Key result
Poor subpleural perfusion on dual-energy computed tomography was observed in 51% of patients with CTEPH compared to 4% of those with PAH (p < 0.01).
Why the study?
It remained unclear whether DE-CT microvasculopathy findings of poor subpleural perfusion in CTEPH are equivalent to those in PAH.
Does the prevalence and hemodynamic impact of poor subpleural perfusion on DE-CT differ between patients with CTEPH and PAH?
Observational (n=136)
Does the prevalence and hemodynamic impact of poor subpleural perfusion on DE-CT differ between patients with CTEPH and PAH?
Answers are grounded in this paper and cite their sources.
Poor subpleural perfusion on DE-CT is significantly more common in CTEPH than PAH and correlates with worse baseline hemodynamics, suggesting different mechanisms of microvasculopathy.
Background: Poor subpleural perfusion (PSP) on dual-energy computed tomography (DE-CT) suggests microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH). However, whether the microvasculopathy findings are equivalent to those in pulmonary arterial hypertension (PAH) remains unclear. The aim of this study was to elucidate the characteristics of microvasculopathy in CTEPH compared to those of that in PAH. Methods: We retrospectively reviewed subpleural perfusion on DE-CT and the hemodynamics of 23 patients with PAH and 113 with inoperable CTEPH. Subpleural perfusion on DE-CT was classified as poor (subpleural spaces in all segments with little or no perfusion) or normal. Results: PSP was observed in 51% of patients with CTEPH and in 4% of those with PAH (p < 0.01). CTEPH patients with PSP had poorer baseline hemodynamics and lower diffusing capacity for carbon monoxide divided by the alveolar volume (DLCO/VA) than those with CTEPH with normal perfusion (pulmonary vascular resistance [PVR]: 768 ± 445 dynes-sec/cm5 vs. 463 ± 284 dynes-sec/cm5, p < 0.01; DLCO/VA, 60.4 ± 16.8% vs. 75.9 ± 15.7%, p < 0.001). Despite the existence of PSP, hemodynamics improved to nearly normal in both groups after balloon pulmonary angioplasty. Conclusions: PSP on DE-CT, which is one of the specific imaging findings in CTEPH, might suggest a different mechanism of microvasculopathy from that in PAH.
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Miwa et al. (2022) conducted an observational in Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension (n=136). Chronic thromboembolic pulmonary hypertension (CTEPH) vs. Pulmonary arterial hypertension (PAH) was evaluated on Poor subpleural perfusion (PSP) on dual-energy computed tomography (p=< 0.01). Poor subpleural perfusion on dual-energy computed tomography was observed in 51% of patients with CTEPH compared to 4% of those with PAH (p < 0.01).
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