Pulmonary Artery Hypertension in Chronic Obstructive Pulmonary Disease: Determination by Chest Radiography

Abstract

Pulmonary artery hypertension is a frequent complication of severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine whether analysis of the chest radiograph can reveal the presence of pulmonary artery hypertension in COPD. Sixty-one men with COPD (forced expiratory volume in 1 second 0.97 ± 0.35 liters, mean ± SD) underwent right heart catheterization, and in 46 the mean pulmonary artery pressure was elevated (> 20 mmHg). Plain chest radiographs of the 61 patients and 42 normal control subjects were evaluated. The right descending pulmonary artery (RDPA) was enlarged (> 16 mm) in 43 of 46 patients (93%) with an elevated mean pulmonary artery pressure, and the left descending pulmonary artery (LDPA) diameter also was enlarged (> 18 mm) in 43 of 46. Combined increased RDPA and increased LDPA diameter measurements permitted correct diagnosis in 45 of 46 patients (98%) with pulmonary artery hypertension, including all 26 with a mild elevation of mean pulmonary artery pressure (21–30 mmHg). There was a significant correlation between mean pulmonary artery pressure and both RDPA and LDPA measurements. Analysis of RDPA and LDPA diameters on the plain chest radiograph is a sensitive and accurate method of detecting the presence and severity of pulmonary artery hypertension in COPD.