Key result
Elevated dRV/dLV ratio and peripheral chronic PE on CT are linked to right heart failure death in CTEPH.
Why the study?
The vascular and parenchymal CT imaging findings in patients newly diagnosed with CTEPH and their correlation with hemodynamic measurements and patient outcomes were not fully characterized.
Observational (n=76)
No
p-value: p=0.021
In patients newly diagnosed with CTEPH, CT-derived dPA/dAA ratio correlates with mean pulmonary artery pressure, and increased dRV/dLV ratio along with exclusively chronic peripheral PE predicts adverse outcomes due to right heart failure.
CT metrics may support risk stratification in incident CTEPH; leaves open prospective validation before clinical adoption.
PURPOSE: The aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome. METHODS: Vascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF). RESULTS: The majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors. CONCLUSION: The majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.
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Große et al. (2018) conducted an observational in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=76). CT imaging findings (increased dRV/dLV ratio and exclusively chronic peripheral PE) vs. Absence of these findings or lower ratios was evaluated on Right heart failure-related death (p=0.021). In patients newly diagnosed with CTEPH, an increased dRV/dLV ratio and the presence of exclusively chronic peripheral pulmonary embolism on presenting CT scans were independently associated with right heart failure-related death.
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