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The value of ventilation/perfusion scanning and CT pulmonary angiography in predicting chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a one-year follow-up study

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Abstract

To investigate the value of ventilation/perfusion (V/Q) scanning and CT pulmonary angiography (PA) in predicting CTEPH development after acute pulmonary embolism (APE). This study was performed in APE patients who had undergone both V/Q and CT PA after 3-month anticoagulation. The residual pulmonary obstructions were assessed based on V/Q and CT PA, and then recorded as pulmonary perfusion detect score (PPDs) and CT pulmonary artery obstruction index (PAOI). The predictive performance of PPDs and CT PAOI for CTEPH were determined and risk factors for predicting CTEPH development were identified. A total of 235 patients with initial diagnosis of APE were included in this study. ROC analysis showed that the AUCs of the PPDs and CT PAOI were 0.957 and 0.895, with corresponding cut-off values of 20.50% and 17.50% for predicting CTEPH development. Neither sensitivity nor specificity differed significantly between PPDs and CT PAOI (Sensitivity: 92.00% vs. 80.00%, P = 0.25; Specificity: 88.10% vs. 89.52%, P = 0.69). The univariable and multivariable logistic regression analysis demonstrated that pulmonary arterial hypertension confirmed by echocardiography at initial APE diagnosis (OR: 6.16, 95%CI: 1.31–29.02, P = 0.02), a PPDs of > 20.50% (OR: 22.95, 95%CI: 2.37–222.19, P = 0.007), and a CT PAOI of > 17.50% (OR: 9.98, 95%CI: 2.06–48.49, P = 0.004) were associated with CTEPH development. Both V/Q and CT PA after 3-month anticoagulation for APE showed great performance in predicting CTEPH development, and V/Q scanning has a tendency to be more sensitive but less specific than CT PA. The residual pulmonary embolism detected by V/Q and CT PA was associated with an increased risk of CTEPH development.

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Data availability

Data are available upon request.

Abbreviations

CTEPH:

Chronic thromboembolic pulmonary hypertension

APE:

Acute pulmonary embolism

PAH:

Pulmonary arterial hypertension

V/Q:

Ventilation/perfusion

PA:

Pulmonary angiography

RPAO:

Residual pulmonary artery obstruction

PPDs:

Pulmonary perfusion defects score

PAOI:

Pulmonary artery obstruction index

RHC:

Right heart catheterization

SPAP:

Systolic pulmonary artery pressure

CPE:

Chronic pulmonary embolism

ICC:

Inter-class correlation coefficient

IQR:

Interquartile range

ROC:

Receiver operating characteristic

AUC:

Area under the ROC curve

OR:

Odds ratio

CI:

Confidence interval

NYHA:

New York Heart Association

RV:

Right ventricular

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Acknowledgements

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Funding

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. National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China

    Xu Han, Kai Han, Xinghong Ma, Ruoxi Sun, Lei Wang & Wei Fang

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  1. Xu Han
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  2. Kai Han
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  3. Xinghong Ma
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  5. Lei Wang
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  6. Wei Fang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XH, KH, XHM, RXS and LW. Conceptualization, resources, and methodology were performed by XH, KH, LW and WF. The first draft of the manuscript was written by XH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wei Fang.

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The authors report no confict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Fuwai Hospital (2021-1573).

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Han, X., Han, K., Ma, X. et al. The value of ventilation/perfusion scanning and CT pulmonary angiography in predicting chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a one-year follow-up study. Int J Cardiovasc Imaging 38, 2249–2259 (2022). https://doi.org/10.1007/s10554-022-02629-5

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