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Pulmonary artery enlargement predicts poor outcome during acute exacerbations of fibrotic interstitial lung disease
Author(s) -
Kogo Mariko,
Otsuka Kojiro,
Morimoto Takeshi,
Nagata Kazuma,
Nakagawa Atsushi,
Tomii Keisuke
Publication year - 2019
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13504
Subject(s) - medicine , interstitial lung disease , exacerbation , cardiology , pulmonary artery , lung , vital capacity , oxygen therapy , ascending aorta , stage (stratigraphy) , diffusing capacity , aorta , lung function , paleontology , biology
Background and objective In fibrotic interstitial lung disease (f‐ILD), pulmonary artery diameter to ascending aorta diameter ratio (PA/A) ≥ 1 during the stable stage is associated with worse outcomes; however, the effect of acute exacerbation (AE) on the PA/A is unknown. Methods Patients with a diagnosis of AE of f‐ILD and with a computed tomography (CT) scan performed during stable period to confirm background fibrosis, as well as a CT scan at admission, were included. The pulmonary arterial diameter, ascending aortic diameter and PA/A were measured using CT during AE and CT prior to AE, when available, to evaluate the changes. Demographic data, co‐morbidities and clinical outcome (90‐day mortality) were analysed. Results Of the 123 patients included, 45 had a PA/A ≥ 1 during AE and compared to the PA/A < 1 group, they were younger, had lower % vital capacity (VC) and % forced vital capacity (FVC), required more long‐term oxygen therapy and other treatments, and had lower PaO 2 /FiO 2 (P/F) ratios. During AE, the PA/A increased from that during stable periods ( P < 0.001), and a PA/A ≥ 1 was significantly associated with 90‐day mortality both before and after adjustment for age, the P/F ratio at admission, long‐term oxygen therapy usage and the type of background f‐ILD ( P = 0.018 and 0.025). Conclusion To the best of our knowledge, this is the first longitudinal examination of the PA/A ratio and evaluation during AE of f‐ILD. Our data show that a PA/A ≥ 1 during AE predicted poor survival outcome in f‐ILD.