Enhancing preoperative assessment in chronic thromboembolic pulmonary hypertension: A comprehensive analysis of interobserver agreement and proximity-based CT pulmonary angiography scoring

Grafham, Grace K.; Bambrick, Marie; Houbois, Christian; Mafeld, Sebastian; Donahoe, Laura; de Perrot, Marc; McInnis, Micheal C.

doi:10.1016/j.heliyon.2023.e20899

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…The thoracic radiologist (M. M.) in our program confirmed the presence of chronic pulmonary embolism on a computed tomography pulmonary angiography (CTPA). The radiologic burden of disease was assessed according to our recently published approach 12 . A 32‐vessel model of the pulmonary vasculature was employed to categorize thromboembolic disease based on anatomic location from proximal to distal as follows: Level 1 (main PA), Level 2 (lobar), Level 3 (segmental), and Level 4 (subsegmental).…”

Section: Methodsmentioning

confidence: 99%

Exercise and pulsatile pulmonary vascular loading in chronic thromboembolic pulmonary disease

Osman,

Girdharry,

Karvasarski

et al. 2024

Pulm. circ.

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Chronic thromboembolic pulmonary disease (CTEPD) is characterized by organized nonresolving thrombi in pulmonary arteries (PA). In CTEPD with pulmonary hypertension (PH), chronic thromboembolic PH (CTEPH), early wave reflection results in abnormalities of pulsatile afterload and augmented PA pressures. We hypothesized that exercise during right heart catheterization (RHC) would elicit more frequent elevations of pulsatile vascular afterload than resistive elevations in patients with CTEPD without PH. The interdependent physiology of pulmonary venous and PA hemodynamics was also evaluated. Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty‐five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (p < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance‐compliance time product at rest. The physiological relationship between changes in PA pressures relative to PAWP was disrupted in the ExABN group. In CTEPD without PH, exercise RHC revealed latent pulmonary vascular afterload elevations in 58% of patients with more frequent augmentation of pulsatile than resistive pulmonary vascular afterload.

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Section: Methodsmentioning

confidence: 99%