A review of imaging modalities in pulmonary hypertension

Ascha, Mona; Renapurkar, Rahul D.; Tonelli, Adriano R.

doi:10.4103/1817-1737.203742

Cited by 55 publications

(12 citation statements)

References 94 publications

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“…As expected, PA diameter significantly correlated with age, pack year history and BMI. As has been shown previously it also correlated (although weakly) with the history of exacerbations the year prior to enrollment [ 15 ]. All components of the BODE index and the index itself statistically correlated well with PA diameter.…”

Section: Discussionsupporting

confidence: 64%

“…The gold standard for its diagnosis is the invasive measurement of the mean Pulmonary Artery Pressure (mPAP) by right heart catheterization [ 13 ]. Several noninvasive tools have been described for the screening for PH, including Transthoracic Doppler Ultrasound measurement of the systolic PAP from the peak tricuspid regurgitation jet or the detection of an enlarged PA in a chest CT defined by a main PA diameter >30mm or a main PA to ascending Aorta ratio>1 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary arterial enlargement predicts long-term survival in COPD patients

et al. 2018

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RationalePulmonary artery enlargement (PAE) is associated with exacerbations in Chronic Obstructive Pulmonary Disease (COPD) and with survival in moderate to severe patients. The potential role of PAE in survival prediction has not been compared with other clinical and physiological prognostic markers.MethodsIn 188 patients with COPD, PA diameter was measured on a chest CT and the following clinical and physiological parameters registered: age, gender, smoking status, pack-years history, dyspnea, lung function, exercise capacity, Body Mass Index, BODE index and history of exacerbations in year prior to enrolment. Proportional Cox regression analysis determined the best predictor of all cause survival.ResultsDuring 83 months (±42), 43 patients died. Age, pack-years history, smoking status, BMI, FEV1%, six minute walking distance, Modified Medical Research Council dyspnea scale, BODE index, exacerbation rate prior to enrollment, PA diameter and PAE (diameter≥30mm) were associated with survival. In the multivariable analysis, age (HR: 1.08; 95%CI: 1.03–1.12, p<0.001) and PAE (HR: 2.78; 95%CI: 1.35–5.75, p = 0.006) were the most powerful parameters associated with all-cause mortality.ConclusionsIn this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Pulmonary arterial enlargement predicts long-term survival in COPD patients

et al. 2018

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“…30 CT signs of pulmonary hypertension was defined as pulmonary artery diameter >30 mm, pulmonary artery diameter to ascending thoracic aorta ratio >1, and contrast medium reflux into the inferior vena cava/hepatic veins. 31 , 32 …”

Section: Methodsmentioning

confidence: 99%

Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease

et al. 2020

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AIM To report the severity and extent of pulmonary thromboembolic disease (PTD) in COVID-19 patients undergoing computed tomography pulmonary angiography (CTPA) in a tertiary centre. MATERIALS AND METHODS This is a retrospective analysis of COVID-19 patients undergoing CTPA over a period of 27 days. The presence, extent, and severity of PTD were documented. Two observers scored the pattern and extent of lung parenchymal disease including potential fibrotic features, as well as lymph node enlargement and pleural effusions. Consensus was achieved via a third observer. Interobserver agreement was assessed using kappa statistics. Student's t -test, chi-squared, and Mann–Whitney U -tests were used to compare imaging features between PTD and non-PTD sub-groups. RESULTS During the study period, 100 patients with confirmed COVID-19 underwent CTPA imaging. Ninety-three studies were analysed, excluding indeterminate CTPA examinations. Overall incidence of PTD was 41/93 (44%) with 28/93 patients showing small vessel PTD (30%). D-dimer was elevated in 90/93 (96.8%) cases. A high Wells' score did not differentiate between PTD and non-PTD groups ( p= 0.801). The interobserver agreement was fair (kappa=0.659) for parenchymal patterns and excellent (kappa=0.816) for severity. Thirty-four of the 93 cases (36.6%) had lymph node enlargement; 29/34 (85.3%) showed no additional source of infection. Sixteen of the 93 (17.2%) cases had potential fibrotic features. CONCLUSION There is a high incidence of PTD in COVID-19 patients undergoing CTPA and lack of a risk stratification tool. The present data indicates a higher suspicion of PTD is needed in severe COVID-19 patients. The concomitant presence of possible fibrotic features on CT indicates the need for follow-up.

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“…The correlation between pulmonary artery diameter and haemodynamics may vary in different types of PH but remains moderate to strong [81,[84][85][86]. According to several studies, the CT measurements are reliable, with 96% sensitivity and >95% positive predictive value [86][87][88]. On the other hand, normal pulmonary artery dimensions cannot exclude mild PH.…”

Section: Imagingmentioning

confidence: 99%

Pulmonary hypertension and chronic lung disease: where are we headed?

et al. 2019

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Pulmonary hypertension related to chronic lung disease, mainly represented by COPD and idiopathic pulmonary fibrosis, is associated with a worse outcome when compared with patients only affected by parenchymal lung disease. At present, no therapies are available to reverse or slow down the pathological process of this condition and most of the clinical trials conducted to date have had no clinically significant impact. Nevertheless, the importance of chronic lung diseases is always more widely recognised and, along with its increasing incidence, associated pulmonary hypertension is also expected to be growing in frequency and as a health burden worldwide. Therefore, it is desirable to develop useful and reliable tools to obtain an early diagnosis and to monitor and follow-up this condition, while new insights in the therapeutic approach are explored.

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A review of imaging modalities in pulmonary hypertension

Cited by 55 publications

References 94 publications

Pulmonary arterial enlargement predicts long-term survival in COPD patients

Pulmonary arterial enlargement predicts long-term survival in COPD patients

Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease

Pulmonary hypertension and chronic lung disease: where are we headed?

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