPA,rPD can provide diagnostic basis for COPD combined with PAH?2.Measurement of the diameter of the main pulmonary artery by chest CT has a good correlation with the measurement of pulmonary artery pressure by echocardiography,indicating that the greater the pulmonary artery pressure,the more obvious the mPA broadening.3.There is a positive correlation between PASP and rPA and rPD.4.Patients with COPD combined with PAH and COPD had right ventricular widening,but there was no significant change in left ventricular diameter.5.Different sizes of rPA can provide prognostic information for COPD patients with PAH and COPD.The greater the ratio,the higher the mortality rate and the worse the prognosis.