Jivraj Khalil, Bedayat Arash, Sung Yon K, Zamanian Roham T, Haddad Francois, Leung Ann N C, Rosenberg Jarrett, Guo H Henry
*Department of Radiology †Department of Pulmonary and Critical Care Medicine §Department of Cardiovascular Medicine ∥Department of Radiology, Division of Biostatistics ‡Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford Health Care, Stanford, CA.
J Thorac Imaging. 2017 Mar;32(2):121-126. doi: 10.1097/RTI.0000000000000252.
Left heart disease is associated with left atrial enlargement and is a common cause of pulmonary hypertension (PH). We investigated the relationship between left atrium maximal axial cross-sectional area (LA-MACSA), as measured on chest computed tomography (CT), and PH due to left heart disease (World Health Organization group 2) in patients with right heart catheterization-proven PH.
A total of 165 patients with PH who had undergone right heart catheterization with pulmonary artery pressure and pulmonary capillary wedge pressure (PCWP) measurements and nongated chest CTs were included. LA-MACSA, LA anterior-posterior, and LA transverse measurements were independently obtained using the hand-drawn region-of-interest and distance measurement tools on standard PACS by 2 blinded cardiothoracic radiologists. Nonparametric statistical analyses and receiver operating characteristic curve were performed.
Forty-three patients had group 2 PH (PCWP>15 mm Hg), and 122 had nongroup 2 PH (PCWP≤15 mm Hg). Median LA-MACSA was significantly different between the group 2 PH and nongroup 2 PH patients (2312 vs. 1762 mm, P<0.001). Interobserver concordance correlation for LA-MACSA was high at 0.91 (P<0.001). At a threshold of 2400 mm, LA-MACSA demonstrated 93% specificity for classifying group 2 PH (area under the curve, 0.73; P<0.001).
LA-MACSA is a readily obtainable and reproducible measurement of left atrial enlargement on CT and can distinguish between group 2 and nongroup 2 PH with high specificity.
左心疾病与左心房扩大相关，是肺动脉高压（PH）的常见原因。我们研究了在胸部计算机断层扫描（CT）上测量的左心房最大轴向横截面积（LA-MACSA）与经右心导管检查证实为PH的左心疾病（世界卫生组织第2组）所致PH之间的关系。
纳入165例接受了右心导管检查以测量肺动脉压和肺毛细血管楔压（PCWP）并进行了非门控胸部CT检查的PH患者。由2名盲法心胸放射科医生使用标准PACS上的手绘感兴趣区域和距离测量工具独立获得LA-MACSA、左心房前后径和左心房横径测量值。进行了非参数统计分析和受试者操作特征曲线分析。
43例患者为第2组PH（PCWP>15 mmHg），122例为非第2组PH（PCWP≤15 mmHg）。第2组PH患者和非第2组PH患者的LA-MACSA中位数有显著差异（2312 vs. 1762 mm，P<0.001）。LA-MACSA的观察者间一致性相关性较高，为0.91（P<0.001）。在阈值为2400 mm时，LA-MACSA对第2组PH分类的特异性为93%（曲线下面积，0.73；P<0.001）。
LA-MACSA是一种在CT上易于获得且可重复的左心房扩大测量指标，能够以高特异性区分第2组和非第2组PH。
