- Research Article
- 10.1164/ajrccm.2025.211.abstracts.a6427
A Comparison of Pulmonary Artery Diameter and Pulmonary Artery to Aorta Ratio to Right Ventricular Systolic Pressure (RVSP) as a Noninvasive Screening Tool for Idiopathic Pulmonary Fibrosis Patients With Group 3 Pulmonary Hypertension
- May 01, 2025
- American Journal of Respiratory and Critical Care Medicine
- N Shah + 4 more +4
Introduction: Patients with idiopathic pulmonary fibrosis (IPF) are at increased risk of pulmonary hypertension (PH). Right heart catheterization (RHC) is the gold standard for diagnosing PH, however, it is invasive. Noninvasive means such as echocardiography have external factors limiting its accuracy. Pulmonary artery (PA) diameter and PA to aorta (PA/Ao) ratio from a CT chest can be used as a noninvasive way to screen for PH. Here, we performed a retrospective study to see if PA diameter and PA/Ao ratio can be effective at predicting PH by RHC. Methods: A retrospective study of 31 IPF patients with group 3 PH undergoing lung transplant evaluation was performed. These results were compared to 27 IPF patients without PH. Each patient required a CT chest, transthoracic echocardiogram, and RHC to be included. Patients in the PH group were all >18 years old with mPAP >20 and pulmonary capillary wedge pressure <15. All CT chests were read by a single radiologist. Cross sectional imaging in axial plane was set to the level of the main PA bifurcation. Main PA diameter was measured in the transverse axis midway between its root and the bifurcation in the axial plane. The diameter of the ascending aorta in the axial plane was measured at the same level in anteroposterior axis. The PA diameter, PA/Ao ratio were compared to the mPAP from RHC. Those with greater than 6 months between CT chest and RHC were excluded. Receiver operator curve (ROC) and logistic regression (LR) analyses were performed to assess the efficacy of PA diameter, PA/Ao ratio and RVSP compared to RHC parameters. ROC was used to determine the cutoff value for PA diameter and PA/Ao ratio and calculate sensitivity and specificities. Results: A PA diameter >3.05 cm, PA/Ao ratio >0.805, and RVSP >33.5 mmHg as determined by ROC analysis were all found to be significant predictors of PH by RHC. LR analysis of those having both PA diameter >3.05 cm and PA/Ao ratio >0.805 demonstrated that having both also predicts PH by RHC with p<0.001, sensitivity of 81.25% and specificity of 76.92%. All ROC and LR analyses with associated AUC, sensitivities, and specificities are reported in Figure 1. Conclusion: A PA diameter >3.05 cm and a PA/Ao ratio >0.805 are statistically significant predictors of PH by RHC. RVSP was effective at predicting PH but in this cohort CT parameters were more effective than RVSP given the higher AUC.
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