Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography

Fritz C Roller; Selcuk M Yildiz; Steffen D Kriechbaum; Sebastian Harth; Andreas Breithecker; Christoph Liebetrau; Armin Schüßler; Eckhard Mayer; Christian W Hamm; Stefan Guth; Gabriele A Krombach; Christoph B Wiedenroth

doi:10.1016/j.ejro.2021.100384

Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography

Eur J Radiol Open. 2021 Oct 18:8:100384. doi: 10.1016/j.ejro.2021.100384. eCollection 2021.

Authors

Fritz C Roller^{1

2}, Selcuk M Yildiz^{1

2}, Steffen D Kriechbaum^{3

2}, Sebastian Harth^{1

2}, Andreas Breithecker^{1

2}, Christoph Liebetrau^{3

2}, Armin Schüßler^{1

2}, Eckhard Mayer^{4

2}, Christian W Hamm^{3

5

2

6}, Stefan Guth⁴, Gabriele A Krombach^{1

2}, Christoph B Wiedenroth⁴

Affiliations

¹ Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.
² German Center for Lung Research (DZL), Giessen, Germany.
³ Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.
⁴ Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.
⁵ Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany.
⁶ German Center for Cardiovascular Research (DZHK), RheinMain Chapter, Frankfurt am Main, Germany.

Abstract

Purpose: The aim of the study was to investigate the potential of electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) as a predictor of disease severity in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Method: Forty-five CTEPH patients with a mean age of 63.8 years±12.7 y (±standard deviation) who had undergone ECG-gated CTPA and right heart catheterization (RHC) were included in the study. Right ventricular to left ventricular volume ratio (RVV/LVV), diameter ratio on 4-chamber view (RVD4CH/LVD4CH), pulmonary trunk (PT) diameter, PT to aortic diameter ratio (PT/A), and septal angle were correlated to mean pulmonary artery pressure (mPAP). Moreover, RVV/LVV and RVD4CH/LVD4CH were adjusted to pulmonary diameter index (PADi) and PT/A index. Areas under the curve (AUC) for predicting mPAP above 40 mmHg, 35 mmHg, and 30 mmHg were calculated.

Results: RVD4CH/LVD4CH revealed the strongest correlation to mPAP before (r = 0.6507) and after (r = 0.7650; p < 0.0001) PT/A adjustment. The AUCs for predicting pH with mPAP over 40 mmHg and 30 mmHg were 0.9229 and 0.864, respectively. A cutoff value of 1.298 enabled prediction of pH with mPAP over 40 mmHg with a sensitivity, specificity, positive predictive, and negative predictive value of 80.00 %, 95.83 %, 88.46 %, and 94.12 %, respectively. Intra- and interobserver variability were excellent for all parameters.

Conclusion: Combining different and easily evaluable ECG-gated CTPA parameters enables excellent prediction of pulmonary hemodynamics in CTEPH patients. Ventricular diameter ratio on 4-chamber view adjusted by the PT/A ratio yielded the best correlation to mPAP.

Keywords: 4CH, four-chamber view; AUC, Area under the curve; CI, Confidence interval; CT, Computed tomography; CTEPH; CTEPH, Chronic thromboembolic pulmonary hypertension; CTPA; CTPA, Computed tomography pulmonary angiography; ECG, Electrocardiogram; HU, Hounsfield units; ICC, intra-class concordance correlation coefficient; LV, Left ventricular; LVD, Left ventricular diameter; LVV, Left ventricular volume; MDCT, Multidetector computed tomography; NPV, Negative predictive value; PADi, Pulmonary artery diameter index; PH, Pulmonary hypertension; PPV, Positive predictive value; PT, Pulmonary trunk; Pulmonary hypertension; RHC, Right heart catheterization; ROC, Receiver operating characteristics; RV, Right ventricular; RVD, Right ventricular diameter; RVV, Right ventricular volume; Right heart catheterization; SD, Standard deviation; mPAP, mean pulmonary artery pressure.