ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update

Sirajuddin, Arlene; Mirmomen, S. Mojdeh; Henry, Travis S.; Kandathil, Asha; Kelly, Aine Marie; King, Christopher S.; Kuzniewski, Christopher T.; Lai, Andrew; Lee, Elizabeth; Martin, Maria D.; Mehta, Parth; Morris, Michael; Raptis, Constantine A.; Roberge, Eric; Sandler, Kim L.; Donnelly, Edwin F.

doi:10.1016/j.jacr.2022.09.018

Cited by 4 publications

(6 citation statements)

References 76 publications

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“…Dilation of the right ventricle, right atrium, coronary sinus and tricuspid regurgitation are further indicators of pulmonary hypertension on CT scans. Overall, CT has an acceptable performance for the diagnosis of pulmonary hypertension with a sensitivity of 87% and a specificity of 89% [6]. In comparison, transthoracic echocardiography has a sensitivity of 85% and specificity of 74% and transesophageal echocardiography has a sensitivity of 84% and specificity of 83% [6].…”

Section: Methodsmentioning

confidence: 98%

“…Overall, CT has an acceptable performance for the diagnosis of pulmonary hypertension with a sensitivity of 87% and a specificity of 89% [6]. In comparison, transthoracic echocardiography has a sensitivity of 85% and specificity of 74% and transesophageal echocardiography has a sensitivity of 84% and specificity of 83% [6]. In addition, we reviewed the electronic health records (CPRS) for the presence or absence of the diagnosis of sleep apnea.…”

Section: Methodsmentioning

confidence: 99%

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Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population

Stark

Chang

2023

JCM

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We have investigated the concurrence of sleep apnea and pulmonary hypertension in a Veteran population. We retrospectively reviewed 142 patients who underwent chest CT scans and had a dilated main pulmonary artery, defined as a width exceeding 29 mm on axial images. Approximately 40% of patients with pulmonary hypertension had associated sleep apnea. No significant difference in pulmonary artery diameters could be found between the group without sleep apnea and the group with sleep apnea (34.5 ± 4.2 mm vs. 34.7 ± 4.4 mm, p = 0.373).

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Section: Methodsmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population

Stark

Chang

2023

JCM

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“…By classifying patients with PAH, CTE-PH, or other forms of severe pulmonary hypertension, clinicians can appropriately refer them to pulmonary hypertension centers for specialized care. 20 In 2022, the European Society of Cardiology (ESC)/the European Respiratory Society (ERS) issued guidelines for the diagnosis and treatment of pulmonary hypertension. 3 If a clinician has a patient with unexplained dyspnea or is suspected of having pulmonary hypertension, the clinician can refer to a diagnostic algorithm to approach the clinical workup (Figure 2).…”

Section: Diagnosismentioning

confidence: 99%

“…The role of diagnostic testing is not only to confirm the presence of pulmonary hypertension, but to help identify the underlying cause and classify it. By classifying patients with PAH, CTE-PH, or other forms of severe pulmonary hypertension, clinicians can appropriately refer them to pulmonary hypertension centers for specialized care 20…”

Section: Diagnosismentioning

confidence: 99%

A clinician's guide to pulmonary hypertension

Wilson,

Sadowski,

Baeten

2024

Jaapa

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Despite advances in diagnosis and treatment, pulmonary hypertension has high morbidity and mortality. The presenting symptoms often are vague and may mimic other more common diseases, so patients can be misdiagnosed or missed early in the disease process. Early detection of pulmonary hypertension by primary care providers can play an important role in patient outcomes and survival. Identifying signs and symptoms, understanding the causes and classifications, and knowing the systematic approach to evaluating and diagnosing patients with suspected pulmonary hypertension are key to preventing premature patient decline.

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“…As a measurable imaging marker that can be obtained in chest computed tomography (CT) images, the pulmonary artery to ascending aorta diameter (PAD/AoD) ratio is highly correlated with the pulmonary arterial pressure obtained by right heart catheterization, and its increase is a potential feature of PAH ( 16 – 18 ). It is also closely related to the change of cardiac structure and function ( 19 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of pulmonary artery to ascending aorta diameter ratio progression on the prognosis of NSCLC patients treated with immune checkpoint inhibitors

Gong,

Li,

Guo

et al. 2024

Front. Immunol.

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BackgroundImmunotherapy, represented by immune checkpoint inhibitors (ICIs), is a major breakthrough in cancer treatment. Studies have reported that the use of ICIs is associated with an increase in the pulmonary artery to ascending aorta diameter (PAD/AoD) ratio. However, the impact of PAD/AoD ratio progression on the prognosis of patients is unclear.MethodsThis retrospective cohort study included patients with stage III or IV non-small cell lung cancer (NSCLC) treated with ICIs at the Wuhan Union Hospital between March 1, 2020, and September 1, 2022. The baseline and post-treatment PAD/AoD ratios of patients were evaluated through chest CT scans. The primary outcome of this study was overall survival (OS), while the secondary outcomes included progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR).ResultsThe PAD/AoD ratio increased after the initiation of ICIs (from 0.75 to 0.78; P < 0.001). A total of 441 patients were divided into severe group (n=221) and non-severe group (n=220) according to the median increase of PAD/AoD ratio (1.06). Compared with the non-severe group, the severe group had a lower DCR (87.8% vs. 96.0%, P = 0.005) and ORR (87.5% vs. 96.0%, P = 0.063). Over the entire duration of follow-up (median 22.0 months), 85 (38.5%) patients in the severe group and 30 (7.3%) patients in the non-severe group died. An increased PAD/AoD ratio was associated with shorter PFS (Hazard ratio (HR): 1.48 [95% CI, 1.14 to 1.93]; P = 0.003) and OS (HR: 3.50 [95% CI, 2.30 to 5.30]; P < 0.001). Similar results were obtained across subgroups.ConclusionsICI treatment exacerbates an increase in the PAD/AoD ratio in patients with cancer, and greater increase in the PAD/AoD ratio was associated with a worse prognosis. PAD/AoD ratio could be a biomarker to stratify prognosis of NSCLC patients treated with ICIs.

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ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update

Cited by 4 publications

References 76 publications

Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population

Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population

A clinician's guide to pulmonary hypertension

The impact of pulmonary artery to ascending aorta diameter ratio progression on the prognosis of NSCLC patients treated with immune checkpoint inhibitors

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