Division of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Eur Radiol. 2018 Nov;28(11):4643-4653. doi: 10.1007/s00330-018-5455-6. Epub 2018 May 14.
To evaluate the ability of chest computed tomography (CT) to predict pulmonary hypertension (PH) and outcome in chronic heart failure with reduced ejection fraction (HFrEF).
We reviewed 119 consecutive patients with HFrEF by CT, transthoracic echocardiography (TTE) and right heart catheterization (RHC). CT-derived pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio), left atrial, right atrial, right ventricular (RV) and left ventricular volumes were correlated with RHC mean pulmonary arterial pressure (mPAP) . Diagnostic accuracy to predict PH and ability to predict primary composite endpoint of all-cause mortality and HF events were evaluated.
RV volume was significantly higher in 81 patients with PH compared to 38 patients without PH (133 ml/m vs. 79 ml/m, p < 0.001) and was moderately correlated with mPAP (r=0.55, p < 0.001). Also, RV volume had higher ability to predict PH (area under the curve: 0.88) than PA diameter (0.79), PA:A ratio (0.76) by CT and tricuspid regurgitation gradient (0.83) and RV basal diameter by TTE (0.84, all p < 0.001). During the follow-up period (median: 3.4 years), 51 patients (43%) had HF events or died. After correction for important clinical, TTE and RHC parameters, RV volume (adjusted hazard ratio [HR]: 1.71, 95% CI 1.31-2.23, p < 0.001) and PA diameter (HR: 1.61, 95% CI 1.18-2.22, p = 0.003) were independent predictors of the primary endpoint.
In patients with HFrEF, measurement of RV volume and PA diameter on ungated CT are non-invasive markers of PH and may help to predict the patient outcome.
• Right ventricular (RV) volume measured by chest CT has good ability to identify pulmonary hypertension (PH) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF). • The accuracy of pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio) to predict PH was similar to previous studies, however, with lower cut-offs (28.1 mm and 0.92, respectively). • Chest CT-derived PA diameter and RV volume independently predict all-cause mortality and HF events and improve outcome prediction in patients with advanced HFrEF.
评估胸部计算机断层扫描（CT）预测射血分数降低的慢性心力衰竭（HFrEF）患者肺动脉高压（PH）和结局的能力。
我们通过 CT、经胸超声心动图（TTE）和右心导管检查（RHC）对 119 例连续 HFrEF 患者进行了回顾性研究。CT 衍生的肺动脉（PA）直径和 PA 与升主动脉直径比（PA:A 比）、左心房、右心房、右心室（RV）和左心室容积与 RHC 平均肺动脉压（mPAP）相关。评估了预测 PH 的诊断准确性和预测主要复合终点（全因死亡率和 HF 事件）的能力。
与 38 例无 PH 患者相比，81 例 PH 患者的 RV 容积明显更高（133ml/m 对 79ml/m，p<0.001），且与 mPAP 中度相关（r=0.55，p<0.001）。此外，RV 容积预测 PH 的能力（曲线下面积：0.88）高于 CT 测量的 PA 直径（0.79）、PA:A 比（0.76）、TTE 测量的三尖瓣反流梯度（0.83）和 RV 基底直径（0.84，均 p<0.001）。在随访期间（中位数：3.4 年），51 例（43%）患者发生 HF 事件或死亡。在校正重要的临床、TTE 和 RHC 参数后，RV 容积（调整后的危险比 [HR]：1.71，95%CI 1.31-2.23，p<0.001）和 PA 直径（HR：1.61，95%CI 1.18-2.22，p=0.003）是主要终点的独立预测因子。
在 HFrEF 患者中，非门控 CT 测量的 RV 容积和 PA 直径是 PH 的非侵入性标志物，可帮助预测患者的预后。
胸部 CT 测量的右心室（RV）容积对射血分数降低的慢性心力衰竭（HF）患者的肺动脉高压（PH）有很好的识别能力。
肺动脉（PA）直径和 PA 与升主动脉直径比（PA:A 比）预测 PH 的准确性与既往研究相似，但截断值较低（分别为 28.1mm 和 0.92）。
胸部 CT 衍生的 PA 直径和 RV 容积独立预测全因死亡率和 HF 事件，并改善晚期 HFrEF 患者的预后预测。
