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A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension

  • CHEST RADIOLOGY
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Abstract

Purpose

The aim of this study was to retrospectively assess the relationship between radiological and hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We introduced a new CT-score to evaluate hemodynamic changes, only employing CT-pulmonary angiography (CTPA).

Materials and methods

145 patients affected by CTEPH underwent hemodynamic and CTPA evaluation. Among these 145 patients, 69 underwent pulmonary endarterectomy (PEA) and performed a CTPA evaluation even after surgery. Hemodynamic assessment considered the values of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), obtained through right heart catheterization (RHC). Radiological evaluation included CTPA signs of pulmonary hypertension.

Results

A highly significant statistical correlation was observed between the new CT-score and both mPAP and PVR (p < 0.000) in the whole sample and also in the subgroup who underwent PEA. In addition, mPAP and PVR showed an important association with the severity of mosaic perfusion (p < 0.000). mPAP also correlated with main pulmonary artery diameter (p < 0.01); a significant association was found in both between PVR and tricuspid regurgitation(p < 0.000) and with PVR and presence of unilateral or bilateral pulmonary thromboembolic occlusion (p < 0.05).

Conclusion

Our results confirm the diagnostic role of CTPA in evaluating patients with CTEPH and in addition open a new horizon in assessing hemodynamic changes in patients with CTEPH, only employing a CTPA, especially when RHC is contraindicated or not possible.

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Abbreviations

AV:

Azygos vein

BAH:

Bronchial arteries hypertrophy

CC:

Collateral circles

CPB:

Cardio-pulmonary bypass

CS:

Coronary sinus

CTEPH:

Chronic thromboembolic pulmonary hypertension

CTPA:

Computed tomography pulmonary angiography

ISB:

Interventricular septum bowing

LV:

Left ventricle diameter

MP:

Mosaic perfusion

PEA:

Pulmonary endarterectomy

PA:

Pulmonary artery

PE:

Pulmonary embolism

PH:

Pulmonary hypertension

RA:

Right atrium

RV:

Right ventricle

RVFWT:

Right ventricle free wall thickness

SD:

Standard deviation

SVC:

Superior vena cava

TR:

Tricuspid regurgitation

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Authors and Affiliations

  1. Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Sant’Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy

    Maria Barbara Leone, Marica Giannotta & Maurizio Zompatori

  2. Heart and Lung Transplantation Program, Cardiac Surgery Department, S. Orsola-Malpighi Hospital, Bologna, Italy

    Mariano Cefarelli & Sofia Martìn Suàrez

  3. Institute of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy

    Massimiliano Palazzini, Enrico Gotti & Nazzareno Galiè

  4. Department of Cardiovascular Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

    Maria Letizia Bacchi Reggiani

Authors
  1. Maria Barbara Leone
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  2. Marica Giannotta
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  3. Massimiliano Palazzini
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  4. Mariano Cefarelli
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  5. Sofia Martìn Suàrez
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  7. Maria Letizia Bacchi Reggiani
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  9. Nazzareno Galiè
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Corresponding author

Correspondence to Maria Barbara Leone.

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No funds were used for the present study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Leone, M.B., Giannotta, M., Palazzini, M. et al. A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension. Radiol med 122, 495–504 (2017). https://doi.org/10.1007/s11547-017-0750-x

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  • DOI: https://doi.org/10.1007/s11547-017-0750-x

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