Ebook Pulmonary Hypertension and CT Measurement of Small Pulmonary Vessels in Severe Emphysema
Pulmonary hypertension is an important predictor of mortality in chronic obstructive pulmonary disease (COPD) (1-3). Various factors, including endothelial dysfunction, inflammation, and hypoxia, have been recognized as potential contributors to the development of secondary pulmonary hypertension in emphysema; but its pathogenesis has not been fully clarified.
Nevertheless, it is generally recognized that vascular remodeling of small pulmonary arteries is an essential morphological feature of pulmonary hypertension; narrowing and diminution of the small pulmonary vessels have been shown on conventional angiography in emphysema (4-6). However, to our knowledge, the in vivo relationship between pulmonary hypertension and the magnitude of small pulmonary vessel morphological change has not been quantitatively assessed in severe emphysema.
A recent histological study suggested that vascular remodeling leads to reduced distensibility of small pulmonary vessels and that this remodeling is closely related to pulmonary hypertension (7). Such a decrease in distensibility of small pulmonary vessels may lead to increased pulmonary vascular resistance and elevated pulmonary vascular pressure. Therefore, we hypothesized that measurements of the total cross sectional area of small pulmonary vessels (CSA) using non-contrast chest CT scans (8) could be used to show a correlation of the relationship with the degree of pulmonary hypertension in patients with emphysema.
The principal purpose of this study was to evaluate the relationship between the total CSA on CT images and the degree of pulmonary hypertension in patients with COPD. For comparison, we also evaluated the correlation of mean pulmonary arterial pressure (Ppa) with other variables previously described useful in diagnosing pulmonary hypertension, such as the diameter of the main pulmonary artery (MPAD) measured by CT scan. Additional multiple linear regression analysis using Ppa as the dependent outcome was also performed to evaluate the impact of the total CSA on CT images.
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