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Computed tomography-measured pulmonary artery to aorta ratio and EUTOS score for detecting dasatinib-induced pulmonary arterial hypertension

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Abstract

Background

Periodic echo-based screening to detect early stages of a rare complication of dasatinib, pulmonary arterial hypertension (PAH), is inefficient and weakens the potential benefit of dasatinib as a potent drug for chronic myelogenous leukemia (CML). This study aimed to identify the predisposing factors of DASA-PAH to stratify high-risk patients for dasatinib-induced PAH (DASA-PAH).

Methods

Sixty consecutive adult patients who received dasatinib were enrolled in this case-control study. We defined DASA-PAH when at least one of the following four criteria was met: (1) recent electrocardiographic changes indicating right ventricular pressure overload, (2) estimated systolic pulmonary arterial pressure > 40 mmHg measured by Doppler echocardiography; (3) computed tomography (CT)-measured pulmonary artery to aorta diameter (PaD/AoD) ratio > 1; and (4) mean pulmonary arterial pressure > 25 mmHg and pulmonary artery wedge pressure < 15 mmHg measured by right heart catheterization.

Results

We identified 13 patients with DASA-PAH among 59 patients analyzed. Baseline PaD/AoD ratios of patients who developed DASA-PAH (PH group) were significantly larger than those who did not (NPH group). A dramatic rise in PaD/AoD ratio after dasatinib treatment was observed. Interestingly, the EUTOS score and spleen size were significantly smaller in the PH than in the NPH group.

Conclusion

High baseline PaD/AoD ratio and low EUTOS score were associated with DASA-PAH development. The spleen might play a protective role against DASA-PAH.

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Abbreviations

AoD:

Aortic diameter

CML:

Chronic myelogenous leukemia

CT:

Computed tomography

DASA:

Dasatinib

DASA-PAH:

Dasatinib-induced pulmonary arterial hypertension

ECG:

Electrocardiography

LA:

Left atrium

LVEF:

Left ventricular ejection fraction

MPAP:

Mean pulmonary arterial pressure

PaD:

Pulmonary artery diameter

PAH:

Pulmonary arterial hypertension

PAWP:

Pulmonary artery wedge pressure

PVR:

Pulmonary vascular resistance

RHC:

Right heart catheterization

SPAP:

Systolic pulmonary arterial pressure

TKI:

Tyrosine kinase inhibitor

TTE:

Transthoracic echocardiography

WU:

Wood units

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan

    Takumi Toya, Yuji Nagatomo, Kazuki Kagami, Midori Yukino, Risako Yasuda, Takayuki Namba, Yasuo Ido, Nobuyuki Masaki, Hirotaka Yada & Takeshi Adachi

  2. Division of Hematology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan

    Shinichi Kobayashi & Fumihiko Kimura

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  1. Takumi Toya
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  2. Yuji Nagatomo
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  3. Kazuki Kagami
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Contributions

TT designed the study, analyzed data, and drafted the paper. YN and YI helped the statistical analysis and manuscript editing. KK and MY helped the data collection. RY and TN performed echo and CT measurement. NM, SK, HY, FK, and TA supported manuscript and figure editing.

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Correspondence to Takumi Toya.

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Toya, T., Nagatomo, Y., Kagami, K. et al. Computed tomography-measured pulmonary artery to aorta ratio and EUTOS score for detecting dasatinib-induced pulmonary arterial hypertension. Int J Cardiovasc Imaging 35, 1435–1442 (2019). https://doi.org/10.1007/s10554-019-01548-2

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