Changing of pulmonary artery diameter in accordance with severity of COVID-19 (assessment based on non-contrast computer tomography)

Abstract

BACKGROUND: Computed tomography is the method of choice for assessing the volume of lung damage in viral pneumonia, including those associated with COVID-19. In addition, computed tomography can determine the main vessels size of the thorax. This allowed us to analyze the relationship between the severity of COVID-19 and the changes in the diameters of the pulmonary artery (PA) and ascending aorta (Ao). Dilation of the PA is a sign of pulmonary hypertension. The study of these patterns may be of clinical significance in determining the treatment tactics and prognosis of the course of COVID-19 disease.

AIM: To evaluate the relationship between PA diameter and the severity of the COVID-19 course in patients of different ages.

MATERIALS AND METHODS: This study is a single-centered, cross-section, continuous, uncontrolled study performed on a group of patients (n=511, 267 men, median 59 years, IQR 49.0–65.0, ages 31–84 years) who were treated in a temporary hospital to treat patient with COVID-19. During hospitalization all patients were examined by CT scan of the chest. All studies were carried out using a mobile CT scan system Airo TruCT (Stryker, USA). The degree of damage to the lung tissue was assessed using the CT volume scale 1–4. Measurement of the LA and Ao diameters was carried out using standard instruments of the radiologist’s CT workstation perpendicular to the long axis of the vessel.

RESULTS: The following statistically significant regularities were obtained: the detection of a dilated pulmonary artery (PA) and an increased PA/Ao ratio correlated to an increase in the degree of lung damage in COVID-19 (Kruskal-Wallis test, K-W p <0.001; median test, MT p <0.001), the diameter of the ascending aorta (Ao) significantly increases with the patient’s age (K-W p <0.001; MT p <0.001). An insignificant correlation between an increase in the diameter of the pulmonary artery (PA) and the patient’s age (K-W p=0.094; MT p=0.311) and an insignificant correlation between detection of a change in aortic (Ao) diameter and the degree of lung damage (K-W p=0.061; MT p=0.165) were shown. In groups with a severe course of the disease and a large volume of lung lesions (CT-3 and CT-4), a significantly greater number of patients with signs of pulmonary hypertension (detection of the dilated pulmonary artery: 29 mm and more) was shown for all age groups.

CONCLUSION: The study showed that PA dilatation and increased PA/Ao diameter ratio were significantly associated with increased pulmonary lesion volume in COVID-19 in all age groups.

Keywords

COVID-19 / pulmonary artery / pulmonary hypertension / thoracic aorta / X-ray computed tomography

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