Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility

Abstract

Objectives To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography. Methods One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated. In ungated CT, dPA, dPA/AA, the ratio of dPA to the diameter of the vertebra, segmental PA diameter, segmental PA-to-bronchus ratio, and the main PA volume were measured; the egg-and-banana sign was recorded. During echocardiography, the tricuspid regurgitation (TR) gradient was measured. The areas under the ROC curves (AUC) of these signs were computed and compared with DeLong test. Correlation between PA distensibility and PA pressure (PAP) was investigated through Pearson's coefficient.Results PA distensibility was lower in patients with PH than in those without PH (11.4 vs. 21.2%, p < 0.001) and correlated negatively with mean PAP (r = − 0.72, p < 0.001). Age, PA size, and mean PAP were independent predictors of PA distensibility. PA distensibility < 18% detected PH-LHD with 96% sensitivity and 73% specificity; its AUC was 0.92, larger than that of any other sign at ungated CT and TR gradient (AUC ranging from 0.54 to 0.83, DeLong: p ranging from 0.020 to < 0.001). Conclusion PA distensibility on an ECG-gated CT can detect PH-LHD better than the parameters reflecting PA dilatation in ungated CT or TR gradient in the echocardiography of patients with severe HFrEF, aortic stenosis, or mitral regurgitation. Key Points• In left heart disease, pulmonary artery distensibility is lower in patients with PH than in those without pulmonary hypertension (11.4 vs. 21.2%, p < 0.001). • In left heart disease, pulmonary artery distensibility detects pulmonary hypertension with an area under the receiver operating curve of 0.92. • In left heart disease, the area under the receiver operating curve of pulmonary artery distensibility for detecting pulmonary hypertension is larger than that of all other signs at ungated CT (p from 0.019 to < 0.001) and tricuspid regurgitation gradient at echocardiography (p = 0.020).

Right main pulmonary artery distensibility on dynamic ventilation CT and its association with respiratory function

“…Previous reports have compared the systolic and diastolic diameters of the main pulmonary artery in cardiac motion, thereby assessing pulmonary arterial distensibility [ 3 , 4 , 6 ]. For example, Colin et al have shown that the more advanced pulmonary hypertension due to COPD, the less distensibility it has [ 6 ].…”

“…Previous reports have compared the systolic and diastolic diameters of the main pulmonary artery in cardiac motion, thereby assessing pulmonary arterial distensibility [ 3 , 4 , 6 ]. For example, Colin et al have shown that the more advanced pulmonary hypertension due to COPD, the less distensibility it has [ 6 ]. However, these studies did not measure the blood vessels four-dimensionally in physiological breathing conditions, because the measurements were made with specific respiratory levels held, or even under respiration, without distinguishing between inhalation and exhalation, and may not reflect normal hemodynamics itself.…”

“…COPD is a leading cause of morbidity and mortality worldwide, and various intra- and extrapulmonary complications exist, but pulmonary hypertension due to lung disease and/or hypoxia, which is classified as group 3 in the Nice classification, is associated with higher mortality [ 2 ]. Several previous studies have investigated pulmonary artery distensibility in pulmonary hypertension [ 3 – 6 ]. However, these may not reflect physiological hemodynamics because they were measured with breath-hold at end-inspiration or even if they were evaluated under respiration, they did not distinguish between inspiration and expiration.…”

Advances in healthcare wearable devices

“…In-time detection of the abnormalities in atrial pulses could lead to the prevention of serious cardiac diseases. Monitoring arterial pressure may potentially help in the diagnosis of cardiac and blood diseases 36,37 . This self-powered tattoo-based HWDs is POC in nature and mitigates the high-power consumption required by conventional arterial monitors.…”

Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

“…A relevant new approach was recently published by Sudo et al [55] who related the MPA diameter to the body surface area (PA/BSA) and thus defined a good predictor for PH detection. The extent to which the distensibility of the pulmonary artery, which can be determined in CT diagnostics, has diagnostic value for the assessment of PH [56] remains to be clarified in further studies.…”