Cardiovascular metrics on CT pulmonary angiography in patients with pulmonary hypertension — re-evaluation under the updated guidelines of pulmonary hypertension

Insights into Imaging

Original Article

Peiyao Zhang¹  Mei Deng²  Anqi Liu²  Qiang Huang³  Qian Gao³  Wanmu Xie³  Linfeng Xi⁴  Min Liu⁵  Zhenguo Huang⁵  Haoyu Yang⁶  Wenqing Xu⁶ 

[1] Capital Medical University, 100069, Beijing, China;China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100005, Beijing, China;Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, 100029, Beijing, China;Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, 100029, Beijing, China;Capital Medical University, 100069, Beijing, China;Department of Radiology, China-Japan Friendship Hospital, 100029, Beijing, China;Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, 100191, Beijing, China;

关键词: Pulmonary hypertension;    Computed tomography pulmonary angiography;    Pulmonary artery pressure;    Right heart catheterization;    Hemodynamics;   

DOI  :  10.1186/s13244-023-01535-1

 received in 2023-07-10, accepted in 2023-09-30,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeTo re-assess cardiovascular metrics on computed tomography pulmonary angiography (CTPA) in predicting pulmonary hypertension (PH) under the 2022 ESC/ERS guidelines.Materials and methodsThis observational study retrospectively included 272 patients (female 143, mean age = 54.9 ± 12.5 years old) with suspected PH. 218 patients were grouped to evaluate cardiovascular metrics on CTPA and develop a binary logistic regression model. The other 54 patients were grouped into the validation group to assess the performance of the prediction model under the updated criteria. Based on mean pulmonary artery pressure (mPAP), patients were divided into three groups: group A consisted of patients with mPAP ≤ 20 mmHg, group B included patients with 20 mmHg < mPAP < 25 mmHg, and group C comprised patients with mPAP ≥ 25 mmHg. Cardiovascular metrics among the three groups were compared, and receiver operating characteristic curves (ROCs) were used to evaluate the performance of cardiovascular metrics in predicting mPAP > 20 mmHg.ResultsThe main pulmonary arterial diameter (MPAd), MPAd/ascending aorta diameter ratio (MPAd/AAd ratio), and right ventricular free wall thickness (RVFWT) showed significant differences among the three groups (p < 0.05). The area under curve (AUC) of MPAd was larger than MPAd/AAd ratio and RVFWT. A MPAd cutoff value of 30.0 mm has a sensitivity of 83.1% and a specificity of 90.4%. The AUC of the binary logistic regression model (Z =  − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was 0.938 ± 0.018. In the validation group, the AUC, sensitivity, specificity, and accuracy of the prediction model were 0.878, 92.7%, 76.9%, and 88.9%, respectively.ConclusionUnder the updated criteria, MPAd with a threshold value of 30.0 mm has better sensitivity and specificity in predicting PH. The binary logistic regression model may improve the diagnostic accuracy.Critical relevance statementUnder the updated criteria, the main pulmonary arterial diameter with a threshold value of 30.0 mm has better sensitivity and specificity in predicting pulmonary hypertension. The binary logistic regression model may improve diagnostic accuracy.Key points• According to 2022 ESC/ERS guidelines, a MPAd cutoff value of 30.0 mm has better sensitivity and specificity in predicting mPAP > 20 mmHg• A binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was developed and had a sensitivity, specificity, and accuracy of 92.7%, 76.9%, and 88.9% in predicting mPAP > 20 mmHg.• A binary logistic regression prediction model outperforms MPAd in predicting mPAP > 20 mmHg.Graphical Abstract

【 授权许可】

CC BY   
© European Society of Radiology (ESR) 2023

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