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European Radiology
Published in: European Radiology 11/2018

01-11-2018 | Chest

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

Authors: Geoffrey C. Colin, Bernhard L. Gerber, Christophe de Meester de Ravenstein, David Byl, Anna Dietz, Michele Kamga, Agnes Pasquet, David Vancraeynest, Jean-Louis Vanoverschelde, Anne-Marie D’Hondt, Benoit Ghaye, Anne-Catherine Pouleur

Published in: European Radiology | Issue 11/2018

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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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Metadata
Title
Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure
Authors
Geoffrey C. Colin
Bernhard L. Gerber
Christophe de Meester de Ravenstein
David Byl
Anna Dietz
Michele Kamga
Agnes Pasquet
David Vancraeynest
Jean-Louis Vanoverschelde
Anne-Marie D’Hondt
Benoit Ghaye
Anne-Catherine Pouleur
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5455-6

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