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Article

Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy

by
Deepa Gopalan
1,2,*,
Jan Y. J. Riley
3,
Kai’en Leong
4,
Senan Alsanjari
2,
William Auger
5 and
Peter Lindholm
1,6
1
Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden
2
Department of Radiology, Imperial College Hospital NHS Trust, London W12 0HS, UK
3
Department of Diagnostic Imaging, Monash Health, Melbourne 3168, Australia
4
Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia
5
Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA
6
Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
*
Author to whom correspondence should be addressed.
Tomography 2023, 9(5), 1787-1798; https://doi.org/10.3390/tomography9050142
Submission received: 20 August 2023 / Revised: 23 September 2023 / Accepted: 24 September 2023 / Published: 26 September 2023
(This article belongs to the Section Cardiovascular Imaging)
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Abstract

CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A retrospective analysis of paired CTPA and right heart hemodynamics in 33 consecutive CTEPH cases before and after pulmonary thromboendarterectomy (PTE) was performed. Semiautomated and manual CT biatrial and biventricular size quantifications were correlated with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. The baseline indexed right atrioventricular volumes were twice the left atrioventricular volumes, with significant (p < 0.001) augmentation of left heart filling following PTE. Except for the left atrial volume to cardiac index, all other chamber ratios significantly correlated with hemodynamics. Left to right ventricular ratio cut point <0.82 has high sensitivity (91% and 97%) and specificity (88% and 85%) for identifying significant elevations of mPAP and PVR, respectively (AUC 0.90 and 0.95), outperforming atrial ratios (sensitivity 78% and 79%, specificity 82% and 92%, and AUC 0.86 and 0.91). Manual LV:RV basal dimension ratio correlates strongly with semiautomated volume ratio (r 0.77, 95% CI 0.64–0.85) and is an expeditious alternative with comparable prognostic utility (AUC 0.90 and 0.95). LV:RV dimension ratio of <1.03 and ≤0.99 (alternatively expressed as RV:LV ratio of >0.97 and ≥1.01) is a simple metric that can be used for CTEPH outcome prediction.
Keywords: CTPA planimetry; CTEPH; pulmonary endarterectomy CTPA planimetry; CTEPH; pulmonary endarterectomy

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MDPI and ACS Style

Gopalan, D.; Riley, J.Y.J.; Leong, K.; Alsanjari, S.; Auger, W.; Lindholm, P. Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy. Tomography 2023, 9, 1787-1798. https://doi.org/10.3390/tomography9050142

AMA Style

Gopalan D, Riley JYJ, Leong K, Alsanjari S, Auger W, Lindholm P. Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy. Tomography. 2023; 9(5):1787-1798. https://doi.org/10.3390/tomography9050142

Chicago/Turabian Style

Gopalan, Deepa, Jan Y. J. Riley, Kai’en Leong, Senan Alsanjari, William Auger, and Peter Lindholm. 2023. "Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy" Tomography 9, no. 5: 1787-1798. https://doi.org/10.3390/tomography9050142

APA Style

Gopalan, D., Riley, J. Y. J., Leong, K., Alsanjari, S., Auger, W., & Lindholm, P. (2023). Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy. Tomography, 9(5), 1787-1798. https://doi.org/10.3390/tomography9050142

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