A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension

Leone, Maria Barbara; Giannotta, Marica; Palazzini, Massimiliano; Cefarelli, Mariano; Suàrez, Sofia Martìn; Gotti, Enrico; Reggiani, Maria Letizia Bacchi; Zompatori, Maurizio; Galiè, Nazzareno

doi:10.1007/s11547-017-0750-x

Cited by 19 publications

(16 citation statements)

References 38 publications

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“…Pulmonary hypertension (PH) as a result of chronic thromboembolic disease is potentially curable with pulmonary endarterectomy (PEA) surgery [ 2 ]. Although newer surgical techniques already allow for resection of thromboemboli at segmental vessel level [ 2 ], the presence of organized thrombi in the central pulmonary arteries is generally considered a criterion for operability of CTEPH [ 3 , 4 ]. CT imaging plays a fundamental role in the diagnostic work-up of patients with CTEPH.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

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PurposeThe aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome.MethodsVascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF).ResultsThe majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors.ConclusionThe majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

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“…The proportion of optimal MCTA studies may be foreseeably improved by greater radiological expertise gained in external referral centers alongside with new-generation CT scanner equipment and improved examination protocols [ 14 ]. Moreover, CT will presumably gain popularity as a noninvasive hemodynamic monitoring tool in CTEPH, as several CT scores have shown a high correlation with hemodynamic parameters and surgical success rates [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a Noninvasive Operability Assessment in Chronic Thromboembolic Pulmonary Hypertension under Real-World Practice

et al. 2020

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This study aimed to evaluate the feasibility of a noninvasive operability assessment of chronic thromboembolic pulmonary hypertension (CTEPH) based on multidetector computed tomographic angiography (MCTA). Up to 176 patients were evaluated from January 2016 to April 2018. Throughout the first phase, the initial surgical decision was made based on MCTA with further analysis of pulmonary angiography (PA) in order to evaluate in which cases the initial decision was not modified by PA. During the second phase, PA was limited to patients judged inoperable based on MCTA or those whose assessment was not possible. Patients deemed operable (50%) based on MCTA along the first phase had been adequately classified, as PA did not modify the initial decision in all but one patient. Comparable results were obtained throughout the implementation phase. Regarding operated patients, the decision of operability was based solely on MCTA in 94% of those with level I disease, in 75% with level II, and 54% with level III. This approach enabled shorter periods of time to complete surgical assessment and the avoidance of PA-related morbidity. Baseline parameters, postoperative measures, and survival rates at 1 year after surgery were comparable in both phases. Noninvasive operability assessment is feasible in a subset of CTEPH patients and optimizes surgical candidacy evaluation.

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“…The proportion of optimal MCTA studies may be foreseeably improved by greater radiological expertise gained in external referral centers alongside with new-generation CT scanner equipment and improved examination protocols [15]. Moreover, CT will presumably gain popularity as a noninvasive hemodynamic monitoring tool in CTEPH as several CT scores have shown high correlation with hemodynamic parameters and surgical success rates [16].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a noninvasive operability assessment in chronic thromboembolic pulmonary hypertension under real-world practice.

Chaverri

Ostolaza

López-Gude

et al. 2020

Preprint

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A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension

Abstract: Our results confirm the diagnostic role of CTPA in evaluating patients with CTEPH and in addition open a new horizon in assessing hemodynamic changes in patients with CTEPH, only employing a CTPA, especially when RHC is contraindicated or not possible.

Cited by 19 publications

References 38 publications

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Feasibility of a Noninvasive Operability Assessment in Chronic Thromboembolic Pulmonary Hypertension under Real-World Practice

Feasibility of a noninvasive operability assessment in chronic thromboembolic pulmonary hypertension under real-world practice.

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