Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble, BP 218, 38043, Grenoble cedex, France.
Eur Radiol. 2013 Oct;23(10):2658-65. doi: 10.1007/s00330-013-2911-1. Epub 2013 Jun 9.
We propose a non-invasive method for diagnosing post-capillary pulmonary hypertension (PH group 2). We evaluated pulmonary capillary wedge pressure (PCWP) by studying the left atrium (LA) on thoracic ECG-gated CT compared with right heart catheterisation (RHC).
We retrospectively studied 54 patients with suspected PH or followed for PH who underwent thoracic ECG-gated CT and RHC within 15 days. The diagnostic accuracy of CT morphological and functional data of the LA for the detection of PCWP >15 mmHg, evaluated by two independent readers, was assessed using correlation and receiver-operating characteristic (ROC) analysis.
Interobserver agreement was high (r = 0.97-0.99). Correlations were found between PCWP and the morphological criteria of the LA such as anteroposterior diameter at 0 % of the R-R interval (r = 0.70, P ≤ 0.001) as well as at 40 % (r = 0.69, P ≤ 0.001). ROC curves constructed with a threshold value of PCWP > 15 mmHg showed an area under the curve between 0.88 and 0.91. Significant correlations were found between PCWP and functional criteria of the LA, including distensibility (r = -0.49, P ≤ 0.001) and ejection fraction (r = -0.58, P ≤ 0.001).
Thoracic ECG-gated CT in a PH workup helps distinguish between pre- and post-capillary PH.
• Computed tomography may help differentiate the various types of pulmonary hypertension (PH). • Post-capillary PH group 2 is due to left heart disease. • Right heart catheterisation is used to separate pre- and post-capillary PH. • Left atrium anteroposterior diameter measured on CT is of value. • ECG-gated CT helps clinicians to assess patients with PH non-invasively.
我们提出一种诊断肺毛细血管后高血压（PH 组 2）的非侵入性方法。我们通过研究胸部心电图门控 CT 上的左心房（LA）与右心导管检查（RHC）相比来评估肺毛细血管楔压（PCWP）。
我们回顾性研究了 54 例疑似 PH 或因 PH 而接受随访的患者，这些患者在 15 天内接受了胸部心电图门控 CT 和 RHC。由两位独立的读者评估 CT 形态和 LA 功能数据对检测 PCWP>15mmHg 的诊断准确性，通过相关性和接受者操作特征（ROC）分析进行评估。
观察者间一致性很高（r=0.97-0.99）。PCWP 与 LA 的形态学标准之间存在相关性，例如在 R-R 间隔的 0%时的前后直径（r=0.70，P≤0.001）以及在 40%时（r=0.69，P≤0.001）。用 PCWP>15mmHg 的阈值构建 ROC 曲线显示曲线下面积在 0.88 到 0.91 之间。PCWP 与 LA 的功能标准之间存在显著相关性，包括可扩张性（r=-0.49，P≤0.001）和射血分数（r=-0.58，P≤0.001）。
PH 检查中的胸部心电图门控 CT 有助于区分毛细血管前和后 PH。
计算机断层扫描可能有助于区分各种类型的肺动脉高压（PH）。
毛细血管后 PH 组 2 是由左心疾病引起的。
右心导管检查用于分离毛细血管前和后 PH。
CT 上测量的左心房前后直径有价值。
ECG 门控 CT 有助于临床医生对 PH 患者进行非侵入性评估。
