Pulmonary Hypertension in Patients With Bronchiectasis: Prognostic Significance of CT Signs

Devaraj, Anand; Wells, Adrian; Meister, Mark G.; Loebinger, Michael R.; Wilson, Robert; Hansell, David M.

doi:10.2214/ajr.10.5221

Cited by 55 publications

(43 citation statements)

References 21 publications

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“…We add that associated COPD might play a pivotal role in predicting mortality, but further research with larger populations is needed. Although PH is a known risk factor for mortality and the percentages of deaths were higher in the patients with PH (42%) versus without PH (28%), there was no significant difference in terms of mortality [34]. This might be hampered by the lack of echocardiographic data in 130 patients.…”

Section: Discussionmentioning

confidence: 98%

Mortality in non-cystic fibrosis bronchiectasis: A prospective cohort analysis

Goeminne¹,

Nawrot

Ruttens³

et al. 2014

Respiratory Medicine

163

126

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Section: Discussionmentioning

confidence: 98%

Mortality in non-cystic fibrosis bronchiectasis: A prospective cohort analysis

Goeminne¹,

Nawrot

Ruttens³

et al. 2014

Respiratory Medicine

163

126

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“…(31–40) Devaraj and colleagues have recently shown that the right and left pulmonary artery diameters exceeding 1.8 cm are the best predictor of mortality in patients with bronchiectasis; as these CT findings are considered to be a biomarker for elevated PAP. (41) There are some authors that have recently proposed using the ratio of the pulmonary artery diameter to the aortic diameter (PAD/AoD) as a proxy for pulmonary arterial enlargement. (20) The PAD/AoD ratio is limited by many factors not the least of which is the great deal of variability in aortic size which is independent of pulmonary arterial pressures.…”

Section: Non Contrast Ct Findings Of Elevated Papmentioning

confidence: 99%

Magnetic Resonance and Computed Tomography Imaging of the Structural and Functional Changes of Pulmonary Arterial Hypertension

Schiebler

Bhalla

Runo

et al. 2013

Journal of Thoracic Imaging

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The current Dana Point classification system (2009) divides elevation of pulmonary artery pressure into Pulmonary Arterial Hypertension (PAH) and Pulmonary Hypertension (PH). Fortunately, pulmonary arterial hypertension (PAH) is not a common disease. However, with the aging of the first world’s population, heart failure is now an important cause of pulmonary hypertension with up to 9% of the population involved. PAH is usually asymptomatic until late in the disease process. While there are indirect features of PAH found on noninvasive imaging studies, the diagnosis and management still requires right heart catheterization. Imaging features of PAH include: 1. Enlargement of the pulmonary trunk and main pulmonary arteries, 2. Decreased pulmonary arterial compliance, 3. Tapering of the peripheral pulmonary arteries, 4. Enlargement of the inferior vena cava, and 5. Increased mean transit time. The chronic requirement to generate high pulmonary arterial pressures measurably affects the right heart and main pulmonary artery. This change in physiology causes the following structural and functional alterations that have been shown to have prognostic significance: Relative area change of the pulmonary trunk, RVSVindex, RVSV, RVEDVindex, LVEDVindex, and baseline RVEF <35%. All of these variables can be quantified non-invasively and followed longitudinally in each patient using MRI to modify the treatment regimen. Untreated PAH frequently results in a rapid clinical decline and death within 3 years of diagnosis. Unfortunately, even with treatment, less than 1/2 of these patients are alive at four years.

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“…In a study involving 70 individuals with bronchiectasis diagnosed by HRCT, air trapping was observed in 34% of the images obtained during expiration (39) . In the present study, the sample of patient in whom appropriate expiratory HRCT scans were available was small ( n = 10), due to the technical difficulties for the acquisition of examinations of good quality.…”

Section: Discussionmentioning

confidence: 99%

Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography

et al. 2017

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ObjectiveTo evaluate radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography (HRCT).Materials and MethodsThe HRCT scans of 43 patients with bronchiectasis were analyzed by two radiologists, who used a scoring system to grade the findings. Kappa (κ) values and overall agreement were calculated.ResultsFor the measurement and appearance of bronchiectasis, the interobserver agreement was moderate (κ = 0.45 and κ = 0.43, respectively), as was the intraobserver agreement (κ = 0.54 and κ = 0.47, respectively). Agreement on the presence of mucous plugging was fair, for central distribution (overall interobserver agreement of 68.3% and κ = 0.39 for intraobserver agreement) and for peripheral distribution (κ = 0.34 and κ = 0.35 for interobserver and intraobserver agreement, respectively). The agreement was also fair for peribronchial thickening (κ = 0.21 and κ = 0.30 for interobserver and intraobserver agreement, respectively). There was fair interobserver and intraobserver agreement on the detection of opacities (κ = 0.39 and 71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24, respectively), and cysts/bullae (κ = 0.47 and κ = 0.44, respectively). Qualitative analysis of the HRCT findings of bronchiectasis and the resulting individual patient scores showed that there was an excellent correlation between the observers (intraclass correlation coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement, respectively).ConclusionIn the interpretation of HRCT findings of bronchiectasis, radiologist agreement appears to be fair. In our final analysis of the findings using the proposed score, we observed excellent interobserver and intraobserver agreement.

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Pulmonary Hypertension in Patients With Bronchiectasis: Prognostic Significance of CT Signs

Abstract: Pulmonary hypertension, reflected by pulmonary arterial enlargement on CT scans, is a highly significant prognostic indicator in the evaluation of patients with bronchiectasis.

Cited by 55 publications

References 21 publications

Mortality in non-cystic fibrosis bronchiectasis: A prospective cohort analysis

Mortality in non-cystic fibrosis bronchiectasis: A prospective cohort analysis

Magnetic Resonance and Computed Tomography Imaging of the Structural and Functional Changes of Pulmonary Arterial Hypertension

Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography

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