Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis

Ullah, Waqas; Minalyan, Artem; Saleem, Sameer; Nadeem, Nayab; Abdullah, Hafez Mohammad Ammar; Abdalla, A. A.; Chan, Vincent; Saeed, Rehan; Khan, M.Zulfiqar Ali; Collins, Sara D.; Mukhtar, Maryam; Grover, Harshwant; Sattar, Yasar; Panchal, Ankur; Gowda, Smitha Narayana; Khwaja, Uneza; Lashari, B.H.; Fischman, David L.

doi:10.1016/j.ijcha.2020.100568

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…Despite increasing recognition of PH, most cases still have delayed detection [6]. The gold standard for detecting PH is right heart catheterization by measuring mean pulmonary arterial systolic pressure (PASP) [7]. However, due to the invasiveness of the procedure, expense, or unavailability, many institutions across the globe do not use this procedure [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital

Darira¹,

Ahmed²,

Hamid³

et al. 2022

Cureus

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Introduction: Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population.Method: In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT's diagnostic capability and cut-off values.Result: The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p<0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively. Conclusions: The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.

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Section: Introductionmentioning

confidence: 99%

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital

Darira¹,

Ahmed²,

Hamid³

et al. 2022

Cureus

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“…However, echocardiographic assessment of PH is known to be technically challenging and operator dependent, with reproducibility and reliability that may vary from one operator to another 5,34,35 . A recent meta-analysis of 27 studies evaluating echocardiographic measures of PH against gold-standard right heart catheterization demonstrated a pooled sensitivity of 85% and specificity of 71%, which was inferior to the performance of cardiac MRI (92% and 86%, respectively) 33 advantages, as it does not require radiation exposure, is not operator dependent, provides excellent spatial resolution of right ventricular morphology and correlates well with invasive assessment of PH 33,34,36 . However, cardiac MRI is not yet widely available outside of specialized centers, is relatively costly, and cannot be utilized in patients with magnetic objects, which limit its use as a screening tool for PH 34,36,37 .…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 32 Doppler echocardiography has long been considered the initial test of choice for non-invasive investigation of suspected pulmonary hypertension due to its convenience, lack of radiation exposure, and its ability to assess multiple hemodynamic and structural elements related to PH. 33 , 34 However, echocardiographic assessment of PH is known to be technically challenging and operator dependent, with reproducibility and reliability that may vary from one operator to another. 5 , 34 , 35 A recent meta-analysis of 27 studies evaluating echocardiographic measures of PH against gold-standard right heart catheterization demonstrated a pooled sensitivity of 85% and specificity of 71%, which was inferior to the performance of cardiac MRI (92% and 86%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography

Synn¹,

Margerie-Mellon

Jeong³

et al. 2021

Pulm. circ.

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Pulmonary hypertension is characterized histologically by intimal and medial thickening in the small pulmonary arteries, eventually resulting in vascular “pruning.” Computed tomography (CT)-based quantification of pruning is associated with clinical measures of pulmonary hypertension, but it is not established whether CT-based pruning correlates with histologic arterial remodeling. Our sample consisted of 138 patients who underwent resection for early-stage lung adenocarcinoma. From histologic sections, we identified small pulmonary arteries and measured the relative area comprising the intima and media (VWA%), with higher VWA% representing greater histologic remodeling. From pre-operative CTs, we used image analysis algorithms to calculate the small vessel volume fraction (BV5/TBV) as a CT-based indicator of pruning (lower BV5/TBV represents greater pruning). We investigated relationships of CT pruning and histologic remodeling using Pearson correlation, simple linear regression, and multivariable regression with adjustment for age, sex, height, weight, smoking status, and total pack-years. We also tested for effect modification by sex and smoking status. In primary models, more severe CT pruning was associated with greater histologic remodeling. The Pearson correlation coefficient between BV5/TBV and VWA% was –0.41, and in linear regression models, VWA% was 3.13% higher (95% CI: 1.95–4.31%, p < 0.0001) per standard deviation lower BV5/TBV. This association persisted after multivariable adjustment. We found no evidence that these relationships differed by sex or smoking status. Among individuals who underwent resection for lung adenocarcinoma, more severe CT-based vascular pruning was associated with greater histologic arterial remodeling. These findings suggest CT imaging may be a non-invasive indicator of pulmonary vascular pathology.

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“…While traditional doppler echocardiography remains the standard for cardiac functional analysis, other non-invasive measures of RV function including magnetic resonance imaging (MRI) and two-dimensional speckle tracking echocardiography are emerging as important tools in the early identification of RV dysfunction in patients of all ages ( Ozturk et al, 2017 ; Khairat et al, 2019 ) and cardiac MRI is able to distinguish tissue characteristics, allowing for quantification of myocardial fibrosis which has been linked to age-related cardiac dysfunction ( Liu et al, 2013 ). Invasive hemodynamic measurements using conductance catheters inserted into the RV provides the most accurate analysis of RV function but are less commonly used due to the invasive nature, high cost and difficulty in obtaining highly reproducible data which is largely attributable to difficulties with accurate catheter placement ( Ullah et al, 2020 ).…”

Section: Right Ventricular Functional Analysismentioning

confidence: 99%

Physiology of the Right Ventricle Across the Lifespan

Woulfe

Walker

2021

Front. Physiol.

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The most common cause of heart failure in the United States is ischemic left heart disease; accordingly, a vast amount of work has been done to elucidate the molecular mechanisms underlying pathologies of the left ventricle (LV) as a general model of heart failure. Until recently, little attention has been paid to the right ventricle (RV) and it has commonly been thought that the mechanical and biochemical properties of the RV are similar to those of the LV. However, therapies used to treat LV failure often fail to improve ventricular function in RV failure underscoring, the need to better understand the unique physiologic and pathophysiologic properties of the RV. Importantly, hemodynamic stresses (such as pressure overload) often underlie right heart failure further differentiating RV failure as unique from LV failure. There are significant structural, mechanical, and biochemical properties distinctive to the RV that influences its function and it is likely that adaptations of the RV occur uniquely across the lifespan. We have previously reviewed the adult RV compared to the LV but there is little known about differences in the pediatric or aged RV. Accordingly, in this mini-review, we will examine the subtle distinctions between the RV and LV that are maintained physiologically across the lifespan and will highlight significant knowledge gaps in our understanding of pediatric and aging RV. Consideration of how RV function is altered in different disease states in an age-specific manner may enable us to define RV function in health and importantly, in response to pathology.

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Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis

Cited by 20 publications

References 34 publications

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital

Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography

Physiology of the Right Ventricle Across the Lifespan

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