Occult pulmonary arterial hypertension in patients with previous pulmonary tuberculosis

Abstract

Background. Pulmonary tuberculosis (TB) still causes a significant public healthcare burden. Despite successful treatment, TB can lead to permanent lung damage and pulmonary hypertension (PH). PH can also occur in the absence of significant lung damage, leading clinicians to question whether pulmonary TB may cause pulmonary arterial hypertension (PAH), an entity that has not been otherwise described. Objectives. To determine the prevalence of PAH in patients previously treated for TB. Methods. We recruited 20 participants who were previously treated for TB and had no other underlying risk factors for the development of PH. The participants underwent electrocardiography (ECG), chest radiography, lung function tests and echocardiography (ECHO). Data from these non-invasive investigations were evaluated to determine findings that were suggestive of PH. Results. At a median duration of 30 months from diagnosis of TB, no participant had echocardiography findings that were suggestive of PH (pulmonary artery pressure (PAP) ≥40 mmHg). However, there was a negative correlation between the time from diagnosis and right ventricular dysfunction assessed by measuring a tricuspid annular plane systolic excursion (r=-0.5136; p=0.0205). Furthermore, one-third of the participants (n=7) had one or more ECG features supporting PH and 85% of the participants (n=17) demonstrated at least one chest X-ray (CXR) feature of PH. Conclusion. Although our study did not demonstrate ECHO findings supporting PH, ECG and CXR modalities were suggestive. Therefore, future studies consisting of larger cohorts and including the use of other sensitive modalities such as computed tomography are warranted. Moreover, these studies will need to determine whether the entity of PAH secondary to previously treated pulmonary TB exists.

EfDenseNet: Automated Pulmonary Hypertension Detection Model Based on EfficientNetb0 and DenseNet201 Using CT Images

“…but the requisite right heart catheterization procedure carries risk and is expensive [6]. In suspect PH cases, noninvasive investigations like blood biomarkers, electrocardiography (ECG), chest X-ray, echocardiography, thoracic computed tomography (CT) and magnetic resonance imaging (MRI) may help corroborate the presence of morphological and/or hemodynamic changes in the heart chambers and lung vasculature consequent to PH-induced remodeling [10]. Artificial intelligence-enabled models are increasingly being used to facilitate disease diagnosis [11], especially in the classification of medical images, like CT, MRI, and X-ray [12].…”

Pulmonary Hypertension in Children across Africa: The Silent Threat

“…In a South African adult study, none of the patients were found to have PH by echocardiography. However, the TAPSE was reduced over time following TB infection [ 56 ].…”