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Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure

  • Chest
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Abstract

Objectives

To evaluate the ability of chest computed tomography (CT) to predict pulmonary hypertension (PH) and outcome in chronic heart failure with reduced ejection fraction (HFrEF).

Methods

We reviewed 119 consecutive patients with HFrEF by CT, transthoracic echocardiography (TTE) and right heart catheterization (RHC). CT-derived pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio), left atrial, right atrial, right ventricular (RV) and left ventricular volumes were correlated with RHC mean pulmonary arterial pressure (mPAP) . Diagnostic accuracy to predict PH and ability to predict primary composite endpoint of all-cause mortality and HF events were evaluated.

Results

RV volume was significantly higher in 81 patients with PH compared to 38 patients without PH (133 ml/m2 vs. 79 ml/m2, p < 0.001) and was moderately correlated with mPAP (r=0.55, p < 0.001). Also, RV volume had higher ability to predict PH (area under the curve: 0.88) than PA diameter (0.79), PA:A ratio (0.76) by CT and tricuspid regurgitation gradient (0.83) and RV basal diameter by TTE (0.84, all p < 0.001). During the follow-up period (median: 3.4 years), 51 patients (43%) had HF events or died. After correction for important clinical, TTE and RHC parameters, RV volume (adjusted hazard ratio [HR]: 1.71, 95% CI 1.31–2.23, p < 0.001) and PA diameter (HR: 1.61, 95% CI 1.18–2.22, p = 0.003) were independent predictors of the primary endpoint.

Conclusion

In patients with HFrEF, measurement of RV volume and PA diameter on ungated CT are non-invasive markers of PH and may help to predict the patient outcome.

Key Points

• Right ventricular (RV) volume measured by chest CT has good ability to identify pulmonary hypertension (PH) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).

• The accuracy of pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio) to predict PH was similar to previous studies, however, with lower cut-offs (28.1 mm and 0.92, respectively).

• Chest CT-derived PA diameter and RV volume independently predict all-cause mortality and HF events and improve outcome prediction in patients with advanced HFrEF.

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Abbreviations

AUC:

Area under the curve

BSA:

Body surface area

CI :

Confidence interval

FAC:

Fractional area change

HFrEF:

Heart failure with reduced injection fraction

IHD:

Ischemic heart disease

IQR:

Interquartile range

LA:

Left atrium

LV:

Left ventricular or ventricle

LVEF:

Left ventricular ejection fraction

NIDCM:

Nonischemic dilated cardiomyopathy

mPAP:

Mean pulmonary artery pressure

PA:

Pulmonary artery

PAP:

Pulmonary artery pressure

PAWP:

Pulmonary artery wedge pressure

PH:

Pulmonary hypertension

PH-LHD:

Pulmonary hypertension due to left heart disease

PVR:

Pulmonary vascular resistance

RA :

Right atrium

ROC:

Receiving operating curve

RHC:

Right heart catheterization

RV:

Right ventricular or right ventricle

TR:

Tricuspid regurgitation

TTE:

Transthoracic echocardiography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Geoffrey C. Colin, David Byl, Anna Dietz & Benoit Ghaye

  2. Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium

    Bernhard L. Gerber, Christophe de Meester de Ravenstein, Michele Kamga, Agnes Pasquet, David Vancraeynest, Jean-Louis Vanoverschelde, Anne-Marie D’Hondt & Anne-Catherine Pouleur

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  1. Geoffrey C. Colin
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  2. Bernhard L. Gerber
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  3. Christophe de Meester de Ravenstein
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  4. David Byl
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  5. Anna Dietz
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  6. Michele Kamga
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  7. Agnes Pasquet
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  8. David Vancraeynest
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  9. Jean-Louis Vanoverschelde
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  10. Anne-Marie D’Hondt
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  11. Benoit Ghaye
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  12. Anne-Catherine Pouleur
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Corresponding author

Correspondence to Geoffrey C. Colin.

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Guarantor

The scientific guarantor of this publication is Anne-Catherine Pouleur, MD, PhD

Conflict of interest

Pr Pouleur is Clinical Master Specialist of the Fondation Nationale de la Recherche Scientifique of the Belgian Government, FRSM.

The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Christophe de Meester kindly provided statistical advice for this manuscript and has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Colin, G.C., Gerber, B.L., de Meester de Ravenstein, C. et al. Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure. Eur Radiol 28, 4643–4653 (2018). https://doi.org/10.1007/s00330-018-5455-6

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  • DOI: https://doi.org/10.1007/s00330-018-5455-6

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