Multiple CT-based metrics, including a main pulmonary artery diameter ≥29 mm (OR 4.8) and right ventricular free wall ≥6 mm (OR 30.5), were significant independent predictors of pulmonary hypertension.
Observational (n=101)
Blinded to clinical and hemodynamic data
No
Do computed tomographic chest metrics predict pulmonary hypertension in acutely hospitalized patients?
Specific CT chest metrics, such as RV free wall thickness and RV/LV lumen ratio, can significantly predict the presence of pulmonary hypertension in acutely hospitalized patients, potentially aiding in non-invasive screening.
Odds Ratio: 4.8
p-value: p=0.0196
BACKGROUND: Early diagnosis of pulmonary hypertension (PH) can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC) for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT) of the chest may be an alternative non-invasive method of detecting PH. METHODS: This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. RESULTS: Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA) diameter ≥29 mm (odds ratio (OR)=4.8), right descending PA diameter ≥19 mm (OR=7.0), true right descending PA diameter ≥16 mm (OR=4.1), true left descending PA diameter ≥21 mm (OR=15.5), right ventricular (RV) free wall ≥6 mm (OR=30.5), RV wall/left ventricular (LV) wall ratio ≥0.32 (OR=8.8), RV/LV lumen ratio ≥1.28 (OR=28.8), main PA/ascending aorta ratio ≥0.84 (OR=6.0) and main PA/descending aorta ratio ≥1.29 (OR=5.7) were significant predictors of PH in this population of hospitalized patients. CONCLUSION: This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients.
Chan et al. (2011) conducted an observational in Pulmonary hypertension (n=101). Main pulmonary artery diameter ≥29 mm on chest CT vs. Main pulmonary artery diameter <29 mm was evaluated on Presence of pulmonary hypertension (resting mPAP ≥25 mmHg) (OR 4.8, p=0.0196). Multiple CT-based metrics, including a main pulmonary artery diameter ≥29 mm (OR 4.8) and right ventricular free wall ≥6 mm (OR 30.5), were significant independent predictors of pulmonary hypertension.