The dilatation of main pulmonary artery and right ventricle observed by enhanced chest computed tomography predict poor outcome in inoperable chronic thromboembolic pulmonary hypertension. Issue 94 (September 2017)

• Record Type: Journal Article
• Authors: Ema, Ryogo; Sugiura, Toshihiko; Kawata, Naoko; Tanabe, Nobuhiro; Kasai, Hajime; Nishimura, Rintaro; Jujo, Takayuki; Shigeta, Ayako; Sakao, Seiichiro; Tatsumi, Koichiro
• Is Part Of: European journal of radiology. Issue 94(2017)
• Page Start: 70
• Page End: 77
• Publication Date: 2017-09
• Subjects: CTEpH chronic thromboembolic pulmonary hypertension -- PAH pulmonary arterial hypertension -- Main PA/AA ratio main pulmonary arterial to ascending aortic diameter ratio -- RHC right heart catheterization -- RV/LV ratio right ventricular to left ventricular diameter ratio -- PAD pulmonary artery diameter -- AAD ascending aortic diameter -- RVD right ventricular diameter -- LVD left ventricular diameter -- mPAP mean pulmonary arterial pressure -- dPAP diastolic pulmonary arterial pressure -- sPAP systolic pulmonary arterial pressure -- PVR pulmonary vascular resistance -- CI cardiac index -- PvO2 mixed venous oxygen pressure -- A-aDO2 alveolar–arterial oxygen gradient -- %VC percentage of vital capacity predicted values -- FEV1/FVC percentage of one second forced expiratory volume -- %FEV1 percentage of forced expiratory volume in one second predicted values -- %DLCO/VA percentage of diffusing capacity of carbon monoxide/alveolar ventilation predicted value -- 6MWD 6 minute-walk distance -- BNP brain natriuretic peptide; Chronic thromboembolic pulmonary hypertension -- Chest computed tomography -- Pulmonary artery dilatation -- Right ventricular dilatation -- Prognosis; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2017.06.007
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Dilatation of the pulmonary artery and right ventricle on chest CT are often observed in patients with pulmonary hypertension. The clinical significance of these image findings has not been defined in chronic thromboembolic pulmonary hypertension. Main PA/AA ratio was associated with the risk for clinical exacerbation and RV/LV raito was associated with the risk for poor prognosis in CTEPH. Abstract : Background: Dilatation of the pulmonary artery and right ventricle on chest computed tomography images is often observed in patients with pulmonary hypertension. The clinical significance of these image findings has not been defined in chronic thromboembolic pulmonary hypertension. We investigated whether the pulmonary arterial and right ventricle dilatation was associated with poor outcome in chronic thromboembolic pulmonary hypertension. Methods: This was a retrospective cohort investigation in 60 subjects with inoperable chronic thromboembolic pulmonary hypertension diagnosed consecutively between 1997 and 2010 at Chiba University Hospital. Digital scout multi-detector chest computed tomography images were obtained. The main pulmonary arterial to ascending aortic diameter ratio and the right ventricular to left ventricular diameter ratio were calculated. Results: Main pulmonary arterial to ascending aortic diameter ratio ranged from 0.85 to 1.84, and right ventricular to left ventricular diameter ratio ranged from 0.71 to 2.88. During the observation period of 1284.5 days (range, 21–4550 days), 13 patients required hospitalization due to worsening; 6 of them died. Kaplan–Meier analysis showed significant differences in hospitalization between the patients with main pulmonary arterial to ascending aortic diameter ratio of ≥1.1 and <1.1 (log-rank test, p = 0.014) and between the patients with right ventricular to left ventricular diameter ratio of ≥1.2 and <1.2 (log-rank test, p = 0.013). There was a significant difference in the prognosis between the patients with RV/LV ratio ≥ 1.2 and those with RV/LV ratio < 1.2 (log-rank test, p = 0.033). Conclusions: Main pulmonary arterial to ascending aortic diameter ratio measured using enhanced CT images was associated with the risk for first clinical exacerbation, and right ventricular to left ventricular diameter ratio was associated with the risk for poor prognosis in inoperable chronic thromboembolic pulmonary hypertension.