Multimodal noninvasive prediction of pulmonary hypertension in IPF

Sonti, Rajiv; Gersten, Rebecca A.; Barnett, Scott D.; Brown, Anne; Nathan, Steven D.

doi:10.1111/crj.13059

Cited by 21 publications

(28 citation statements)

References 29 publications

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“…32 Multiple studies have demonstrated that patients with PH‐ILD have a lower 6MWD than ILD patients without PH. 10 , 11 , 13 , 19 , 33 Not only does a reduced 6MWD suggest the diagnosis of concomitant PH in ILD patients, but it is also associated with decreased survival. 2 However, there is conflicting data demonstrating that shorter distances on a 6MWT were actually not predictive of PH in ILD.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in patients with interstitial lung disease: a tool for early detection

et al. 2022

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Pulmonary hypertension (PH) complicates the treatment of interstitial lung disease (ILD) patients resulting in poor functional status and worse outcomes. Early recognition of PH in ILD is important for initiating therapy and considering lung transplantation. However, no standard exists regarding which patients to screen for PH‐ILD or the optimal method to do so. The aim of this study was to create a risk assessment tool that could reliably predict PH in ILD patients. We developed a PH‐ILD Detection tool that incorporated history, exam, 6‐min walk distance, diffusion capacity for carbon monoxide, chest imaging, and cardiac biomarkers to create an eight‐component score. This tool was analyzed retrospectively in 154 ILD patients where each patient was given a score ranging from 0 to 12. The sensitivity (SN) and specificity (SP) of the PH‐ILD Detection tool and an area‐under‐the‐curve (AUC) were calculated. In this cohort, 74 patients (48.1%) had PH‐ILD. A score of ≥6 on the PH‐ILD Detection tool was associated with a diagnosis of PH‐ILD (SN: 86.5%; SP: 86.3%; area‐under‐the‐curve: 0.920, p < 0.001). The PH‐ILD Detection tool provides high SN and SP for detecting PH in ILD patients. With confirmation in larger cohorts, this tool could improve the diagnosis of PH in ILD and may suggest further testing with right heart catheterization and earlier intervention with inhaled treprostinil and/or lung transplant evaluation.

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Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in patients with interstitial lung disease: a tool for early detection

et al. 2022

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“…In human medicine, the gold standard to diagnose an increase in pulmonary arterial pressure is right heart catheterization (24). In veterinary medicine, this technique is not commonly used and echocardiography remains the method of choice to diagnose PH (15).…”

Section: Discussionmentioning

confidence: 99%

Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

Soliveres

Entee

Couvreur³

et al. 2021

Front. Vet. Sci.

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West Highland white terriers (WHWTs) affected with canine idiopathic pulmonary fibrosis (CIPF) are at risk of developing precapillary pulmonary hypertension (PH). In humans, thoracic computed tomography angiography (CTA) is commonly used to diagnose and monitor patients with lower airway diseases. In such patients, CTA helps to identify comorbidities, such as PH, that could negatively impact prognosis. Diameter of the pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), and right ventricle-to-left ventricle ratio (RV/LV) are CTA parameters commonly used to assess the presence of PH. Pulmonary vein-to-right pulmonary artery ratio (PV/PA) is a new echocardiographic parameter that can be used in dogs to diagnose PH. The primary aim of this study was to evaluate the use of various CTA parameters to diagnose PH. An additional aim was to evaluate the correlation of RV/LV measurements between different CTA planes. CTA and echocardiography were prospectively performed on a total of 47 WHWTs; 22 affected with CIPF and 25 presumed healthy control dogs. Dogs were considered to have PH if pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured on 2D-mode echocardiography was less than to 0.7. WHWTs affected with CIPF had higher PT/Ao compared with control patients. In WHWTs affected with CIPF, PT size was larger in dogs with PH (15.4 mm) compared with dogs without PH (13 mm, p = 0.003). A cutoff value of 13.8 mm predicted PH in WHWTs affected with CIPF with a sensitivity of 90% and a specificity of 87% (AUC = 0.93). High correlations were observed between the different CTA planes of RV/LV. Results suggest that diameter of the PT measured by CTA can be used to diagnose PH in WHWTs with CIPF.

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“…An interesting study of 105 patients with idiopathic pulmonary fibrosis (IPF) revealed that the ratios FVC/DLCO (forced vital capacity/diffusion capacity) and diameters of pulmonary artery/aorta were useful adjuncts to sPAP to predict PH in a linear regression model (R 2 ¼0.39). 25 Another small study (n ¼ 61) with IPF patients regressed FVC/DLCO and resting pulse oximetry with PA mean as a continuous variable (R 2 ¼0.55). 26 Whether these models are reliable in cardiological patients without lung disease is unclear.…”

Section: Discussionmentioning

confidence: 99%

Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure

Wernhart

Hedderich²

2020

JRSM Cardiovascular Disease

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Objective Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH. Methods and design We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC. Main outcome measures In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PAmean, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis. Results We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VCmax), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08–4.65) and 1.86 (1.11–3.21) for a 1 l decrease in VCmax. On their own, VCmax proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH. Conclusions We provide a combinatorial model to predict PH from sPAP and VCmax in older adults, which may help to avoid invasive procedures.

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Multimodal noninvasive prediction of pulmonary hypertension in IPF

Cited by 21 publications

References 29 publications

Pulmonary hypertension in patients with interstitial lung disease: a tool for early detection

Pulmonary hypertension in patients with interstitial lung disease: a tool for early detection

Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure

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