Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
J Heart Lung Transplant. 2024 Jan;43(1):54-65. doi: 10.1016/j.healun.2023.08.013. Epub 2023 Aug 22.
While computed tomography pulmonary angiography (CTPA) is an integral part of the work-up in patients with suspected pulmonary hypertension (PH), there is no established CTPA-derived prognostic marker. We aimed to assess whether quantitative readouts of lung vessel morphology correlate with established prognostic indicators in PH.
We applied a fully-automatic in-house developed algorithm for segmentation of arteries and veins to determine lung vessel morphology in patients with precapillary PH who underwent right heart catheterization and CTPA between May 2016 and May 2019. Primary endpoint of this retrospective study was the calculation of receiver operating characteristics for identifying low and high mortality risk according to the 3-strata risk assessment model presented in the current guidelines.
We analyzed 73 patients, median age 65 years (interquartile range (IQR): 54-76), female/male ratio 35/38, median mean pulmonary arterial pressure 37 mm Hg (IQR: 30-46), and found significant correlations with important prognostic factors in pulmonary arterial hypertension. N-terminal pro-brain natriuretic peptide, cardiac index, mixed venous oxygen saturation, and 6-minute walking distance were correlated with the ratio of the number of arteries over veins with vessel diameters of 6-10 mm (Spearman correlation coefficients ρ = 0.64, p < 0.001; ρ = -0.60, p < 0.001; ρ = -0.47, p = 0.005; ρ = -0.45, p = 0.001, respectively). This ratio predicted a low- and high-risk score with an area under the curve of 0.73 (95% confidence interval (CI): 0.56-0.90) and 0.86 (95% CI: 0.74-0.97), respectively.
The ratio of the number of arteries over veins with diameters between 6 and 10 mm is significantly correlated with prognostic markers in pulmonary hypertension and predicts low and high mortality risk.
虽然计算机断层肺动脉造影（CTPA）是疑似肺动脉高压（PH）患者检查的重要组成部分，但目前尚无确定的 CTPA 衍生预后标志物。我们旨在评估肺血管形态的定量读数是否与 PH 中的既定预后指标相关。
我们应用了一种完全自动化的内部开发的动脉和静脉分割算法，以确定 2016 年 5 月至 2019 年 5 月期间接受右心导管检查和 CTPA 的毛细血管前 PH 患者的肺血管形态。这项回顾性研究的主要终点是根据当前指南中提出的 3 层风险评估模型计算识别低危和高危死亡率的受试者工作特征。
我们分析了 73 例患者，中位年龄 65 岁（四分位距（IQR）：54-76），男女比例 35/38，平均肺动脉压 37mmHg（IQR：30-46），与肺动脉高压的重要预后因素存在显著相关性。N 末端脑钠肽前体、心指数、混合静脉血氧饱和度和 6 分钟步行距离与直径为 6-10mm 的动脉与静脉数量之比呈相关（Spearman 相关系数 ρ=0.64，p<0.001；ρ=-0.60，p<0.001；ρ=-0.47，p=0.005；ρ=-0.45，p=0.001）。该比值预测低危和高危评分的曲线下面积分别为 0.73（95%置信区间（CI）：0.56-0.90）和 0.86（95% CI：0.74-0.97）。
直径在 6 至 10mm 之间的动脉与静脉数量之比与肺动脉高压的预后标志物显著相关，并可预测低危和高危死亡率。
