Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study

Abstract

Background: Computed tomography (CT) of the aorta and cardiac vessels, which is performed in patients with severe aortic valve stenosis (AS) before transcatheter aortic valve replacement (TAVR), offers the possibility of non-invasive detection of pulmonary hypertension (PH), for example, by determining the diameter of the main pulmonary artery (PA), the right pulmonary artery (RPA) or the left pulmonary artery (LPA). An improvement of the significance of these radiological parameters is often achieved by indexing to the body surface area (BSA). The aim of this study was to compare different echocardiographic systolic pulmonary artery pressure (sPAP) values with radiological data in order to define potential clinical cut-off values for the presence or absence of PH. Methods: A total of 138 patients with severe AS undergoing TAVR underwent pre-interventional transthoracic echocardiography with determination of sPAP values and performance of CT angiography (CTA) of the aorta and femoral arteries. Radiologically, the PA, RPA, LPA, and ascending aorta (AA) diameters were obtained. Vascular diameters were not only indexed to BSA but also ratios were created with AA diameter (for example PA/AA-ratio). From these CT-derived vascular parameters, AUROC curves were obtained regarding the prediction of different sPAP values (sPAP 40–45–50 mmHg) and finally correlation analyses were calculated. Results: The best AUROC and correlation analyses were generally obtained at an sPAP ≥ 40 mmHg. When considering diameters alone, the PA diameter was superior to the RPA and LPA. Indexing to BSA generally increased the diagnostic quality of the parameters, and finally, in a synopsis of all results, PA/BSA had the best AUC 0.741 (95% CI 0.646–0. 836; p < 0.001; YI 0.39; sensitivity 0.87; specificity 0.52) and Spearman’s correlation coefficient (r = 0.408; p < 0.001) at an sPAP of ≥40 mmHg. Conclusions: Features related to pulmonary hypertension are fast and easily measurable on pre-TAVR CT and offer great potential regarding non-invasive detection of pulmonary hypertension in patients with severe AS and can support the echocardiographic diagnosis. In this study, the diameter of the main pulmonary artery with the additionally determined ratios were superior to the values of the right and left pulmonary artery. Additional indexing to body surface area and thus further individualization of the parameters with respect to height and weight can further improve the diagnostic quality.

Radiological Parameters for the Detection of Pulmonary Hypertension in Severe Aortic Valve Stenosis and Their Influence on Mortality: Does Sex Matter?

“…Since computed tomography angiography (CTA) is strongly recommended during the workup preceding TAVR intervention, and as current European Society of Cardiology (ESC) guidelines also suggest CTA imaging as an alternative for noninvasive PH diagnosis [10], our working group recently investigated CTA-derived measurements such as the pulmonary artery (PA) diameter and PA diameter/body surface area (PA/BSA) and their potential in the diagnosis of PH prior to TAVR [8,11,12]. Regarding the PA/BSA measurements, no statistically significant differences were found in the mortality rates of patients above and below the calculated cut-off values [8].…”

Bibliometric analysis of T‐cells immunity in pulmonary hypertension from 1992 to 2022

“…Up to now, new assessment tools are increasingly available for PH 4,5 . While due to its complex pathogenesis, although there are some effective treatments, 6 there is still a lack of very effective treatments for PH, so it is urgent to explore the pathogenesis of PH.…”

“…Up to now, new assessment tools are increasingly available for PH. 4,5 While due to its complex pathogenesis, although there are some effective treatments, 6 there is still a lack of very effective treatments for PH, so it is urgent to explore the pathogenesis of PH. Pulmonary vascular remodeling is the key structural alteration in PH and involves changes in the intima, media, and adventitia, often with the interplay of inflammatory/immune cells.…”