Research Article
BibTex RIS Cite

The roles of the main pulmonary artery diameter, ascending aorta diameter, and their ratio in the prognosis of dyspneic patients

Year 2026, Volume: 17 Issue: 57 , 19 - 24 , 16.04.2026
https://doi.org/10.17944/interdiscip.1790148
https://izlik.org/JA29SN65PB

Abstract

Objective: This study aimed to evaluate the prognostic significance of the main pulmonary artery diameter (mPAD), ascending aorta diameter (AAD), and the mPAD/AAD ratio in dyspneic patients.
Method: In this retrospective study, patients aged >18 years who presented to the emergency department (ED) with dyspnea and underwent thoracic computed tomography (CT) between July 1, 2021, and December 31, 2022, were included. Demographic data, clinical outcomes, and radiological measurements were analyzed.
Results: A total of 372 patients were enrolled, of whom 59 (16%) died during hospitalization. Non-survivors had significantly higher mPAD and mPAD/AAD ratios compared with survivors. Receiver operating characteristic analysis demonstrated that mPAD was the strongest predictor of in-hospital mortality, with an area under the curve of 0.72. Using a cut-off value of ≥29 mm, mPAD yielded a sensitivity of 81%, specificity of 52%, positive predictive value (PPV) of 24%, and negative predictive value (NPV) of 94%.
Conclusion: The mPAD and the mPAD/AAD ratio can be used as reliable indicators of prognosis in patients presenting with dyspnea, such as predicting the need for mechanical ventilation, intensive care unit admission, and in-hospital mortality.

Ethical Statement

Ethics Committee Approval: Alanya Alaaddin Keykubat University Clinical Research Ethics Committee, Decision number: 2-15 Date: February 15, 2023.

Supporting Institution

None.

Thanks

None.

References

  • Kelly AM, Keijzers G, Klim S, Graham CA, Craig S, Kuan W Sen, et al. An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Academic Emergency Medicine. 2017 Mar 11;24(3):328–36. https://doi.org/10.1111/acem.13118
  • Ay MO, Kozaci N, Avci M, Cekic B, Cerit N, Keskin O, et al. Utility of biochemical markers and RVD/LVD ratio in acute pulmonary embolism risk classification in Emergency Department. Eur Rev Med Pharmacol Sci. 2017 Oct;21(19):4391–7.
  • Kozaci N, Ay MO, Beydilli I, Kartal ZA, Celik A, Sasmaz I, et al. Right-sided electrocardiogram usage in acute pulmonary embolism. Am J Emerg Med. 2016 Aug;34(8):1437–41. https://doi.org/10.1016/j.ajem.2016.04.025
  • Türkay Kunt A, Kozaci N, Torun E. Mortality Predictors in Patients Diagnosed with COVID-19 in the Emergency Department: ECG, Laboratory and CT. Medicina (B Aires). 2021 Jun 17;57(6):629. https://doi.org/10.3390/medicina57060629
  • Figarska SM, Boezen HM, Vonk JM. Dyspnea severity, changes in dyspnea status and mortality in the general population: the Vlagtwedde/Vlaardingen study. Eur J Epidemiol. 2012 Nov 7;27(11):867–76. https://doi.org/10.1007/s10654-012-9736-0
  • DeVos E, Jacobson L. Approach to Adult Patients with Acute Dyspnea. Emerg Med Clin North Am. 2016 Feb;34(1):129–49. https://doi.org/10.1016/j.emc.2015.08.008
  • Chien C-H, Shih F-C, Chen C-Y, Chen C-H, Wu W-L, Mak C-W. Unenhanced multidetector computed tomography findings in acute central pulmonary embolism. BMC Med Imaging. 2019 Dec 14;19(1):65. https://doi.org/10.1186/s12880-019-0364-y
  • Zhu Q-Q, Gong T, Huang G-Q, Niu Z-F, Yue T, Xu F-Y, et al. Pulmonary artery trunk enlargement on admission as a predictor of mortality in in-hospital patients with COVID-19. Jpn J Radiol. 2021 Jun 22;39(6):589–97. https://doi.org/10.1007/s11604-021-01094-9
  • Simsek DT, Simsek C, Erdil I, Dogan H, Ozucelik DN. Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department. Iran Red Crescent Med J. 2022 Mar 31;24(12):e890. https://doi.org/10.32592/ircmj.2022.24.12.890
  • Tonelli AR, Johnson S, Alkukhun L, Yadav R, Dweik RA. Changes in main pulmonary artery diameter during follow-up have prognostic implications in pulmonary arterial hypertension. Respirology. 2017 Nov;22(8):1649–55. https://doi.org/10.1111/resp.13073
  • Andersen CU, Mellemkjær S, Nielsen-Kudsk JE, Bendstrup E, Hilberg O, Simonsen U. Pulmonary hypertension in chronic obstructive and interstitial lung diseases. Int J Cardiol. 2013 Oct;168(3):1795–804. https://doi.org/10.1016/j.ijcard.2013.06.033
  • Raymond TE, Khabbaza JE, Yadav R, Tonelli AR. Significance of Main Pulmonary Artery Dilation on Imaging Studies. Ann Am Thorac Soc. 2014 Dec;11(10):1623–32. https://doi.org/10.1513/AnnalsATS.201406-253PP
  • Chen J, Huang Y-L, Huang H, Zheng T, Cong G-Z. The non-linear association between ascending aorta diameter and risk of 12-month mortality in Chinese patients with heart failure: A retrospective cohort study. Front Cardiovasc Med. 2022 Aug 30;9:917325. https://doi.org/10.3389/fcvm.2022.917325
  • Truong QA, Massaro JM, Rogers IS, Mahabadi AA, Kriegel MF, Fox CS, et al. Reference Values for Normal Pulmonary Artery Dimensions by Noncontrast Cardiac Computed Tomography. Circ Cardiovasc Imaging. 2012 Jan;5(1):147–54. https://doi.org/10.1161/CIRCIMAGING.111.968610
  • Terzikhan N, Bos D, Lahousse L, Wolff L, Verhamme KMC, Leening MJG, et al. Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study. European Respiratory Journal. 2017 Jun 15;49(6):1602168. https://doi.org/10.1183/13993003.02168-2016
  • Zafer Baytugan N, Çağlayan Kandemir H. Pulmonary artery diameter on chest CT predicts in-hospital mortality in patients with COVID-19 pneumonia [Internet]. Vol. 17, researchsquare.com. 2022. p. 75–81. https://doi.org/10.21203/rs.3.rs-1748853/v1
  • Riachy MA, Ismail A, Awali M, Farah F, Haddad SF, Kerbage A, et al. Pulmonary Artery Enlargement: An Independent Risk Factor for Mortality in Patients Hospitalized With COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2022 Oct;6(5):399–408. https://doi.org/10.1016/j.mayocpiqo.2022.07.001
  • Nakanishi R, Rana JS, Shalev A, Gransar H, Hayes SW, Labounty TM, et al. Mortality Risk as a Function of the Ratio of Pulmonary Trunk to Ascending Aorta Diameter In Patients With Suspected Coronary Artery Disease. Am J Cardiol. 2013 May;111(9):1259–63. https://doi.org/10.1016/j.amjcard.2013.01.266
  • Erdoğan M, Öztürk S, Erdöl MA, Kasapkara A, Beşler MS, Kayaaslan B, et al. Prognostic utility of pulmonary artery and ascending aorta diameters derived from computed tomography in COVID-19 patients. Echocardiography. 2021 Sep 6;38(9):1543–51. https://doi.org/10.1111/echo.15170
  • Gašparović K, Pavliša G, Hrabak Paar M, Brestovac M, Lovrić Benčić M, Šeparović Hanževački J, et al. Diagnostic accuracy, sensitivity, and specificity of CT pulmonary artery to aorta diameter ratio in screening for pulmonary hypertension in end-stage COPD patients. Croat Med J. 2021 Oct;62(5):446–55. https://doi.org/10.3325/cmj.2021.62.446
  • Karazincir S, Balcı A, Seyfeli E, Akoğlu S, Babayiğit C, Akgül F, et al. CT assessment of main pulmonary artery diameter. Article in Diagnostic and interventional radiology [Internet]. 2008;14:72–4.
  • Dulli JG, Chandrashekar H, Naveen J, Srinivas MR, Rao SG, Gowda SS. Measurement of Main Pulmonary Artery Diameter and its Ratio with Ascending Aorta in Indian Population by Multi Detector Computed Tomography. Journal of Clinical and Diagnostic Research. 2020;14(9):13–5. https://doi.org/10.7860/JCDR/2020/44175.14029
There are 22 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research Article
Authors

İsmail Erkan Aydin 0000-0003-3552-5459

Nalan Kozaci 0000-0001-7758-3839

Submission Date September 24, 2025
Acceptance Date December 21, 2025
Publication Date April 16, 2026
DOI https://doi.org/10.17944/interdiscip.1790148
IZ https://izlik.org/JA29SN65PB
Published in Issue Year 2026 Volume: 17 Issue: 57

Cite

Vancouver 1.İsmail Erkan Aydin, Nalan Kozaci. The roles of the main pulmonary artery diameter, ascending aorta diameter, and their ratio in the prognosis of dyspneic patients. Interdiscip Med J. 2026 Apr. 1;17(57):19-24. doi:10.17944/interdiscip.1790148