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Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility

European Radiology volume 30, pages 6204–6212 (2020)Cite this article

Abstract

Objectives

To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography.

Methods

One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated. In ungated CT, dPA, dPA/AA, the ratio of dPA to the diameter of the vertebra, segmental PA diameter, segmental PA-to-bronchus ratio, and the main PA volume were measured; the egg-and-banana sign was recorded. During echocardiography, the tricuspid regurgitation (TR) gradient was measured. The areas under the ROC curves (AUC) of these signs were computed and compared with DeLong test. Correlation between PA distensibility and PA pressure (PAP) was investigated through Pearson’s coefficient.

Results

PA distensibility was lower in patients with PH than in those without PH (11.4 vs. 21.2%, p < 0.001) and correlated negatively with mean PAP (r = − 0.72, p < 0.001). Age, PA size, and mean PAP were independent predictors of PA distensibility. PA distensibility < 18% detected PH-LHD with 96% sensitivity and 73% specificity; its AUC was 0.92, larger than that of any other sign at ungated CT and TR gradient (AUC ranging from 0.54 to 0.83, DeLong: p ranging from 0.020 to < 0.001).

Conclusion

PA distensibility on an ECG-gated CT can detect PH-LHD better than the parameters reflecting PA dilatation in ungated CT or TR gradient in the echocardiography of patients with severe HFrEF, aortic stenosis, or mitral regurgitation.

Key Points

• In left heart disease, pulmonary artery distensibility is lower in patients with PH than in those without pulmonary hypertension (11.4 vs. 21.2%, p < 0.001).

• In left heart disease, pulmonary artery distensibility detects pulmonary hypertension with an area under the receiver operating curve of 0.92.

• In left heart disease, the area under the receiver operating curve of pulmonary artery distensibility for detecting pulmonary hypertension is larger than that of all other signs at ungated CT (p from 0.019 to < 0.001) and tricuspid regurgitation gradient at echocardiography (p = 0.020).

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Abbreviations

ABR:

Pulmonary artery to bronchus ratio

AUC:

Area under the receiver operating characteristic curve

dPA:

Diameter of the main pulmonary artery

dPA/AA:

Diameter of the main pulmonary artery to the diameter of the ascending aorta ratio

dPA/V:

Diameter of the main pulmonary artery to the diameter of the vertebral body ratio

HFrEF:

Heart failure with reduced injection fraction

PA:

Pulmonary artery

PAP:

Pulmonary artery pressure

PAWP:

Pulmonary artery wedge pressure

PH:

Pulmonary hypertension

PH-LDH:

Pulmonary hypertension due to left heart disease

TR:

Tricuspid regurgitation

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Funding

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

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Affiliations

  1. Division of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium

    Geoffrey C. Colin, Guillaume Verlynde, Emmanuel Coche & Benoit Ghaye

  2. Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium

    Anne-Catherine Pouleur, Bernhard L. Gerber, Christophe Beauloye & Joelle Kefer

  3. Department of Cardiology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium

    Jean-Luc Vachiéry

  4. Department of Radiology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium

    Pierre Alain Gevenois

Authors
  1. Geoffrey C. Colin
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  2. Guillaume Verlynde
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  3. Anne-Catherine Pouleur
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  4. Bernhard L. Gerber
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  5. Christophe Beauloye
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  6. Joelle Kefer
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  7. Emmanuel Coche
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  8. Jean-Luc Vachiéry
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  9. Pierre Alain Gevenois
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  10. Benoit Ghaye
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Corresponding author

Correspondence to Geoffrey C. Colin.

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The scientific guarantor of this publication is Dr. Geoffrey C Colin.

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

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

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• prospective

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• performed at one institution

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Colin, G.C., Verlynde, G., Pouleur, AC. et al. Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility. Eur Radiol 30, 6204–6212 (2020). https://doi.org/10.1007/s00330-020-06959-7

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  • DOI: https://doi.org/10.1007/s00330-020-06959-7

Keywords

  • Pulmonary hypertension
  • Computed tomography
  • Echocardiography
  • Heart failure