Screening For Pulmonary Hypertension With Multidetector Computed Tomography Among Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Abstract

Aim: To assess the accuracy of multi-detector computed tomography (MDCT) derived pulmonary vessel measurements in predicting pulmonary hypertension (PH) among patients with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).Background: PH is common among patients with severe AS undergoing TAVI and is associated with adverse outcomes. MDCT is the imaging modality of choice to assess anatomical dimensions among patients selected for TAVI.Methods: One hundred and thirty-nine patients with severe AS undergoing TAVI with both CT scans and right heart catheterizations (RHC) were included. CT diameters of the main pulmonary artery (MPA), right (RPA) and left (LPA), and ascending aorta (AA) were measured. The relationship between CT measurements and PA pressures assessing using RHC was tested with linear regression.Results: The CT derived ratio of the diameter of the MPA to the diameter of the AA (PA/AAratio) correlated best with mean PA pressure (R2 = 0.48) and PA systolic pressure (R2 = 0.50). Receiver operating characteristic curve analysis showed that the PA/AAratio is a moderate predictor of PH (AUC 0.74, 95% CI 0.65–0.83, p < 0.0001) and that the optimal cut off point is 0.80 (sensitivity 56%, specificity 88%, positive predictive value 95.5%, negative predictive value 30.6% for PH).Conclusions: Elderly patients with severe AS and PA/AAratio values ≥ 0.80 on MDCT are more likely to have PH but PH cannot be reliably excluded among such patients with lower PA/AAratio values.

A Story of PA/BSA and Biomarkers to Diagnose Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—The Rise of IGF-BP2 and GDF-15

“…Additionally, CT angiography is utilized to gain information about the great arteries and aortic valve annulus of every patient undergoing TAVR. As per current European Society of Cardiology (ESC) guidelines [ 10 ], CT imaging may be used to assess PH in a non-invasive manner [ 11 , 12 ]. Pulmonary artery diameter/body surface area (PA/BSA), with a cut-off value of 16.6 mm/m 2 , was used in this study to possibly diagnose PH.…”

Pulmonary artery systolic pressure at 1-month predicts 1-year survival after transcatheter aortic valve implantation

“…However, the majority of studies use PASP as a key component of PH evaluation. O'Sullivan et al [25] tested computed tomography for PH evaluation and proposed the ratio of the diameter of the main pulmonary artery to the diameter of the ascending aorta as best correlating with PASP. In patients with PA/AA ratio >0.80, PH is more likely, however, PH cannot be reliably excluded among patients with lower PA/AA ratio values.…”

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

“…This contrasted with the statement of Turner et al [53], who found a relevant association with respect to 1-year survival, particularly in the complex calculation of MPA area. O'Sullivan et al [54] used a similar patient population as Eberhard et al (TAVR patients with RHC data as well as multi-detector computed tomography (MDCT) measurements). The results showed not only significantly higher MPA Diameter and PA/AA ratios in PH patients, but also good correlation analyses with corresponding right heart catheterization data.…”