Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure
To evaluate the ability of chest computed tomography (CT) to predict pulmonary hypertension (PH) and outcome in chronic heart failure with reduced ejection fraction (HFrEF).
We reviewed 119 consecutive patients with HFrEF by CT, transthoracic echocardiography (TTE) and right heart catheterization (RHC). CT-derived pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio), left atrial, right atrial, right ventricular (RV) and left ventricular volumes were correlated with RHC mean pulmonary arterial pressure (mPAP) . Diagnostic accuracy to predict PH and ability to predict primary composite endpoint of all-cause mortality and HF events were evaluated.
RV volume was significantly higher in 81 patients with PH compared to 38 patients without PH (133 ml/m2 vs. 79 ml/m2, p < 0.001) and was moderately correlated with mPAP (r=0.55, p < 0.001). Also, RV volume had higher ability to predict PH (area under the curve: 0.88) than PA diameter (0.79), PA:A ratio (0.76) by CT and tricuspid regurgitation gradient (0.83) and RV basal diameter by TTE (0.84, all p < 0.001). During the follow-up period (median: 3.4 years), 51 patients (43%) had HF events or died. After correction for important clinical, TTE and RHC parameters, RV volume (adjusted hazard ratio [HR]: 1.71, 95% CI 1.31–2.23, p < 0.001) and PA diameter (HR: 1.61, 95% CI 1.18–2.22, p = 0.003) were independent predictors of the primary endpoint.
In patients with HFrEF, measurement of RV volume and PA diameter on ungated CT are non-invasive markers of PH and may help to predict the patient outcome.
• Right ventricular (RV) volume measured by chest CT has good ability to identify pulmonary hypertension (PH) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).
• The accuracy of pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio) to predict PH was similar to previous studies, however, with lower cut-offs (28.1 mm and 0.92, respectively).
• Chest CT-derived PA diameter and RV volume independently predict all-cause mortality and HF events and improve outcome prediction in patients with advanced HFrEF.
KeywordsPulmonary hypertension Dilated cardiomyopathy Ischemic heart disease Pulmonary artery Prognosis
Area under the curve
Body surface area
Fractional area change
Heart failure with reduced injection fraction
Ischemic heart disease
Left ventricular or ventricle
Left ventricular ejection fraction
Nonischemic dilated cardiomyopathy
Mean pulmonary artery pressure
Pulmonary artery pressure
Pulmonary artery wedge pressure
Pulmonary hypertension due to left heart disease
Pulmonary vascular resistance
Receiving operating curve
Right heart catheterization
Right ventricular or right ventricle
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Anne-Catherine Pouleur, MD, PhD
Conflict of interest
Pr Pouleur is Clinical Master Specialist of the Fondation Nationale de la Recherche Scientifique of the Belgian Government, FRSM.
The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Christophe de Meester kindly provided statistical advice for this manuscript and has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 26.Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefGoogle Scholar
- 28.Hicks KA, Tcheng JE, Bozkurt B et al (2015) ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). J Am Coll Cardiol 66:403–469CrossRefGoogle Scholar