Date of Award

2012

Embargo Period

8-1-2024

Document Type

Thesis

Degree Name

Master of Science (MS)

College

College of Graduate Studies

First Advisor

Daniel T. Lackland

Second Advisor

Paul J. Nietert

Third Advisor

James G. Ravenel

Fourth Advisor

Richard M. Silver

Abstract

Purpose: To determine the validity of main pulmonary artery diameter (MPAD) as a marker of pulmonary hypertension in scleroderma patients with and without interstitial lung disease (lLD). Materials and Methods: We cross-referenced the radiologic database with medical records to identify patients with both computed tomography (CT) scans of the chest and right-heart catheterization separated by no more than six months. Computed tomography scans were reviewed to determine MPAD and extent of ILD for each patient. Ground glass opacity and fibrosis were individually scored by a single thoracic radiologist on a five-point scale. The same radiologist also determined the quality of delineation for the great vessels. MPAD was calculated based on the average of measurements taken from two separate observers. Mean pulmonary arterial pressures (mPAP) were determined by RHC. Patients were divided into either group A (n = 20) or group B (n = 27) based on the absence or presence of interstitial fibrosis respectively. Patients with available data from pulmonary function tests (PFTs) were divided into those with FVC > 70% predicted (Group C) and those with FVC < 70% predicted (Group D). Groups were compared using either the Student t test or Mann-Whitney U test depending on the distribution of each variable under consideration. Either the Pearson correlation coefficient or the Spearman rank-correlation coefficient was calculated for each group to evaluate the relationship between MPAD and mPAP. Results: Groups A and B were similar with regard to MPAD (p = 0.28) and mPAP (p = 0.34) upon Mann-Whitney U testing. MPAD was strongly correlated with mPAP in both Group A (r = 0.68, P = 0.001) and Group B (r = 0.70, P < 0.0001). The correlation between MPAD and mPAP in Group C (r = 0.69, P = 0.002) was substantially higher than that in Group 0 (r = 0.42, P = 0.11). Conclusion: In our patient sample with scleroderma, MPAD is strongly correlated with mPAP and may indicate the development of pulmonary hypertension regardless of the presence of mild to moderate interstitial fibrosis. An increase in the severity of restrictive lung disease as measured by FVC appears to attenuate the correlation between MPAO and mPAP.

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