Key result
Combined CT-echo triage improves prediction of invasive RV failure over CT alone to AUC ~0.86.
Why the study?
Identifying patients with markedly elevated pulmonary vascular resistance before catheterization may improve prioritization, streamline testing, and anticipate right ventricular failure risk, motivating the evaluation of a combined CT and echocardiography prediction model.
Does a combined CT and echocardiography triage model improve prediction of markedly elevated pulmonary vascular resistance and invasive right ventricular failure phenotype at catheterization in patients referred for pulmonary hypertension evaluation?
Observational (n=268)
Does a combined CT and echocardiography triage model improve prediction of markedly elevated pulmonary vascular resistance and invasive right ventricular failure phenotype at catheterization in patients referred for pulmonary hypertension evaluation?
A combined CT and echocardiographic triage model accurately identifies patients with high pulmonary vascular resistance and invasive right ventricular failure physiology, potentially enabling earlier prioritization for right heart catheterization.
Combining CT and echo markers may refine pre-catheterization triage for severe pulmonary hypertension; leaves open whether this non-invasive rule safely defers invasive hemodynamics in external cohorts.
Background Identifying patients with markedly elevated pulmonary vascular resistance (PVR) before catheterization may improve prioritization, streamline testing, and anticipate RV failure risk. Purpose To evaluate whether a CT–echo model predicts high PVR and an invasive RV failure phenotype. Methods We included consecutive patients referred for PH evaluation undergoing contrast CT and echocardiography within 30 days of RHC (2021–2025). High PVR was defined as ≥5 Wood units. RV failure phenotype was defined as right atrial pressure ≥12 mmHg with cardiac index <2.2 L/min/m². CT markers included RV/LV ratio and PA/Ao ratio (Figure 1). Echo markers included TR velocity and TAPSE/PASP. Results Among 268 patients (mean age 53±16 years; 61% female), 71 (26%) had PVR ≥5 and 52 (19%) met RV failure phenotype (Table 1). High PVR was associated with higher RV/LV ratio (1.22±0.17 vs 0.97±0.16, p<0.001) and PA/Ao ratio (1.04±0.12 vs 0.91±0.10, p<0.001). Adding TAPSE/PASP improved prediction of RV failure phenotype (AUC 0.86 vs 0.79 with CT alone). A pragmatic rule (RV/LV ≥1.2 or PA/Ao ≥1.0 plus TAPSE/PASP <0.35) had 76% sensitivity and 78% specificity for RV failure phenotype and a negative predictive value of 92% (Figure 2). Conclusion A practical CT–echo triage model identifies patients likely to have markedly elevated PVR and invasive RV failure physiology, supporting earlier prioritization for catheterization and targeted management pathways.
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Albulushi et al. (2026) conducted an observational in Suspected pulmonary hypertension (n=268). CT-echo triage model (RV/LV ratio, PA/Ao ratio, and TAPSE/PASP) vs. CT alone was evaluated on Prediction of invasive RV failure phenotype (right atrial pressure ≥12 mmHg with cardiac index <2.2 L/min/m²) and high PVR (≥5 Wood units) (AUC 0.86 vs 0.79). A combined CT-echo triage model improved prediction of invasive RV failure phenotype over CT alone (AUC 0.86 vs 0.79), achieving 76% sensitivity, 78% specificity, and 92% negative predictive value.
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