Computed tomography-measured pulmonary artery to aorta ratio and EUTOS score for detecting dasatinib-induced pulmonary arterial hypertension

  • Takumi ToyaEmail author
  • Yuji Nagatomo
  • Kazuki Kagami
  • Midori Yukino
  • Risako Yasuda
  • Takayuki Namba
  • Yasuo Ido
  • Shinichi Kobayashi
  • Nobuyuki Masaki
  • Hirotaka Yada
  • Fumihiko Kimura
  • Takeshi Adachi
Original Paper



Periodic echo-based screening to detect early stages of a rare complication of dasatinib, pulmonary arterial hypertension (PAH), is inefficient and weakens the potential benefit of dasatinib as a potent drug for chronic myelogenous leukemia (CML). This study aimed to identify the predisposing factors of DASA-PAH to stratify high-risk patients for dasatinib-induced PAH (DASA-PAH).


Sixty consecutive adult patients who received dasatinib were enrolled in this case-control study. We defined DASA-PAH when at least one of the following four criteria was met: (1) recent electrocardiographic changes indicating right ventricular pressure overload, (2) estimated systolic pulmonary arterial pressure > 40 mmHg measured by Doppler echocardiography; (3) computed tomography (CT)-measured pulmonary artery to aorta diameter (PaD/AoD) ratio > 1; and (4) mean pulmonary arterial pressure > 25 mmHg and pulmonary artery wedge pressure < 15 mmHg measured by right heart catheterization.


We identified 13 patients with DASA-PAH among 59 patients analyzed. Baseline PaD/AoD ratios of patients who developed DASA-PAH (PH group) were significantly larger than those who did not (NPH group). A dramatic rise in PaD/AoD ratio after dasatinib treatment was observed. Interestingly, the EUTOS score and spleen size were significantly smaller in the PH than in the NPH group.


High baseline PaD/AoD ratio and low EUTOS score were associated with DASA-PAH development. The spleen might play a protective role against DASA-PAH.


CT Dasatinib EUTOS score Pulmonary arterial hypertension 



Aortic diameter


Chronic myelogenous leukemia


Computed tomography




Dasatinib-induced pulmonary arterial hypertension




Left atrium


Left ventricular ejection fraction


Mean pulmonary arterial pressure


Pulmonary artery diameter


Pulmonary arterial hypertension


Pulmonary artery wedge pressure


Pulmonary vascular resistance


Right heart catheterization


Systolic pulmonary arterial pressure


Tyrosine kinase inhibitor


Transthoracic echocardiography


Wood units



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

TT designed the study, analyzed data, and drafted the paper. YN and YI helped the statistical analysis and manuscript editing. KK and MY helped the data collection. RY and TN performed echo and CT measurement. NM, SK, HY, FK, and TA supported manuscript and figure editing.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Takumi Toya
    • 1
    Email author
  • Yuji Nagatomo
    • 1
  • Kazuki Kagami
    • 1
  • Midori Yukino
    • 1
  • Risako Yasuda
    • 1
  • Takayuki Namba
    • 1
  • Yasuo Ido
    • 1
  • Shinichi Kobayashi
    • 2
  • Nobuyuki Masaki
    • 1
  • Hirotaka Yada
    • 1
  • Fumihiko Kimura
    • 2
  • Takeshi Adachi
    • 1
  1. 1.Division of CardiologyNational Defense Medical CollegeTokorozawaJapan
  2. 2.Division of HematologyNational Defense Medical CollegeTokorozawaJapan

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