Novel Computed Tomography Angiography Parameter Is Associated with Low Cardiac Index in Patients with Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Analysis.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-09-07 DOI:10.3390/jcdd11090281

Estefania Oliveros, Michel Ibrahim, Carlos Manuel Romero, Paul Navo, Patricia Otero Valdes, Yevgeniy Brailovsky, Amir Darki, Riyaz Bashir, Anjali Vaidya, Paul Forfia, Chandra Dass

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引用次数: 0

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of incomplete resolution of acute pulmonary embolism. We hypothesize changes in CT Hounsfield Unit gradient (HU-Δ) created by the dispersion of IV contrast through the downstream blood pool correlate with cardiac index (CI). We sought to compare HU-Δ with invasively obtained CI.

Methods: We completed a retrospective analysis of CTEPH patients in which individuals with low CI (<2.2-L/min/m²) were identified. Both absolute and fractional HU-Δ were derived from pulmonary CTA by subtracting the HU value of the left atrium (LA) and left ventricle (LV) from the main pulmonary artery (MPA) (absolute) and expressing them as a percentage of MPA-HU (fractional) on static axial images. These were compared between low and normal CI.

Results: Of the 237 patients, 50.2% were female, 53.2% were White, 36.7% were Black. Hemodynamics were mean pulmonary artery (PA) pressure = 45.4 ± 11.2-mmHg, pulmonary vascular resistance = 9.2 ± 4.4-WU, CI = 2.05 ± 0.48-L/min/m². There was a higher mean MPA-HU = 391.1 ± 113.6 than LA-HU = 251.6 ± 81. In patients with low CI, the HU-Δ was higher, HU-ΔMPA-LA was 148.9 ± 78.4 vs. 124.5 ± 77.2 (p = 0.02), and HU-ΔMPA-LV was 170.7 ± 87 vs. 140 ± 82 (p = 0.009). A HU-ΔMPA-LA = 118 had a sensitivity of 75.6% and specificity of 77% to detect low CI, AUC 0.61, p = 0.003. A HU-ΔPA-LV = 156 had a sensitivity of 77% and specificity of 53% to detect low CI, AUC = 0.62, p = 0.001. A fractional reduction HU-ΔMPA-LA of 35% had a sensitivity and specificity of 79% and 53%, respectively, to detect low CI (AUC 0.65, p < 0.001). A fractional reduction of the HU-ΔMPA-LV of 40% had a sensitivity and specificity of 80% and 55%, respectively, to detect low CI (AUC 0.65, p < 0.001). HU Δ were highly reproducible (Kappa = 0.9, p < 0.001, 95% CI 0.86-0.95).

Conclusions: High HU Δ between MPA-LA and MPA-LV were associated with low CI in patients with CTEPH.

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新型计算机断层扫描血管造影参数与慢性血栓栓塞性肺动脉高压患者的低心脏指数有关：回顾性分析

慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞未完全缓解的一种并发症。我们假设，静脉造影剂在下游血池中的弥散造成的 CT Hounsfield 单位梯度（HU-Δ）变化与心脏指数（CI）相关。我们试图将 HU-Δ 与有创获得的 CI 进行比较：我们完成了一项 CTEPH 患者的回顾性分析，其中发现了低 CI（2 例）患者。在静态轴向图像上，通过从主肺动脉（MPA）减去左心房（LA）和左心室（LV）的 HU 值（绝对值）并将其表示为 MPA-HU 的百分比（分数值），从肺 CTA 中得出绝对值和分数值 HU-Δ。这些结果在低 CI 和正常 CI 之间进行了比较：在 237 名患者中，50.2% 为女性，53.2% 为白人，36.7% 为黑人。血液动力学数据为平均肺动脉（PA）压 = 45.4 ± 11.2-mmHg，肺血管阻力 = 9.2 ± 4.4-WU，CI = 2.05 ± 0.48-L/min/m2。平均 MPA-HU = 391.1 ± 113.6 高于 LA-HU = 251.6 ± 81。低 CI 患者的 HU-Δ 更高，HU-ΔMPA-LA 为 148.9 ± 78.4 对 124.5 ± 77.2（P = 0.02），HU-ΔMPA-LV 为 170.7 ± 87 对 140 ± 82（P = 0.009）。HU-ΔMPA-LA = 118 检测低 CI 的灵敏度为 75.6%，特异度为 77%，AUC 为 0.61，p = 0.003。HU-ΔMPA-LV = 156 对检测低 CI 的灵敏度为 77%，特异性为 53%，AUC = 0.62，p = 0.001。HU-ΔMPA-LA 分数降低 35% 对检测低 CI 的灵敏度和特异性分别为 79% 和 53%（AUC 0.65，p < 0.001）。HU-ΔMPA-LV 分数降低 40% 对检测低 CI 的灵敏度和特异性分别为 80% 和 55%（AUC 0.65，p < 0.001）。HU Δ的可重复性很高（Kappa = 0.9，p < 0.001，95% CI 0.86-0.95）：结论：MPA-LA和MPA-LV之间的高HUΔ与CTEPH患者的低CI有关。

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464