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Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

  • Computed Tomography
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Abstract

Objective

To evaluate whether the change in computed tomography pulmonary angiography (CTPA) metrics after balloon pulmonary angioplasty (BPA) can predict treatment effect in chronic thromboembolic pulmonary hypertension (CTEPH) patients.

Methods

This study included 82 CTEPH patients who underwent both CTPA and right heart catheterization (RHC) before and at the scheduled time of 6 months after BPA. The diameters of the main pulmonary artery (dPA), ascending aorta (dAA), right atrium (dRA), right ventricular free wall thickness (dRVW), and right and left ventricles (dRV, dLV) were measured on CTPA. The correlation of the New York Heart Association functional class (NYHA FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) level, and calculated CT metrics with a decrease in mean pulmonary artery pressure (ΔmPAP) using RHC (used as the reference for BPA effect) was investigated. Using multiple regression analysis, independent variables were also identified.

Results

In univariate analysis, clinical indicators (NYHA FC, 6MWD, and BNP level) improved significantly after BPA and were significantly correlated with ΔmPAP (p < 0.01). In the univariate analysis of CTPA parameters, dPA, dRA, dPA/dAA ratio, dRVW, and dRV/dLV ratio decreased significantly and were significantly correlated with ΔmPAP (p < 0.01). Multivariate analysis demonstrated that decreased dPA (p = 0.001) and decreased dRA (p = 0.039) on CTPA were independent predictive factors of ΔmPAP.

Conclusions

Decreased dPA and dRA on CTPA could predict a decrease in mPAP after BPA, thus potentially eliminating unnecessary invasive catheterization.

Key Points

• The reduction in mean pulmonary artery pressure after balloon pulmonary angioplasty in CTEPH patients was significantly correlated with the clinical indices improvement and CTPA parameter decrease.

• The decreased diameter of the main pulmonary artery and the decreased diameter of the right atrium on CTPA were independent predictors of mean pulmonary artery pressure reduction.

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Abbreviations

6MWD:

6-minute walking distance

BMI:

Body mass index

BNP:

Brain natriuretic peptide

BPA:

Balloon pulmonary angioplasty

CIx:

Cardiac index

CO:

Cardiac output

CTEPH:

Chronic thromboembolic pulmonary hypertension

CTPA:

Computed tomography pulmonary angiography

dAA:

Diameter of the ascending aorta

DECT:

Dual-energy computed tomography

dLV:

Diameter of the left ventricle

dPA:

Diameter of the main pulmonary artery

dRA:

Diameter of the right atrium

dRV:

Diameter of the right ventricle

ICC:

Intraclass correlation coefficient

mPAP:

Mean pulmonary arterial pressure

mRAP:

Mean right atrial pressure

NYHA FC:

New York Heart Association functional class

PAH:

Pulmonary arterial hypertension

PAWP:

Pulmonary artery wedge pressure

PEA:

Pulmonary thromboendarterectomy

PVR:

Pulmonary vascular resistance

RHC:

Right heart catheterization

ROI:

Region of interest

sBP/dBP/mBP:

Systolic/diastolic/mean blood pressures

SD:

Standard deviation

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Acknowledgements

The authors would like to acknowledge all of the patients for their willingness to participate in the study. The authors also thank Naomi Tamaki and Kyoko Komatsu for their valuable assistance.

Funding

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

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Authors and Affiliations

  1. Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan

    Jitsuro Tsukada, Yoshitake Yamada, Shunsuke Matsumoto, Masanori Inoue, Seishi Nakatsuka & Masahiro Jinzaki

  2. Department of Radiology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Jitsuro Tsukada & Masahiro Okada

  3. Department of Cardiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan

    Takashi Kawakami & Keiichi Fukuda

Authors
  1. Jitsuro Tsukada
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  2. Yoshitake Yamada
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  3. Takashi Kawakami
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  4. Shunsuke Matsumoto
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  5. Masanori Inoue
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  6. Seishi Nakatsuka
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  7. Masahiro Okada
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  8. Keiichi Fukuda
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  9. Masahiro Jinzaki
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Corresponding authors

Correspondence to Yoshitake Yamada or Takashi Kawakami.

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Guarantor

The scientific guarantor of this publication is Yoshitake Yamada.

Conflict of interest

Masahiro Jinzaki is a recipient of a grant from Canon Medical Systems. However, Canon Medical Systems was not involved in the design and implementation of this study, the collection, analysis, and interpretation of the data, or the preparation, review, and approval of the manuscript.

All other authors are not associated with companies or other entities.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The study complied with the Declaration of Helsinki, and the protocol for this prospective observational study was approved by the Ethics Committee of our institution (No. 20120224).

Methodology

• retrospective

• observational

• performed at one institution

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Tsukada, J., Yamada, Y., Kawakami, T. et al. Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Radiol 31, 5524–5532 (2021). https://doi.org/10.1007/s00330-021-07711-5

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  • DOI: https://doi.org/10.1007/s00330-021-07711-5

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