Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD.
Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD.
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DOI：
10.2147/copd.s52204
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发表时间：
2013
影响因子：
2.8
通讯作者：
Dransfield MT
中科院分区：
文献类型：
--
作者：
Wells JM;Dransfield MT
慢性阻塞性肺疾病(COPD)是一种复杂的疾病，其定义是对有害刺激、炎症和血管变化的渐进性气流受限。慢性阻塞性肺疾病的恶化是疾病自然发展史上的关键事件，占疾病负担、成本和死亡率的大部分。肺血管疾病是疾病进展和恶化风险的重要危险因素。在计算机断层扫描上，相对的肺动脉增大，由肺动脉与主动脉(PA：A)比值和GT；1来定义，已被评估为肺血管疾病的一个标志。PA：A比率可以独立于心电门控或造影剂的使用而可靠地测量，在健康患者中，PA：A比率0.9被认为是异常的。PA：A比值与有创性血流动力学参数，主要是各种疾病情况下的平均肺动脉压进行了比较，与间质性肺疾病相比，梗阻性疾病的PA：A与平均肺动脉压的相关性更强。在没有已知心脏或肺部疾病的患者中，PA：A比率是死亡率的预测指标，而在COPD患者中，PA：A比率升高与恶化风险增加相关，表现优于这些事件的其他公认预测指标。未来的研究应该旨在确定该指标随时间的稳定性，并评估PA：指导特定治疗的比率的效用。
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.