Prognostic factors of pulmonary hypertension associated with connective tissue disease: pulmonary artery size measured by chest CT

Prognostic utility of pulmonary artery and ascending aorta diameters derived from computed tomography in COVID-19 patients

Aim

Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID‐19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA‐to‐AAo ratio to determine in‐hospital mortality in COVID‐19 patients.

Materials and methods

This retrospective study included 255 hospitalized severe or critical COVID‐19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA‐to‐AAo ratio was calculated by division of MPA to AAo.

Results

Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01–12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13–1.46, p < 0.001), AAo (OR: .90, 95% CI: .81–.99, p = 0.040), and MPA‐to‐AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86–11.7, p = 0.001) as independent predictors of in‐hospital mortality. Time‐dependent multivariate Cox‐proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03–3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01–1.17, p = 0.048) as independent predictors of in‐hospital mortality, whereas AAo and MPA‐to‐AAo ratio did not reach statistical significance.

Conclusion

Pulmonary artery enlargement strongly predicts in‐hospital mortality in hospitalized COVID‐19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.

Diffusion capacity abnormalities for carbon monoxide in patients with COVID-19 at 3-month follow-up

Objective

To evaluate pulmonary function and clinical symptoms in coronavirus disease 2019 (COVID-19) survivors within 3 months after hospital discharge, and to identify risk factors associated with impaired lung function.

Methods and material

COVID-19 patients were prospectively followed-up with pulmonary function tests and clinical characteristics for 3 months following discharge from a hospital in Wuhan, China between January and February 2020.

Results

647 patients were included. 87 (13%) patients presented with weakness, 63 (10%) with palpitations and 56 (9%) with dyspnoea. The prevalence of each of the three symptoms were markedly higher in severe patients than nonsevere patients (19% versus 10% for weakness, p=0.003; 14% versus 7% for palpitations, p=0.007; 12% versus 7% for dyspnoea, p=0.014). Results of multivariable regression showed increased odds of ongoing symptoms among severe patients (OR 1.7, 95% CI 1.1–2.6; p=0.026) or patients with longer hospital stays (OR 1.03, 95% CI 1.00–1.05; p=0.041). Pulmonary function test results were available for 81 patients, including 41 nonsevere and 40 severe patients. In this subgroup, 44 (54%) patients manifested abnormal diffusing capacity of the lung for carbon monoxide (D_LCO) (68% severe versus 42% nonsevere patients, p=0.019). Chest computed tomography (CT) total severity score >10.5 (OR 10.4, 95% CI 2.5–44.1; p=0.001) on admission and acute respiratory distress syndrome (ARDS) (OR 4.6, 95% CI 1.4–15.5; p=0.014) were significantly associated with impaired D_LCO. Pulmonary interstitial damage may be associated with abnormal D_LCO.

Conclusion

Pulmonary function, particularly D_LCO, declined in COVID-19 survivors. This decrease was associated with total severity score of chest CT >10.5 and ARDS occurrence. Pulmonary interstitial damage might contribute to the imparied D_LCO.

COVID-19 patients present with impaired D_LCO at 90 days after discharge, particularly severe patients. Chest CT TSS >10.5 and ARDS occurrence are associated with impaired D_LCO. Pulmonary interstitial damage may contribute to the impaired D_LCO.https://bit.ly/2JevUtm

Evaluation of Left Ventricular Diastolic Function by 2-D Speckle Tracking Echocardiography in Patients with Connective Tissue Disease-Associated Pulmonary Artery Hypertension

The purpose of this study was to evaluate the role of 2-D speckle tracking imaging in assessing left ventricular diastolic function in patients with connective tissue disease (CTD). A total of 98 CTD patients and 32 healthy controls were prospectively recruited. Early (E) and late (A) diastolic velocities of the transmitral flow were measured by pulsed Doppler echocardiography. Peak early diastolic myocardial velocity (E') was calculated on tissue Doppler echocardiography. The longitudinal strain rate (SR) was calculated as the average of three apical views, while circumferential and radial SRs were measured in three short-axis views. Pulmonary arterial hypertension (PAH) was defined as systolic pulmonary arterial pressure (sPAP) >36 mm Hg. Compared with the control group, CTD patients exhibited significant impairment of left ventricular diastolic function, manifested as lower global SR during early diastole (SRe) in the longitudinal deformation and higher E/SRe in both longitudinal and radial deformation. CTD-PAH patients had significantly lower SRe and higher E/SRe values in both the longitudinal and radial deformation compared with the patients with CTD without PAH. Pearson's correlation analysis revealed that sPAP levels correlated positively with E/E', longitudinal E/SRe, circumferential E/SRe and radial SRe, and it correlated negatively with septal E' and radial E/SRe. Receiver operating characteristic curve analysis suggested that E/E', longitudinal E/SRe and radial SRe could be used to predict PAH. The present study indicates that 2-D speckle tracking imaging is a useful method for evaluation of left ventricular diastolic function, and these derived parameters can serve as good predictors of PAH, but it may not be superior to the commonly used E/E' in CTD patients.