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Pulmonary artery enlargement during AE of f-ILD predicts poor survival outcome

27 Jul 2019

A pulmonary artery diameter to ascending aorta diameter ratio (PA/A) ≥1 during acute exacerbation (AE) is a predictor of poor survival outcomes in patients with fibrotic interstitial lung disease (f-ILD), suggest the results of a recent study.

“To the best of our knowledge, this is the first longitudinal examination of the PA/A ratio and evaluation during AE of f‐ILD,” the investigators claimed.

Forty-five of the 123 patients included had PA/A ≥1 during AE. Compared to the PA/A <1, these patients were younger, had lower % vital capacity (VC) and % forced vital capacity (FVC), required more long-term oxygen therapy and other treatment, and had lower PaO2/FiO2 (P/F) ratios.

PA/A during AE increased compared with that during stable periods (p<0.001). Moreover, PA/A ≥1 significantly correlated 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).

This study included 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. CT during and prior (when available) to AE were used to measure the pulmonary arterial diameter, ascending aortic diameter and PA/A so as to assess the changes. Demographic data, comorbidities and clinical outcome (90-day mortality) were analysed.

“In f‐ILD, PA/A ≥1 during the stable stage is associated with worse outcomes,” the investigators noted, “[but] the effect of AE on the PA/A is unknown.”

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