Dynamic changes in main pulmonary artery-to-ascending aorta diameter ratio in patients with high-altitude pulmonary edema: clinical implications

doi:10.3877/cma.j.issn.1674-0785.2026.05.002

Abstract

Abstract:

Objective

To investigate the non-invasive diagnostic value and clinical significance of the main pulmonary artery to ascending aorta diameter ratio (MPA/AOr) measured by multi-slice spiral CT in patients with high-altitude pulmonary edema (HAPE).

Methods

This retrospective study included 69 patients with clinically diagnosed HAPE who were admitted to a medical center between December 2022 and June 2025. Chest CT images and clinical data were collected for each patient both before and after treatment. Another 69 healthy subjects matched for general clinical characteristics were selected as the control group. The maximum diameter of the main pulmonary artery and the diameter of the ascending aorta were measured on axial mediastinal-window CT images for all subjects, and the MPA/AOr was calculated. Changes in MPA/AOr in the HAPE group before and after treatment were compared, as well as differences between the HAPE group and the control group at each time point. Correlations of pre-treatment MPA/AOr with arterial oxygen saturation (SpO₂) and length of hospital stay were also examined.

Results

The mean MPA/AOr in the HAPE group before treatment was 1.20±0.10, which decreased significantly to 1.01±0.09 after treatment, compared with 0.98±0.13 in the control group. Pre-treatment MPA/AOr was significantly higher than both the post-treatment value (t=19.33, P＜0.01) and that of the control group (t=11.48, P＜0.01). No statistically significant difference was observed in MPA/AOr between the post-treatment HAPE group and the control group (t=1.84, P＞0.05). Pre-treatment MPA/AOr in HAPE patients was significantly negatively correlated with SpO₂ (r=-0.55, P＜0.01) and positively correlated with length of hospital stay (r=0.71, P＜0.01).

Conclusion

Pulmonary artery pressure is significantly elevated in HAPE patients at disease onset and returns to near-normal levels after effective treatment. A higher pre-treatment MPA/AOr is independently associated with more severe hypoxemia and a longer hospital stay. CT-derived MPA/AOr can objectively reflect dynamic changes in pulmonary artery pressure in HAPE patients throughout the treatment course, and thus may serve as a reliable non-invasive imaging biomarker for evaluating both disease severity and therapeutic efficacy in HAPE.

Key words: High-altitude pulmonary edema, Tomography, spiral computed, Pulmonary hypertension

Qiang Zhang, Mei Liu, Juanqin Niu, Gang Chen, Lina Yue, Yuxi Yan, Pengju Jia, Yonghua Huang, Kang Liu. Dynamic changes in main pulmonary artery-to-ascending aorta diameter ratio in patients with high-altitude pulmonary edema: clinical implications[J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(05): 346-350.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2026.05.002

https://zhlcyszz.cma-cmc.com.cn/EN/Y2026/V20/I05/346

Figures/Tables 5

患者一般资料	HAPE组（n=69）	HC组（n=69）	t/χ²/Z值	P值
年龄（岁， $x ¯$ ±s）	26.75±5.45	26.78±5.46	0.03^a	0.98
BMI（分， $x ¯$ ±s）	23.20±2.10	22.70±2.60	0.94^a	0.35
吸烟[例（%）]	25（36.5）	28（40.6）	1.06^b	0.30
SpO₂（%）	70（64，76）	87（85，90）	-9.93^c	＜0.001
住院日（d）	5（3，5）	-	-	-

患者一般资料	HAPE组（n=69）	HC组（n=69）	t/χ²/Z值	P值
年龄（岁， $x ¯$ ±s）	26.75±5.45	26.78±5.46	0.03^a	0.98
BMI（分， $x ¯$ ±s）	23.20±2.10	22.70±2.60	0.94^a	0.35
吸烟[例（%）]	25（36.5）	28（40.6）	1.06^b	0.30
SpO₂（%）	70（64，76）	87（85，90）	-9.93^c	＜0.001
住院日（d）	5（3，5）	-	-	-

组别	列数	MPA/AOr		t值	P值
组别	列数	治疗前	治疗后	t值	P值
HAPE组	69	1.20±0.10	1.01±0.09	19.33	＜0.001
HC组	69	0.98±0.13^*		11.48	＜0.001^a
组间比较	-	-		1.84	0.68^b

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