CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry

Rajaram, Smitha; Swift, Andrew J.; Condliffe, Robin; Johns, Chris; Elliot, Charles; Hill, Catherine; Davies, Christine; Hurdman, Judith; Sabroe, Ian; Wild, Jim M.; Kiely, David G.

doi:10.1136/thoraxjnl-2014-206088

Cited by 96 publications

(72 citation statements)

References 5 publications

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“…Pulmonary capillary haemangiomatosis is suggested by diffuse bilateral thickening of the interlobular septa and the presence of small, centrilobular, poorly circumscribed nodular opacities. However, ground-glass abnormalities are also present in PAH, occurring in more than one-third of patients [50].…”

Section: Echocardiographymentioning

confidence: 99%

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2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: Echocardiographymentioning

confidence: 99%

“…It may suggest the diagnosis of PH (PA or RV enlargement), identify a cause of PH such as CTEPH or lung disease, provide clues as to the form of PAH (e.g. oesophageal dilation in SSc or congenital cardiac defects such as anomalous pulmonary venous drainage) and also provide prognostic information [50].…”

Section: Echocardiographymentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…Professor David Kiely (Sheffield) described the CT characteristics of PH and explained that centrilobular ground glass opacification in patients with unexplained breathlessness should alert us to the possibility of PAH 53. CT is also useful for prognostication in PAH, with pleural effusions, septal lines and inferior vena cava dilatation predicting increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Review of the British Thoracic Society Winter Meeting 2016, 7–9 December, London, UK

Woodcock

José

Jenkins

2017

Thorax

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“…Although CTPA is an ungated scan, it allows for evaluation of cardiac chambers, structural changes in vessels, lung parenchyma, and the mediastinum. 73 It has been shown to be helpful in assessing disease severity in PAH, and characteristic features such as biatrial dilation can be appreciated in LHD. 3 More recently, there has been interest in the use of CMR imaging in the assessment of PH.…”

Section: Echocardiographymentioning

confidence: 99%

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

et al. 2016

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Abstract:The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data.Keywords: pulmonary arterial hypertension, combined pre-and postcapillary pulmonary hypertension, heart failure with preserved ejection fraction, diastolic dysfunction. (Table 1) by a mean pulmonary arterial pressure (PAP) of ≥25 mmHg at right heart catheterization (RHC), with the most recent classification identifying 5 groups (Fig. 1): 2 group 1, pulmonary arterial hypertension (PAH), which can be idiopathic (IPAH) or associated with other conditions (most frequently systemic sclerosis and congenital heart disease); group 2, PH owing to left heart disease (PH-LHD); group 3, PH owing to lung disease (PH-Lung); group 4, chronic thromboembolic PH (CTEPH); and group 5, PH owing to unclear or multifactorial mechanisms. Accurate classification of disease is important in identifying the most appropriate form of therapy 3 and defining prognosis. 4 This requires a systematic approach to the evaluation of the breathless patient and an awareness of conditions associated with particular forms of PH. Pulmonary hypertension (PH) is definedThe most commonly encountered form of PH is related to left heart disease (LHD). 5,6 PH may be seen in heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HF-rEF), and its presence in HF-rEF is known to convey a poor prognosis. 7 HF-pEF accounts for approximately half of all new heart failure (HF) diagnoses. 8,9 While HF-pEF was initially believed to confer a better outcome than HF-rEF, the two conditions have equivalent morbidity and mortality. [10][11][12] The prevalence of PH-HF-pEF is unclear and varies with diagnostic criteria. Studies quote rates of between 53% and 83% (based on an echocardiographic systolic PAP [sPAP] > 35 mmHg or mean PAP > 25 mmHg at RHC). 13-15 A recent study 16 found that only 7% of heart failure (HF) patients had PH (but used an sPAP cutoff of ≥45 mmHg at echocardiography). PATHOPHYSIOLOGY OF PH-LHDPAH, PH-Lung, and CTEPH are precapillary in nature, caused by obstruction or destruction of the pulmonary arterial bed, whereas PH-LHD is thought to be primarily due to postcapillary abnormalities. 5 In patients with LHD, an increase in left ventricular (LV) and left atrial (LA) filling pressu...

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CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry

Cited by 96 publications

References 5 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Review of the British Thoracic Society Winter Meeting 2016, 7–9 December, London, UK

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

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