Background: Pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD) is a common complication that requires early detection for better patient outcomes. Computed tomography pulmonary angiography (CTPA) offers comprehensive assessment of pulmonary vessels and cardiac chambers in patients with suspected PH. This study aimed to evaluate the diagnostic performance of CTPA in predicting COPD-associated ‎PH and to identify optimal CTPA parameters for its diagnosis.

Methods: This cross-sectional study included 30 COPD patients who underwent CTPA. The following measurements were recorded: main pulmonary artery (MPA) diameter; right and left PA diameters; MPA/ascending aorta diameters ratio; segmental PA/accompanying bronchus ratio; right ventricular (RV) lumen diameter; left ventricular (LV) lumen diameter; RV lumen/LV lumen ratio; RV wall thickness; and RV outflow tract thickness. According to transthoracic echocardiography (TTE) findings (reference standard), patients were classified into those with PH and without PH. Diagnostic performance of CTPA was evaluated using a 2x2 contingency table to estimate its accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Receiver operating characteristic (ROC) curve analysis with calculation of the area under the curve (AUC) was performed for each CTPA parameter.

Results: CTPA showed 80% accuracy, 85% sensitivity, 70% specificity, 85% PPV, and 70% NPV (P=0.002) in predicting COPD-associated PH. MPA diameter was the optimal parameter to predict PH, demonstrating the highest AUC = 1 at cut-off value of ≥ 28.7 mm.

Conclusion: CTPA showed good diagnostic performance in predicting COPD-associated PH, with MPA diameter being the optimal parameter.

Keywords: COPD; Pulmonary Hypertension; CTPA; TTE.