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Increased main pulmonary artery diameter and main pulmonary artery to ascending aortic diameter ratio in smokers undergoing lung cancer screening

  • Author Footnotes
    1 Two first authors.
    David Steiger
    Footnotes
    1 Two first authors.
    Affiliations
    Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
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  • Author Footnotes
    1 Two first authors.
    Dan Han
    Footnotes
    1 Two first authors.
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
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  • Rowena Yip
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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  • Kunwei Li
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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  • Xiangmeng Chen
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Radiology, Jiangmen Central Hospital, Jiangmen, China
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  • Li Liu
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Diagnostic Radiology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, China
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  • Jiayi Liu
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China
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  • Teng Ma
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America

    Department of Radiology, Tong Ren Hospital, Capital Medical University, Dongcheng District, Beijing, China
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  • Faisal Siddiqi
    Affiliations
    Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
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  • David F. Yankelevitz
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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  • Claudia I. Henschke
    Correspondence
    Corresponding author at: Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10023, United States of America.
    Affiliations
    Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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  • Author Footnotes
    1 Two first authors.

      Highlights

      • The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively.
      • BMI was significantly associated with both having MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003) after adjusting for other covariates.
      • No significant association between emphysema on CT and an increase in MPA or MPA:AA was found in this study.
      • When the MPA ≥ 34 mm or MPA:AA ≥ 1.0, further evaluation for possible PH is recommended.

      Abstract

      Objectives

      Pulmonary hypertension (PH) is a progressive, potentially fatal disease, difficult to diagnose early due to non-specific nature of symptoms. PH is associated with increased morbidity and death in many respiratory and cardiac disorders, and with all-cause mortality, independent of age and cardiopulmonary disease. The main pulmonary artery diameter (MPA), and ratio of MPA to adjacent ascending aorta (AA), MPA:AA, on Chest CT are strong indicators of suspected PH.
      Our goal was to determine the prevalence of abnormally high values of these indicators of PH in asymptomatic low-dose CT (LDCT) screening participants at risk of lung cancer, and determine the associated risk factors.

      Methods

      We reviewed consecutive baseline LDCT scans of 1949 smokers in an IRB-approved study. We measured the MPA and AA diameter and calculated MPA:AA ratio. We defined abnormally high values as being more than two standard deviations above the average (MPA ≥ 34 mm and MPA:AA ≥ 1.0). Regression analyses were used to identify risk factors and CT findings of participants associated with high values.

      Results

      The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. Multivariable regression demonstrated that BMI was a significant risk factor, both for MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003). Emphysema was significant in the univariate but not in the multivariate analysis.

      Conclusions

      We determined that the possible prevalence of PH as defined by abnormally high values of MPA and of MPA:AA was greater than previously described in the general population and that pulmonary consultation be recommended for these participants, in view of the significance of PH.

      Keywords

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