Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 8
Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD
Authors Wells JM , Dransfield MT
Received 30 July 2013
Accepted for publication 18 September 2013
Published 29 October 2013 Volume 2013:8 Pages 509—521
DOI https://doi.org/10.2147/COPD.S52204
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
J Michael Wells, Mark T Dransfield
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
Abstract: Chronic obstructive pulmonary disease (COPD) is a complex condition defined by progressive airflow limitation in response to noxious stimuli, inflammation, and vascular changes. COPD exacerbations are critical events in the natural history of the disease, accounting for the majority of disease burden, cost, and mortality. Pulmonary vascular disease is an important risk factor for disease progression and exacerbation risk. Relative pulmonary artery enlargement on computed tomography scan, defined by a pulmonary artery to aortic (PA:A) ratio >1, has been evaluated as a marker of pulmonary vascular disease. The PA:A ratio can be measured reliably independent of electrocardiographic gating or the use of contrast, and in healthy patients a PA:A ratio >0.9 is considered to be abnormal. The PA:A ratio has been compared with invasive hemodynamic parameters, primarily mean pulmonary artery pressure in various disease conditions and is more strongly correlated with mean pulmonary artery pressure in obstructive as compared with interstitial lung disease. In patients without known cardiac or pulmonary disease, the PA:A ratio is predictive of mortality, while in COPD, an elevated PA:A ratio is correlated with increased exacerbation risk, outperforming other well established predictors of these events. Future studies should be aimed at determining the stability of the metric over time and evaluating the utility of the PA:A ratio in guiding specific therapies.
Keywords: pulmonary artery enlargement, aorta, ratio, pulmonary hypertension, chronic obstructive pulmonary disease, computed tomography
© 2013 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.