计算机断层血管造影术对肺动脉高压患者肺内核心和外周血管系统进行自动容积测量以无创评估血流动力学（2022年更新的血流动力学定义）
Automated volumetry of core and peel intrapulmonary vasculature on computed tomography angiography for non-invasive estimation of hemodynamics in patients with pulmonary hypertension (2022 updated hemodynamic definition).
作者信息
Melzig Claudius, Weinheimer Oliver, Egenlauf Benjamin, Do Thuy D, Wielpütz Mark O, Grünig Ekkehard, Kauczor Hans-Ulrich, Heussel Claus Peter, Rengier Fabian
机构信息
Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.
出版信息
Cardiovasc Diagn Ther. 2024 Dec 31;14(6):1083-1095. doi: 10.21037/cdt-24-293. Epub 2024 Dec 19.
BACKGROUND
Computed tomography pulmonary angiography (CTPA) is frequently performed in patients with pulmonary hypertension (PH) and may aid non-invasive estimation of pulmonary hemodynamics. We, therefore, investigated automated volumetry of intrapulmonary vasculature on CTPA, separated into core and peel fractions of the lung volume and its potential to differentially reflect pulmonary hemodynamics in patients with pre- and postcapillary PH.
METHODS
A retrospective case-control study of 72 consecutive patients with PH according to the 2022 joint guidelines of the European Society of Cardiology and the European Respiratory Society who underwent right heart catheterization (RHC) and CTPA within 7 days between August 2013 and February 2016 at Thoraxklinik at Heidelberg University Hospital (Heidelberg, Germany) was conducted. Vessel segmentation was performed using the in-house software YACTA. Vascular volumes in different core and peel fractions of the lung were corrected for body surface area. Spearman correlation coefficients with mean pulmonary arterial pressure (mPAP), pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were calculated, and a linear regression analysis was done to account for potential confounders.
RESULTS
Median age of the study sample was 71.5 years [interquartile range (IQR), 60.0-77.0 years], 48 (66.67%) were female. Median mPAP was 35.5 mmHg (IQR, 27.0-47.2 mmHg). Postcapillary PH was present in 24/72 (33.3%) patients and precapillary PH in 48/72 (66.7%) patients. Moderate to strong correlations between core intrapulmonary vessel volumes and mPAP were observed in postcapillary PH patients with a maximum at 50% core lung volume (r=0.71, P<0.001). No significant influence of age or sex on this relationship was identified. Correlation with RHC measurements was weak or negligible in patients with precapillary PH.
CONCLUSIONS
Automated volumetry of vessels in the core lung strongly correlated with mPAP in patients with postcapillary PH and has potential for non-invasive assessment of postcapillary PH in patients undergoing CTPA.
背景
计算机断层扫描肺动脉造影（CTPA）常用于肺动脉高压（PH）患者，有助于对肺血流动力学进行无创评估。因此，我们研究了CTPA上肺内血管的自动容积分析，将肺容积分为核心部分和外周部分，以及其在鉴别反映毛细血管后性PH和毛细血管前性PH患者肺血流动力学方面的潜力。
方法
根据欧洲心脏病学会和欧洲呼吸学会2022年联合指南，对2013年8月至2016年2月期间在德国海德堡大学医院胸科连续72例接受右心导管检查（RHC）和CTPA的PH患者进行回顾性病例对照研究。使用内部软件YACTA进行血管分割。将肺不同核心部分和外周部分的血管容积校正体表面积。计算与平均肺动脉压（mPAP）、肺动脉楔压（PAWP）和肺血管阻力（PVR）的Spearman相关系数，并进行线性回归分析以考虑潜在混杂因素。
结果
研究样本的中位年龄为71.5岁[四分位间距（IQR），60.0 - 77.0岁]，48例（66.67%）为女性。中位mPAP为35.5 mmHg（IQR，27.0 - 47.2 mmHg）。24/72例（33.3%）患者为毛细血管后性PH，48/72例（66.7%）患者为毛细血管前性PH。在毛细血管后性PH患者中，观察到核心肺内血管容积与mPAP之间存在中度至强相关性，在核心肺容积为50%时达到最大值（r = 0.71，P < 0.001）。未发现年龄或性别对这种关系有显著影响。在毛细血管前性PH患者中，与RHC测量值的相关性较弱或可忽略不计。
结论
核心肺内血管的自动容积分析与毛细血管后性PH患者的mPAP密切相关，对接受CTPA的患者进行毛细血管后性PH的无创评估具有潜力。
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