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Pulmonary Artery Dilation on CT Associates with Mean Pulmonary Artery Pressure and Mortality

Strategic Insights

— 2 min read

A recent study published in the Annals of the American Thoracic Society has shed light on the relationship between pulmonary artery (PA) dilation on computed tomography (CT) and mean pulmonary artery pressure (mPAP) in patients with pulmonary hypertension (PH). Researchers from Vanderbilt University Medical Center investigated the association between PA size, mPAP, and survival in individuals with group 1 or 2 PH and matched controls. The study, which included 691 subjects, found that PA diameter and PA:aorta ratio demonstrated significant association with mPAP, with PA diameter increasing incrementally from no PH to mild PH to moderate-severe PH.

Key Takeaways:

  • PA dilation on CT is associated with moderate-severe pulmonary hypertension (PH) using outdated diagnostic criteria.
  • The study found that PA diameter and PA:aorta ratio demonstrated significant association with mean pulmonary artery pressure (mPAP) (r = 0.557 and 0.564, respectively).
  • PA size increased incrementally from no PH to mild PH to moderate-severe PH for PA diameter (27.64 [95% CI 17.64-37.64] to 30.65 [18.99-42.31] to 36.00 [22.46-49.54] mm) and PA:aorta (0.89 [0.53-1.24] to 0.99 [0.63-1.35] to 1.19 [0.60-1.78]).
  • PA diameter and PA:aorta demonstrated good discrimination of mPAP 20 mmHg (AUC 0.834 and 0.816, respectively).
  • Transplant-free survival decreased across the continuum of PA diameter and PA:aorta (p < 0.001).
  • The study cautioned that the association between PA size and mPAP in mild PH remains unclear.

Statistics:

  • 691 subjects were included in the study.
  • 595 subjects underwent right heart catheterization (RHC).
  • PA diameter and PA:aorta ratio demonstrated significant association with mPAP (r = 0.557 and 0.564, respectively).
  • PA diameter increased from 27.64 mm (95% CI 17.64-37.64) in no PH to 30.65 mm (18.99-42.31) in mild PH to 36.00 mm (22.46-49.54) in moderate-severe PH.
  • PA:aorta ratio increased from 0.89 (0.53-1.24) in no PH to 0.99 (0.63-1.35) in mild PH to 1.19 (0.60-1.78) in moderate-severe PH.
  • Transplant-free survival decreased across the continuum of PA diameter and PA:aorta (p < 0.001).

Sources:

  • Pulmonary Artery Size on CT Associates with Mean Pulmonary Artery Pressure and Mortality. Annals of the American Thoracic Society, 2025.
  • Vanderbilt University Medical Center. Health & Medicine Week. October 31, 2025; p 8507.
  • Tyler J. Couch, Vanderbilt University Medical Center, Division of Allergy Pulmonary and Critical Care Medicine, Nashville, Tennessee, United States.
  • Gerald J. Beck, Erika B. Rozenzweig, J. Jeffrey Carr, Serpil C. Erzurum, Robert P. Frantz, Paul M. Hassoun, Nicholas S. Hill, Evelyn M. Horn, Jason K. Lempel, Jane A. Leopold, Hui Nian, David N. Ray, Franz P. Rischard, and Kevin T. Schwalbach.

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