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Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study

Natalie Terzikhan, Daniel Bos, Lies Lahousse, Lennard Wolff, Katia M.C. Verhamme, Maarten J.G. Leening, Janine F. Felix, Henning Gall, Hossein A. Ghofrani, Oscar H. Franco, M. Arfan Ikram, Bruno H. Stricker, Aad van der Lugt, Guy Brusselle
European Respiratory Journal 2017 49: 1602168; DOI: 10.1183/13993003.02168-2016
Natalie Terzikhan
Dept of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumDept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Daniel Bos
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Lies Lahousse
Dept of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumDept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lennard Wolff
Dept of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Katia M.C. Verhamme
Dept of Medical Informatics, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Maarten J.G. Leening
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USADept of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Janine F. Felix
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Henning Gall
Universities of Giessen and Marburg Lung Center – Member of the German Center for Lung Research (DZL), Giessen, Germany
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Hossein A. Ghofrani
Universities of Giessen and Marburg Lung Center – Member of the German Center for Lung Research (DZL), Giessen, Germany
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Oscar H. Franco
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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M. Arfan Ikram
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bruno H. Stricker
Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Internal Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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  • For correspondence: b.stricker@erasmusmc.nl
Aad van der Lugt
Dept of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Guy Brusselle
Dept of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumDept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The NetherlandsDept of Respiratory Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract

A pulmonary artery to aorta ratio (PA:A) >1 is a proxy of pulmonary hypertension. It is not known whether this measure carries prognostic information in the general population and in individuals with chronic obstructive pulmonary disease (COPD).

Between 2003 and 2006, 2197 participants from the population-based Rotterdam Study (mean±sd age 69.7±6.7 years; 51.3% female), underwent cardiac computed tomography (CT) scanning with PA:A quantification, defined as the ratio between the diameters of the pulmonary artery and the aorta. COPD was diagnosed based on spirometry or clinical presentation and obstructive lung function measured by a treating physician. Cox regression was used to investigate the risk of mortality.

We observed no association between 1-sd increase of PA:A and mortality in the general population. Larger PA:A was associated with an increased risk of mortality in individuals with COPD, particularly in moderate-to-severe COPD (hazard ratio 1.36, 95% CI 1.03–1.79). We demonstrated that the risk of mortality in COPD was driven by severe COPD, and that this risk increased with decreasing diffusing capacity.

Larger PA:A is not associated with mortality in an older general population, but is an independent determinant of mortality in moderate-to-severe COPD. Measuring PA:A in CT scans obtained for other indications may yield important prognostic information in individuals with COPD.

Abstract

An increased pulmonary artery to aorta ratio is an independent determinant of mortality in moderate-to-severe COPD http://ow.ly/A12C30a0H9f

Footnotes

  • Support statement: This work was supported by a grant from the Fund for Scientific Research Flanders (FWO) project (G035014N). L. Lahousse is a postdoctoral fellow of the FWO. The Rotterdam Study is funded by Erasmus MC and Erasmus University Rotterdam; the Netherlands Organisation for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Ministry of Education, Culture and Science; the Netherlands Ministry for Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

  • Received November 4, 2016.
  • Accepted March 8, 2017.
  • Copyright ©ERS 2017
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Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study
Natalie Terzikhan, Daniel Bos, Lies Lahousse, Lennard Wolff, Katia M.C. Verhamme, Maarten J.G. Leening, Janine F. Felix, Henning Gall, Hossein A. Ghofrani, Oscar H. Franco, M. Arfan Ikram, Bruno H. Stricker, Aad van der Lugt, Guy Brusselle
European Respiratory Journal Jun 2017, 49 (6) 1602168; DOI: 10.1183/13993003.02168-2016

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Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study
Natalie Terzikhan, Daniel Bos, Lies Lahousse, Lennard Wolff, Katia M.C. Verhamme, Maarten J.G. Leening, Janine F. Felix, Henning Gall, Hossein A. Ghofrani, Oscar H. Franco, M. Arfan Ikram, Bruno H. Stricker, Aad van der Lugt, Guy Brusselle
European Respiratory Journal Jun 2017, 49 (6) 1602168; DOI: 10.1183/13993003.02168-2016
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