Frequency, Predictors, and Prognostic Impact of Pulmonary Artery Aneurysms in Patients With Pulmonary Arterial Hypertension

• Published in: The American journal of cardiology 2019-02, Vol.123 (3), p.474-481
• Main Authors: Nuche, Jorge, Montero Cabezas, José-Manuel, Jiménez López-Guarch, Carmen, Velázquez Martín, Maite, Alonso Charterina, Sergio, Revilla Ostolaza, Yolanda, Arribas Ynsaurriaga, Fernando, Escribano Subías, Pilar
• Format: Article
• Language: English
• Subjects: Aneurysm; Aneurysms; Cardiovascular disease; Computation; Computed tomography; Confidence intervals; Congenital diseases; Connective tissues; Death; Diagnosis; Health risks; Heart; Hemodynamics; Hypertension; Lung transplantation; Magnetic resonance; Medical imaging; Medical prognosis; Mortality; Multivariate analysis; Patients; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Rank tests; Resonance; Risk analysis; Risk factors; Tissues; Transplants & implants; Ultrasonic imaging; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.10.028

Detection of pulmonary artery aneurysms (PAA) in pulmonary arterial hypertension (PAH) is increasing. We sought to determine the frequency of PAA in a PAH cohort, variables related to its development and its prognostic impact. We conducted a retrospective analysis of PAH patients who underwent a computed tomography or magnetic resonance. PAA was defined as a pulmonary artery >40 mm. Baseline, echocardiographic, and hemodynamic findings at PAH diagnosis were compared. Freedom from death or lung transplant was estimated by Kaplan–Meier method and compared by log-rank test. Predictors of PAA development were analyzed with multivariate models. Two-hundred patients underwent a computed tomography and/or magnetic resonance. In 77 (38%), a PAA (48.3 ± 7.2 mm) was detected. Time-course (months) of PAH was an independent risk factor for PAA (hazard ratio 1.01; 95% confidence interval 1.002 to 1.019; p = 0.016) whilst connective tissue disease was associated with a lower risk (hazard ratio 0.236; 95% confidence interval 0.060 to 0.920; p = 0.037). PAA patients showed lower rates of death and lung transplant from PAH diagnosis (p = 0.005), but no differences appeared when survival analysis was performed from first imaging test (p = 0.269). PAA patients presented a nonsignificant higher rate of sudden death (5% PAA vs 1% no-PAA; p = 0.073). In conclusion, the frequency of PAA was 38%. PAH time-course was an independent risk factor for PAA development whereas connective tissue disease -related PAH patients showed a lower risk. PAA patients showed lower rates of death or lung transplant from PAH diagnosis but no differences were found from imaging test. PAA patients had a nonsignificant higher rate of sudden death.