CT Scanning in the Evaluation of Pulmonary Hypertension

Kam, Jennifer C.; Pi, Justin; Doraiswamy, Vikram; Elnahar, Yaser; Abdul-Jawad, Sami; DeBari, Vincent A.; Klukowicz, Alan; Shamoon, Fayez; Miller, Richard A.

doi:10.1007/s00408-013-9464-6

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…A wide range of cut-off values for identifying RHC-confirmed pulmonary hypertension have been proposed for MPAD (from 25 to 38 mm) and PA:Ao (from 0.84 to 1.4) [4,6,7,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. We elected to use the cut-offs proposed in the European Society of Cardiology/European Respiratory Society pulmonary hypertension guideline for our main analyses [13,14], but also ran analyses using a range of values, and found that alternative cut-off values performed better.…”

Section: Discussionmentioning

confidence: 99%

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Ratanawatkul

Richards

et al. 2020

ERJ Open Res

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BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

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Section: Discussionmentioning

confidence: 99%

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Ratanawatkul

Richards

et al. 2020

ERJ Open Res

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“…Depending on the study population, the cut-off selected for the PA diameter (25-33.3 mm), and the gold standard used, the reported sensitivity can range between 47%-100% and the specificity between 41%-100% [10,12,13,[16][17][18][20][21][22]28]. As anticipated, there is considerable overlap in the cut-off value and some overlap with what has been reported in the population without PH (Table 1).…”

Section: Diagnostic Utility Of Pa Sizementioning

confidence: 66%

The Significance of Pulmonary Artery Size in Pulmonary Hypertension

et al. 2014

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Pulmonary hypertension (PH) has been found to have significant morbidity and mortality. The treatment of PH has advanced considerably with increasingly more effective and safer options. With an increasing effort to diagnose patients early, non-invasive techniques are often used to screen those patients likely to have PH. Computerized tomography (CT) chest scans are increasingly utilized in the evaluation of patients with exertional dyspnea, including those with suspected PH. The main role of the CT scan is to evaluate for any associated underlying diseases. There have been attempts to address the utility of CT to predict the presence of PH. This article reviews previously published investigations to summarize the relationship between pulmonary artery dimensions and PH to determine both the strength of the correlation and its discriminatory ability for use in clinical practice.

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“…Claims of performance and survival benefits are minimal with a huge cost to the healthcare system and the individual patients. 16-19 Timely interventions like lung transplant may be delayed because of the false security of potential benefits from new treatment strategies. 20,21 In our study, we found indications of worsening in patients with NYHA functional class III and above that might be confirmed by a larger sample.…”

Section: Discussionmentioning

confidence: 99%

“…3-10 Radiological findings of enlarged pulmonary artery size on computed tomography (CT) of the chest may correlate with the presence of PH but does not predict severity. 12-16…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome and survival in 30 pulmonary hypertension patients with high severity indices and advanced functional class

et al. 2019

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BACKGROUND: Pulmonary hypertension (PH) is an idiopathic or secondary disorder associated with many systemic illnesses. Long-term survival in PH depends on the severity and functional class. Several new drugs are now available to treat PH, but their impact on clinical outcome and survival are not well established.OBJECTIVES: Evaluate severity parameters and the impact of current recommended therapy on survival in PH.DESIGN: Cross-sectional.SETTINGS: Tertiary care center.PATIENTS AND METHODS: The study included adult patients who had undergone right heart catheterization since 2012 and were diagnosed with pulmonary hypertension. Survival was recorded after 6 years, at the end of the study. Nine severity variables for PH were assessed including right ventricular size by echocardiogram and pulmonary artery diameter (PA diameter) and the ratio of pulmonary artery diameter to ascending aorta diameter (PA/Ao ratio) by CT.MAIN OUTCOME MEASURES: Evaluation of severity parameters.SAMPLE SIZE: 30 patients.RESULTS: Twenty-five patients were positive for 8/9 severity parameters. Eight of 30 (26.6%) patients died. In nonsurvivors, right ventricular size was increased by 25% (P=.427), pulmonary vascular resistance increased by 29.4% in nonsurvivors (P=.302), the 6-minute walk distance decreased by 21% (P=.875), median brain natriuretic peptide increased by 96% (P=.890), median GGT and alkaline phosphatase were 3 times higher in nonsurvivors (P=.893 and P=.047, respectively) and PA/Ao was nonsignificantly decreased in nonsurvivors (P=.373), Survival was decreased by a median of 2.3 years in nonsurvivors.CONCLUSION: Our study identified a subgroup of PH patients with NYHA functional class III and above with worsening severity indicators who were labeled as a high-risk group. These patients showed continuous deterioration in their clinical status despite escalation of therapy with current guidelines. We recommend these high-risk group patients be referred for early lung transplantation.LIMITATIONS: Low sample size and only a single center. Needs confirmation with a larger multicenter trial.CONFLICT OF INTEREST: None.

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CT Scanning in the Evaluation of Pulmonary Hypertension

Abstract: CT scanning correctly identified all patients with PH with MPADs >34 mm and excluded all patients without PH when MPADs were <27 mm. We advocate that the measurement of MPAD by CT scanning can be quickly and easily performed by the clinician to screen for the presence of PH.

Cited by 14 publications

References 23 publications

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

The Significance of Pulmonary Artery Size in Pulmonary Hypertension

Clinical outcome and survival in 30 pulmonary hypertension patients with high severity indices and advanced functional class

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