Computed Tomographic Screening of Pulmonary Arterial Hypertension in Candidates for Lung Transplantation

Pérez-Enguix, D.; Morales, P.; Tomás, José M.; Vera, Francisco Javier García; Lloret, R.

doi:10.1016/j.transproceed.2007.07.055

Cited by 48 publications

(39 citation statements)

References 15 publications

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“…The degree of histological vascular alteration in COPD varies according to vessel size (22). In patients with pulmonary hypertension in COPD, histological vascular alteration can be found mainly in muscular pulmonary arteries (21)(22)(23)(24). In this study, the lower limit of detection of cross-sectional area of pulmonary vessel is defined by the size of the CT pixel (approximately 0.6 mm in this study).…”

Section: Discussionmentioning

confidence: 76%

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Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

157

158

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Rationale: Vascular alteration of small pulmonary vessels is one of the characteristic features of pulmonary hypertension in chronic obstructive pulmonary disease. The in vivo relationship between pulmonary hypertension and morphological alteration of the small pulmonary vessels has not been assessed in patients with severe emphysema. Objectives: We evaluated the correlation of total cross-sectional area of small pulmonary vessels (CSA) assessed on computed tomography (CT) scans with the degree of pulmonary hypertension estimated by right heart catheterization. Methods: In 79 patients with severe emphysema enrolled in the National Emphysema Treatment Trial (NETT), we measured CSA less than 5 mm 2 (CSA ,5 ) and 5 to 10 mm 2 (CSA 5210 ), and calculated the percentage of total CSA for the lung area (%CSA ,5 and %CSA 5-10 , respectively). The correlations of %CSA ,5 and %CSA 5-10 with pulmonary arterial mean pressure (Ppa) obtained by right heart catheterization were evaluated. Multiple linear regression analysis using Ppa as the dependent outcome was also performed. Measurements and Main Results: The %CSA ,5 had a significant negative correlation with Ppa (r 5 20.512, P , 0.0001), whereas the correlation between %CSA 5-10 and Ppa did not reach statistical significance (r 5 20.196, P 5 0.083). Multiple linear regression analysis showed that %CSA ,5 and diffusing capacity of carbon monoxide (DL CO ) % predicted were independent predictors of Ppa (r 2 5 0.541): %CSA ,5 (P , 0.0001), and DL CO % predicted (P 5 0.022). Conclusions: The %CSA ,5 measured on CT images is significantly correlated to Ppa in severe emphysema and can estimate the degree of pulmonary hypertension.Keywords: chronic obstructive pulmonary disease; emphysema; pulmonary hypertension; CT Pulmonary hypertension is an important predictor of mortality in chronic obstructive pulmonary disease (COPD) (1-3). Various factors, including endothelial dysfunction, inflammation, and hypoxia, have been recognized as potential contributors to the development of secondary pulmonary hypertension in emphysema, but its pathogenesis has not been fully clarified. Nevertheless, it is generally recognized that vascular remodeling of small pulmonary arteries is an essential morphological feature of pulmonary hypertension; narrowing and diminution of the small pulmonary vessels have been shown on conventional angiography in emphysema (4-6). However, to our knowledge, the in vivo relationship between pulmonary hypertension and the magnitude of small pulmonary vessel morphological change has not been quantitatively assessed in severe emphysema.A recent histological study suggested that vascular remodeling leads to reduced distensibility of small pulmonary vessels and that this remodeling is closely related to pulmonary hypertension (7). Such a decrease in distensibility of small pulmonary vessels may lead to increased pulmonary vascular resistance and elevated pulmonary vascular pressure. Therefore, we hypothesized that measurements of the total cross-sectional area of small ...

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Section: Discussionmentioning

confidence: 76%

“…We also used Spearman correlation coefficients to express the relationship between Ppa and PFTs, %LAA 2950 , Pa O 2 , and other variables previously described as indicators of pulmonary arterial pressure, including MPAD and MPAD/AoD (17,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

157

158

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“…It also has the potential to provide the fi rst pointer toward the diagnosis of the condition ( 11,12,14 ). Echocardiography is more usually relied on to identify PH ( 17 ), although it also can substantially lead to an under-or overestimation of systolic pulmonary arterial pressure ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…It has also been shown that pulmonary arterial size (but not the ratio of the diameter of the pulmonary artery to the diameter of the ascending aorta) is an unreliable marker of mPAP in patients with pulmonary fi brosis ( 13 ). Few studies have explored the more peripheral pulmonary vasculature, although an increase in the segmental artery-tobronchus ratio in at least three lobes has been shown to be a reliable indicator of PH ( 12,14 ).…”

Section: Patientsmentioning

confidence: 99%

Detection of Pulmonary Hypertension with Multidetector CT and Echocardiography Alone and in Combination

Devaraj

Wells²,

Meister³

et al. 2010

Radiology

175

131

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“…It known to have the potential to be the first indicator towards the diagnosis of PH. 11,14,21 CT in conjunction with electrocardiographic measurements are strong correlates of MPA in patients especially those with underlying disorders. CT scan also provided a plausible mechanism for the development of relative enlargement of pulmonary artery in patients with severe COPD, which in turn has been linked with exacerbation.…”

Section: Discussionmentioning

confidence: 99%

Estimation of measured pulmonary artery to aorta ratio for prognosis of pulmonary hypertension in chronic obstructive pulmonary disease patients

Madas

Vittal

2016

Int J Adv Med

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Computed Tomographic Screening of Pulmonary Arterial Hypertension in Candidates for Lung Transplantation

Cited by 48 publications

References 15 publications

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Detection of Pulmonary Hypertension with Multidetector CT and Echocardiography Alone and in Combination

Estimation of measured pulmonary artery to aorta ratio for prognosis of pulmonary hypertension in chronic obstructive pulmonary disease patients

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