Simon Bax1, Joseph Jacob2, Riaz Ahmed3, Charlene Bredy4, Konstantinos Dimopoulos5, Aleksander Kempny6, Maria Kokosi7, Gregory Kier8, Elisabetta Renzoni7, Philip L Molyneaux9, Felix Chua7, Vasilis Kouranos7, Peter George10, Colm McCabe6, Michael Wilde3, Anand Devaraj11, Athol Wells7, S John Wort5, Laura C Price6. 1. National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust, London, England; Surrey and Sussex Hospital, Redhill, Surrey, England; National Heart and Lung Institute, Imperial College, London, England. Electronic address: s.bax@nhs.net. 2. Department of Respiratory Medicine, University College London, London, England; Centre for Medical Image Computing, University College London, London, England. 3. Surrey and Sussex Hospital, Redhill, Surrey, England. 4. National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust, London, England; CHU Arnaud de Villeneuve, Montpellier, France. 5. National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust, London, England; National Heart and Lung Institute, Imperial College, London, England. 6. National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust, London, England. 7. Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust, London, England. 8. Princess Alexandra Hospital, Department of Respiratory Medicine, Woolloongabba, Australia. 9. Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust, London, England; Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, England. 10. Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust, London, England; National Heart and Lung Institute, Imperial College, London, England. 11. Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England.
Abstract
BACKGROUND: Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism. METHODS: Demographic characteristics, ILD subtype, echocardiography, and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterization at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored according to CT criteria. The RV:LV ratio at CTPA was evaluated by using three different methods. Cox proportional hazards analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS: A total of 92 patients were included (64% male; mean age 65 ± 11 years) with an FVC 57 ± 20% predicted, corrected transfer factor of the lung for carbon monoxide 22 ± 8% predicted, and corrected transfer coefficient of the lung for carbon monoxide 51 ± 17% predicted. PH was confirmed at right heart catheterization in 78%. Of all the CTPA-derived measures, an RV:LV ratio ≥ 1.0 strongly predicted mortality or transplantation at univariate analysis (hazard ratio, 3.26; 95% CI, 1.49-7.13; P = .003), whereas invasive hemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (hazard ratio, 3.19; 95% CI, 1.44-7.10; P = .004), adjusting for an ILD diagnosis of idiopathic pulmonary fibrosis and CT imaging-derived ILD severity. CONCLUSIONS: An increased RV:LV ratio measured at CTPA provides a simple, noninvasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow-up, more aggressive treatment, and consideration of lung transplantation.
BACKGROUND:Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism. METHODS: Demographic characteristics, ILD subtype, echocardiography, and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterization at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored according to CT criteria. The RV:LV ratio at CTPA was evaluated by using three different methods. Cox proportional hazards analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS: A total of 92 patients were included (64% male; mean age 65 ± 11 years) with an FVC 57 ± 20% predicted, corrected transfer factor of the lung for carbon monoxide 22 ± 8% predicted, and corrected transfer coefficient of the lung for carbon monoxide 51 ± 17% predicted. PH was confirmed at right heart catheterization in 78%. Of all the CTPA-derived measures, an RV:LV ratio ≥ 1.0 strongly predicted mortality or transplantation at univariate analysis (hazard ratio, 3.26; 95% CI, 1.49-7.13; P = .003), whereas invasive hemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (hazard ratio, 3.19; 95% CI, 1.44-7.10; P = .004), adjusting for an ILD diagnosis of idiopathic pulmonary fibrosis and CT imaging-derived ILD severity. CONCLUSIONS: An increased RV:LV ratio measured at CTPA provides a simple, noninvasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow-up, more aggressive treatment, and consideration of lung transplantation.
Authors: R McStay; A Johnstone; S S Hare; J Jacob; A Nair; J C L Rodrigues; A Edey; G Robinson Journal: Clin Radiol Date: 2020-10-08 Impact factor: 2.350
Authors: Michael J Sharkey; Jonathan C Taylor; Samer Alabed; Krit Dwivedi; Kavitasagary Karunasaagarar; Christopher S Johns; Smitha Rajaram; Pankaj Garg; Dheyaa Alkhanfar; Peter Metherall; Declan P O'Regan; Rob J van der Geest; Robin Condliffe; David G Kiely; Michail Mamalakis; Andrew J Swift Journal: Front Cardiovasc Med Date: 2022-09-26