Sang-Eun Lee1, Ji Hyun Im1, Ji Min Sung2, In-Jeong Cho1, Chi Young Shim1, Geu-Ru Hong1, Namsik Chung1, Jo Won Jung3, Hyuk-Jae Chang4. 1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei Univsersity College of Medicine, Yonsei University Health System, Seoul, South Korea. 2. Department of Research Affairs, Yonsei Univsersity College of Medicine, Yonsei University Health System, Seoul, South Korea. 3. Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei Univsersity College of Medicine, Yonsei University Health System, Seoul, South Korea. 4. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei Univsersity College of Medicine, Yonsei University Health System, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei Univsersity College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac.
Abstract
BACKGROUND: We explored the value of cardiac computed tomography (CT) for the detection and prediction of mechanical complications related to the risk of sudden cardiac death (SCD) in pulmonary arterial hypertension (PAH) patients. METHODS: PAH patients (n=60, mean age 47±15, 31.7% male) with pulmonary artery (PA) enlargement (≥40mm) by echocardiography were studied with cardiac CT. Complications explored were the presence of left main coronary artery (LM) compression, airway compression, PA dissection and PA thrombosis in relation to diameters of main PA (MPA) which were measured in (1) axial plane (MPAAx) and (2) LM oblique view (MPALMobq). RESULTS: Mechanical complications were found in 21 patients (35.0%): LM compression in 20 patients; airway compression in 3 patients; and PA thrombosis in 4 patients. Patients with complications had more dilated MPALMobq than patients without complication (59.4±13.0mm vs. 42.4±7.0mm, p<0.001). The area under the receiver operating characteristic curve for MPALMobq was 0.889 (95% confidence interval: 0.795 to 0.983, p<0.001) with the highest discriminating sensitivity and specificity being 90.5% and 69.2%, respectively at MPALMobq of 45mm. MPAAx failed to predict the presence of mechanical complications (p>0.05). CONCLUSION: MPALMobq≥45mm was significantly associated with the presence of mechanical complications of PAH. Evaluation with CT should be considered in PAH patients with dilated MPA.
BACKGROUND: We explored the value of cardiac computed tomography (CT) for the detection and prediction of mechanical complications related to the risk of sudden cardiac death (SCD) in pulmonary arterial hypertension (PAH) patients. METHODS: PAH patients (n=60, mean age 47±15, 31.7% male) with pulmonary artery (PA) enlargement (≥40mm) by echocardiography were studied with cardiac CT. Complications explored were the presence of left main coronary artery (LM) compression, airway compression, PA dissection and PA thrombosis in relation to diameters of main PA (MPA) which were measured in (1) axial plane (MPAAx) and (2) LM oblique view (MPALMobq). RESULTS: Mechanical complications were found in 21 patients (35.0%): LM compression in 20 patients; airway compression in 3 patients; and PA thrombosis in 4 patients. Patients with complications had more dilated MPALMobq than patients without complication (59.4±13.0mm vs. 42.4±7.0mm, p<0.001). The area under the receiver operating characteristic curve for MPALMobq was 0.889 (95% confidence interval: 0.795 to 0.983, p<0.001) with the highest discriminating sensitivity and specificity being 90.5% and 69.2%, respectively at MPALMobq of 45mm. MPAAx failed to predict the presence of mechanical complications (p>0.05). CONCLUSION:MPALMobq≥45mm was significantly associated with the presence of mechanical complications of PAH. Evaluation with CT should be considered in PAH patients with dilated MPA.
Authors: Ruxandra Badea; Dan M Dorobantu; Mansour T A Sharabiani; Lucian M Predescu; Ioan M Coman; Carmen Ginghina Journal: Clin Res Cardiol Date: 2022-03-15 Impact factor: 5.460