Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis

Eberhard, Matthias; Mastalerz, Monika; Pavicevic, Jovana; Frauenfelder, Thomas; Nietlispach, Fabiàn; Tanner, Felix C.; Nguyen-Kim, Thi Dan Linh

doi:10.1007/s10554-017-1180-5

Cited by 18 publications

(17 citation statements)

References 43 publications

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“…The reasons for this are unclear but may relate to the fact that the pulmonary artery measurements may have been made during end-systole rather than end-diastole. The investigators also did not find any significant differences between MPA diameters of patients with combined post-and pre-capillary PH and no PH, whereas we observed significant differences between these groups ( 15 ).…”

Section: Discussioncontrasting

confidence: 71%

“…Therefore, the key observation of this study is that a lower PA/AA ratio value is required to screen for PH among TAVI patients. To date only one other study assessed the value of CT pulmonary vascular measurements as a predictor of PH and mortality in symptomatic severe AS ( 15 ). In contrast to the present study, the authors did not observe that PA/AA ratio was any better at predicting PH as compared with MPA.…”

Section: Discussionmentioning

confidence: 99%

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

O’Sullivan

Montalbetti

Zbinden

et al. 2018

Front. Cardiovasc. Med.

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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.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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

O’Sullivan

Montalbetti

Zbinden

et al. 2018

Front. Cardiovasc. Med.

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“…Thus, the added diagnostic value of ECGgated CT should be balanced with these technical issues before considering its potential clinical interest. However, the use of ECG-gated CT before cardiac interventions is growing, and the diagnosis of PH is very important because of the higher overall mortality rate in patients with PH than in those without PH after cardiac procedures, including transcatheter aortic valve implantation [12]. PA distensibility could thus detect PH in patients who have ECG-gated CT as part of their work-up.…”

Section: Discussionmentioning

confidence: 99%

“…), who had 3 years of experience in cardiac imaging, and blinded to right heart catheterization results. In ungated CT, dPA, dPA/AA, and dPA/V were measured as previously reported [8][9][10][11][12][13][14][15][16][17][18]. The small segmental PA diameter was measured in four lobes on axial sections: the apical segment of the right upper lobe, the posterior segment of the left upper lobe, the posterior basal segment of the right lower lobe, and the posterior basal segment of the left lower lobe [17].…”

Section: Ecg-gated and Ungated Ctmentioning

confidence: 99%

“…Various parameters have been reported for noninvasive detection of PH in ungated chest computed tomography (CT), mainly based on PA measurements, including the diameter of the main PA (dPA) [6][7][8][9][10][11][12][13][14][15][16], the ratio between dPA and the diameter of the ascending aorta (dPA/AA) [8][9][10][11][12][13][14][15][16][17][18], the ratio between dPA and the diameter of the thoracic vertebra (dPA/ V) [17], the volume of the main PA [19,20], the segmental PA diameter [17], the segmental PA-to-bronchus ratio (ABR) [7,12,17], and the so-called egg-and-banana sign [12,15]. These parameters have been separately assessed and are all of limited value unless combined with echocardiography [17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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).

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Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation

Hakgor,

Dursun,

Kahraman

et al. 2024

Cathet Cardio Intervent

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BackgroundPulmonary hypertension (PH) and right ventricular dysfunction are poor prognostic predictors in patients underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS).AimsThe prognostic impact of the main pulmonary artery/ascending aorta diameter ratio (MPA/AOr), measured simply by computed‐tomographic angiography (CTA), was investigated in this patient group.MethodsA total of 374 retrospectively evaluated patients (mean age 78.1 ± 8.4 years, 192 [51.3%] females) who underwent TAVI for severe AS were included. MPA/AOr was measured on preprocedural CTA in all patients and the effect of this measurement on the presence of PH, in‐hospital and 2‐year‐overall long‐term mortality was investigated.ResultsThe presence of PH was defined as a systolic pulmonary artery pressure (sPAP) >42 mmHg measured by echocardiography. According to multivariate‐logistic‐regression analysis, MPA/AOr (adjusted [Adj] odds ratio [OR]: 1.188, confidence interval [CI] 95% [1.002–1.410], p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (adj OR:0.736, CI 95% [0.663–0.816], p < 0.001) and left atrial diameter (adj OR:1.051, CI 95% [1.007–1.098], p = 0.024) were identified as independent predictors of PH. In addition, a statistically significant correlation was found between MPA/AOr and TAPSE (r: −0.283, p < 0.001). Furthermore, MPA/AOr was found to be an independent predictor of both in‐hospital (adj OR:1.434, CI 95% [1.093–1.881], p = 0.009) and 2‐year long‐term (adj OR:1.518, CI 95% [1.243–1.853], p < 0.001) mortality in multivariate analysis including TAPSE, STS score and sPAP. In the 2‐year Kaplan–Meier survival probability analysis, an MPA/AOr >0.86 was found to have a hazard ratio of 3.697 (95% CI: 2.341–5.840), with a log‐rank p < 0.001.ConclusionMPA/AOr, which can be measured simply by CTA, may be useful as an indicator of the presence of PH and poor prognosis in patients planned for TAVI for severe AS.

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Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis

Cited by 18 publications

References 43 publications

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

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

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

Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation

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