Aneurysmal pulmonary artery size (≥40 mm) was associated with higher mean pulmonary artery pressure (46 vs 19 and 35 mmHg) and increased likelihood of death or transplant (p<0.001).
Cohort (n=690)
Does aneurysmal pulmonary artery size predict worse hemodynamics and survival in patients with pulmonary hypertension?
Aneurysmal pulmonary artery size in pulmonary hypertension is associated with worse hemodynamics and reduced survival, highlighting its prognostic importance.
p-value: p=<0.001
Abstract Rationale Prior studies demonstrate pulmonary artery (PA) enlargement on computed tomography (CT) in pulmonary hypertension (PH). Some patients exhibit markedly enlarged or “aneurysmal” PA dilation, but its clinical relevance remains unclear. We aimed to characterize clinical characteristics, hemodynamics, and survival probability of patients with aneurysmal PA size. Methods Demographics, clinical characteristics, and CT imaging were obtained for individuals with group 1 or 2 PH and matched controls in the Pulmonary Vascular Disease Phenomics cohort. PA diameter was measured using Osirix software. PA diameter was categorized based on previously reported values as normal (27 mm females, 29 mm males), enlarged (27-39 mm females, 29-39 mm males), or aneurysmal (≥40 mm). Outcomes included mean PA pressure (mPAP) on right heart catheterization (RHC) and time to death or heart/lung transplant. Associations with mortality and mPAP were evaluated using multivariable Cox and linear regression models, adjusting for age, sex, and BMI. Descriptive statistics are presented as median IQR. Results 690 subjects met the inclusion criteria for survival analysis (364 WSPH group 1 or matched comparator, 241 group 2 or comparator, 85 healthy control), with 594 undergoing RHC. PA diameter was normal in 163 participants, enlarged in 414, and aneurysmal in 113. Aneurysmal PA, compared with normal or enlarged PA, was associated with younger age (53 ± 14 vs 55 ± 16 and 59 ± 15 years, respectively; p 0.001), non-White race (18.9% vs 8% and 17.2%; p = 0.034), pro-BNP (1950 ± 5708 vs 531 ±1651 and 110 ± 2258 pg/mL; p 0.001), PH duration (6.78 ± 6.86 vs 2.24 ± 4.39 and 3.82 ± 5.47 years; p 0.001), group 1 disease (77% vs 37% and 61%), and congenital heart disease (CHD)-PAH (10.6% vs 0.0% and 4.8%, p 0.001). Aneurysmal PA subjects had higher mPAP (46 36-57 vs 19 16- 25 and 35 28-47 mmHg, p 0.001), pulmonary vascular resistance (PVR) (5.5 3.6-9.4 vs 1.7 1.0-2.3 and 4.1 2.4-7.1 Woods units, p 0.001), cardiac index (CI; 2.73 2.34-3.29 vs 2.55 2.13-2.98 and 2.52 2.12-3.10 L/min/m2, p 0.02) and likelihood of death or transplant (p 0.001; Figure 1). Conclusion “Aneurysmal” PA was more common in younger, non-White subjects with longer WSPH group 1 disease duration, CHD, and higher pro-BNP levels. Aneurysmal PA was associated with elevated mPAP, PVR, and CI, and reduced likelihood of survival. These findings highlight the need to further elucidate the pathophysiology and prognostic implications of aneurysmal PA remodeling in PH. This abstract is funded by: NHLBI and the Pulmonary Hypertension Association
Ray et al. (Fri,) conducted a cohort in Pulmonary hypertension (n=690). Aneurysmal pulmonary artery size (≥40 mm) vs. Normal or enlarged pulmonary artery size was evaluated on Mean pulmonary artery pressure (mPAP) and time to death or heart/lung transplant (p=<0.001). Aneurysmal pulmonary artery size (≥40 mm) was associated with higher mean pulmonary artery pressure (46 vs 19 and 35 mmHg) and increased likelihood of death or transplant (p<0.001).