Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease

Affiliations

¹ From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.). jmwells@uab.edu.
² From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.).

PMID: 25855668
PMCID: PMC4392846
DOI: 10.1161/CIRCIMAGING.114.002546

Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease

J Michael Wells et al. Circ Cardiovasc Imaging. 2015 Apr.

. 2015 Apr;8(4):10.1161/CIRCIMAGING.114.002546 e002546.

doi: 10.1161/CIRCIMAGING.114.002546.

Affiliations

¹ From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.). jmwells@uab.edu.
² From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.).

PMID: 25855668
PMCID: PMC4392846
DOI: 10.1161/CIRCIMAGING.114.002546

Abstract

Background: Chronic obstructive pulmonary disease causes significant morbidity and concomitant pulmonary vascular disease and cardiac dysfunction are associated with poor prognosis. Computed tomography-detected relative pulmonary artery (PA) enlargement defined as a PA to ascending aorta diameter ratio >1 (PA:A>1) is a marker for pulmonary hypertension and predicts chronic obstructive pulmonary disease exacerbations. However, little is known about the relationship between the PA:A ratio, pulmonary blood volume, and cardiac function.

Methods and results: A single-center prospective cohort study of patients with chronic obstructive pulmonary disease was conducted. Clinical characteristics and computed tomography metrics, including the PA:A and pulmonary blood vessel volume, were measured. Ventricular functions, volumes, and dimensions were measured by cine cardiac MRI with 3-dimensional analysis. Linear regression examined the relationships between clinical characteristics, computed tomography and cardiac MRI metrics, and 6-minute walk distance. Twenty-four patients were evaluated and those with PA:A>1 had higher right ventricular (RV) end-diastolic and end-systolic volume indices accompanied by lower RV ejection fraction (52±7% versus 60±9%; P=0.04). The PA:A correlated inversely with total intraparenchymal pulmonary blood vessel volume and the volume of distal vessels with a cross-sectional area of <5 mm(2). Lower forced expiratory volume, PA:A>1, and hyperinflation correlated with reduced RV ejection fraction. Both PA diameter and reduced RV ejection fraction were independently associated with reduced 6-minute walk distance.

Conclusions: The loss of blood volume in distal pulmonary vessels is associated with PA enlargement on computed tomography. Cardiac MRI detects early RV dysfunction and remodeling in nonsevere chronic obstructive pulmonary disease patients with a PA:A>1. Both RV dysfunction and PA enlargement are independently associated with reduced walk distance.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00608764.

Keywords: cardiac magnetic resonance imaging; hypertension, pulmonary; pulmonary disease; pulmonary heart disease; smoking.

PubMed Disclaimer

Figures

**Figure 1**
Pulmonary artery (PA) enlargement is related to loss of blood volume in small intraparenchymal vessels. **Panels A and C** are representative images from a patient with a PA:A ratio <1 and minimal loss of blood volume in small intraparenchymal blood vessels. **Panels B and D** are images taken from a patient with a PA:A ratio >1 and extensive pruning of the small intraparenchymal vasculature. **Panels A and B** are axial images of the PA and ascending aorta (A) taken at the level of the PA bifurcation. **Panels C and D** are image reconstructions of the intra-pulmonary blood volume (BV5/TBV).

**Figure 2**
Correlation between PA:A and BV5, TBV and BV5/TBV. PA:A = pulmonary artery diameter to aortic diameter ratio; TBV = Total intraparenchymal blood vessel volume; BV5 = Pulmonary blood volume in vessels with cross sectional area < 5 mm²

See this image and copyright information in PMC

References

1. Wells JM, Washko GR, Han MK, Abbas N, Nath H, Mamary AJ, Regan E, Bailey WC, Martinez FJ, Westfall E, Beaty TH, Curran-Everett D, Curtis JL, Hokanson JE, Lynch DA, Make BJ, Crapo JD, Silverman EK, Bowler RP, Dransfield MT. Pulmonary arterial enlargement and acute exacerbations of copd. N Engl J Med. 2012;367:913–921. - PMC - PubMed
1. Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT. Ct scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe copd. Chest. 2014;145:824–832. - PMC - PubMed
1. Estepar RS, Kinney GL, Black-Shinn JL, Bowler RP, Kindlmann GL, Ross JC, Kikinis R, Han MK, Come CE, Diaz AA, Cho MH, Hersh CP, Schroeder JD, Reilly JJ, Lynch DA, Crapo JD, Wells JM, Dransfield MT, Hokanson JE, Washko GR. Computed tomographic measures of pulmonary vascular morphology in smokers and their clinical implications. Am J Respir Crit Care Med. 2013;188:231–239. - PMC - PubMed
1. Petty TL. Scope of the copd problem in north america: Early studies of prevalence and nhanes iii data: Basis for early identification and intervention. Chest. 2000;117:326S–331S. - PubMed
1. Stone AC, Machan JT, Mazer J, Casserly B, Klinger JR. Echocardiographic evidence of pulmonary hypertension is associated with increased 1-year mortality in patients admitted with chronic obstructive pulmonary disease. Lung. 2011;189:207–212. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease

Affiliations

Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical