Abstract 16534: Pulmonary Artery Tapering Pattern on Chest CT-Angiogram Predicts Phenotype of Pulmonary Hypertension
IntroductionNon-invasive methods to identify phenotype of pulmonary hypertension (PH) are essential to improve the diagnostic algorithm of PH. HypothesisDelayed tapering of pulmonary artery (PA) is a signature of pre-capillary PH, while in post-capillary PH, the PA tapers rapidly. This differential...
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| Published in: | Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A16534 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
by the American College of Cardiology Foundation and the American Heart Association, Inc
17-11-2020
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| Online Access: | Get full text |
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| Summary: | IntroductionNon-invasive methods to identify phenotype of pulmonary hypertension (PH) are essential to improve the diagnostic algorithm of PH. HypothesisDelayed tapering of pulmonary artery (PA) is a signature of pre-capillary PH, while in post-capillary PH, the PA tapers rapidly. This differential tapering pattern of PA can be detected on a chest CT-angiogram (CTA), and quantified as a ratio of main PA diameter to PA branch diameter (right or left) at 5.0 cm length after the PA bifurcation. MethodsWe identified 30 subjects with chest CTA and PH confirmed with invasive right heart catheterization (RHC). We identified 3 PH phenotypes1. “PVD” (pulmonary vascular disease) = Pre-capillary PH (n=10, PVR>3.0 WU, PAWP <15mmHg), 2. “Mixed” = pre- and post-capillary PH (n=10, PVR>3.0 WU, PAWP >15mmHg), and 3. “PVH” (pulmonary venous hypertension) = post-capillary PH (n=10, PVR<3.0 Woods units [WU], PAWP >15mmHg). ResultsThe results are summarized in Table. Additional results are expressed as comparison among the three groups in orderPVD vs Mixed vs PVH (mean±SD, % or n, as appropriate). CTA-chest findingsRV basal diameter (mm)= 51.1±8.4 vs 51.0±5.4 vs 38.1±13.9, left ventricular (LV) basal diameter (mm)= 32.1±7.2 vs 31.6±13.3 vs 56.6±15.2*, PA:Ao ratio= 1.1±0.1 vs 1.1±0.2 vs 1.0±0.1. Echo findingstricuspid annular plane systolic excursion (TAPSE, mm)= 16±3 vs 19±4 vs 22±10*. We performed ROC to identify predictive ability of PA:RPA-5 and PA:LPA-5 to predict PVR>3 WU. The AUC for PA:RPA-5 = 0.859 (p=0.03) and for PA:LPA-5 = 0.812 (p=0.01); with optimal cut-off for both parameters (PA:RPA-5 and PA:LPA-5) was 1.85. Among the overall cohort, the patients with PA:RPA<1.85, 15/16 had PVR>3 and 11/16 were on PH meds. ConclusionPattern of PA tapering quantified with PA:RPA-5 or PA:LPA-5 can reliably identify elevated PVR (>3.0 WU). Pre-capillary PH imprints a signature morphological mark on the pattern of PA dilation that can be identified with a CTA-thorax. |
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| ISSN: | 0009-7322 1524-4539 |
| DOI: | 10.1161/circ.142.suppl_3.16534 |