Chin Matthew, Johns Christopher, Currie Benjamin J, Weatherley Nicholas, Hill Catherine, Elliot Charlie, Rajaram Smitha, Wild Jim M, Condliffe Robin, Bianchi Stephen, Kiely David G, Swift Andrew J
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
Front Cardiovasc Med. 2018 Jun 8;5:53. doi: 10.3389/fcvm.2018.00053. eCollection 2018.
It is postulated that ILD causes PA dilatation independent of the presence of pulmonary hypertension (PH), so the use of PA size to screen for PH is not recommended. The aims of this study were to investigate the association of PA size with the presence and severity of ILD and to assess the diagnostic accuracy of PA size for detecting PH.
Incident patients referred to a tertiary PH centre underwent baseline thoracic CT, MRI and right heart catheterisation (RHC). Pulmonary artery diameter was measured on CT pulmonary angiography and pulmonary arterial areas on MRI. A thoracic radiologist scored the severity of ILD on CT from 0 to 4, 0 = absent, 1 = 1-25%, 2 = 26-50%, 3 = 51-75%, and 4 = 76-100% extent of involvement. Receiver operating characteristic analysis and linear regression were employed to assess diagnostic accuracy and independent associations of PA size.
110 had suspected PH due to ILD (age 65 years (SD 13), M:F 37:73) and 379 had suspected PH without ILD (age 64 years (SD 13), M:F 161:218). CT derived main PA diameter was accurate for detection of PH in patients both with and without ILD - AUC 0.873, =< 0.001, and AUC 0.835, =< 0.001, respectively, as was MRI diastolic PA area, AUC 0.897, =< 0.001, and AUC 0.857, =< 0.001, respectively Significant correlations were identified between mean pulmonary arterial pressure (mPAP) and PA diameter in ILD (r = 0.608, < 0.001), and non-ILD cohort (r = 0.426, < 0.001). PA size was independently associated with mPAP ( < 0.001) and BSA ( = 0.001), but not with forced vital capacity % predicted ( = 0.597), Transfer factor of the lungs for carbon monoxide (T) % predicted ( = 0.321) or the presence of ILD on CT ( = 0.905). The severity of ILD was not associated with pulmonary artery dilatation (r = 0.071, = 0.459).
Pulmonary arterial pressure elevation leads to pulmonary arterial dilation, which is not independently influenced by the presence or severity of ILD measured by FVC, T, or disease severity on CT. Pulmonary arterial diameter has diagnostic value in patients with or without ILD and suspected PH.
据推测，间质性肺病（ILD）可导致肺动脉扩张，且与肺动脉高压（PH）的存在无关，因此不建议使用肺动脉大小来筛查PH。本研究的目的是调查肺动脉大小与ILD的存在及严重程度之间的关联，并评估肺动脉大小检测PH的诊断准确性。
转诊至三级PH中心的初诊患者接受了基线胸部CT、MRI和右心导管检查（RHC）。在CT肺动脉造影上测量肺动脉直径，在MRI上测量肺动脉面积。一名胸部放射科医生根据CT对ILD的严重程度进行评分，范围为0至4分，0分=无，1分=累及范围1%-25%，2分=累及范围26%-50%，3分=累及范围51%-75%，4分=累及范围76%-100%。采用受试者工作特征分析和线性回归来评估诊断准确性及肺动脉大小的独立关联。
110例因ILD疑似PH的患者（年龄65岁（标准差13），男:女=37:73），379例无ILD疑似PH的患者（年龄64岁（标准差13），男:女=161:218）。CT得出的主肺动脉直径在检测有和无ILD的患者的PH方面都很准确——AUC分别为0.873，P<0.001和0.835，P<0.001，MRI舒张期肺动脉面积也是如此，AUC分别为0.897，P<0.001和0.857，P<0.001。在ILD队列（r=0.608，P<0.001）和非ILD队列（r=0.426，P<0.001）中，平均肺动脉压（mPAP）与肺动脉直径之间存在显著相关性。肺动脉大小与mPAP（P<0.001）和体表面积（BSA）（P=0.001）独立相关，但与预测的用力肺活量百分比（P=0.597）、预测的肺一氧化碳转运因子（T）百分比（P=0.321）或CT上ILD的存在（P=0.905）无关。ILD的严重程度与肺动脉扩张无关（r=0.071，P=0.459）。
肺动脉压力升高导致肺动脉扩张，这不受通过用力肺活量、肺一氧化碳转运因子或CT上疾病严重程度所测量的ILD的存在或严重程度的独立影响。肺动脉直径在有或无ILD且疑似PH的患者中具有诊断价值。
