Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility

Abstract

Objectives

To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography.

Methods

One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated. In ungated CT, dPA, dPA/AA, the ratio of dPA to the diameter of the vertebra, segmental PA diameter, segmental PA-to-bronchus ratio, and the main PA volume were measured; the egg-and-banana sign was recorded. During echocardiography, the tricuspid regurgitation (TR) gradient was measured. The areas under the ROC curves (AUC) of these signs were computed and compared with DeLong test. Correlation between PA distensibility and PA pressure (PAP) was investigated through Pearson’s coefficient.

Results

PA distensibility was lower in patients with PH than in those without PH (11.4 vs. 21.2%, p < 0.001) and correlated negatively with mean PAP (r = − 0.72, p < 0.001). Age, PA size, and mean PAP were independent predictors of PA distensibility. PA distensibility < 18% detected PH-LHD with 96% sensitivity and 73% specificity; its AUC was 0.92, larger than that of any other sign at ungated CT and TR gradient (AUC ranging from 0.54 to 0.83, DeLong: p ranging from 0.020 to < 0.001).

Conclusion

PA distensibility on an ECG-gated CT can detect PH-LHD better than the parameters reflecting PA dilatation in ungated CT or TR gradient in the echocardiography of patients with severe HFrEF, aortic stenosis, or mitral regurgitation.

Key Points

• In left heart disease, pulmonary artery distensibility is lower in patients with PH than in those without pulmonary hypertension (11.4 vs. 21.2%, p < 0.001).

• In left heart disease, pulmonary artery distensibility detects pulmonary hypertension with an area under the receiver operating curve of 0.92.

• In left heart disease, the area under the receiver operating curve of pulmonary artery distensibility for detecting pulmonary hypertension is larger than that of all other signs at ungated CT (p from 0.019 to < 0.001) and tricuspid regurgitation gradient at echocardiography (p = 0.020).

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

ABR:

Pulmonary artery to bronchus ratio

AUC:

Area under the receiver operating characteristic curve

dPA:

Diameter of the main pulmonary artery

dPA/AA:

Diameter of the main pulmonary artery to the diameter of the ascending aorta ratio

dPA/V:

Diameter of the main pulmonary artery to the diameter of the vertebral body ratio

HFrEF:

Heart failure with reduced injection fraction

PA:

Pulmonary artery

PAP:

Pulmonary artery pressure

PAWP:

Pulmonary artery wedge pressure

PH:

Pulmonary hypertension

PH-LDH:

Pulmonary hypertension due to left heart disease

TR:

Tricuspid regurgitation

References

  1. 1.

    Galie N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119

    Article  Google Scholar 

  2. 2.

    Vachiery JL, Adir Y, Barbera JA et al (2013) Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol 62(25 Suppl):D100–D108

    Article  Google Scholar 

  3. 3.

    Ghio S, Gavazzi A, Campana C et al (2001) Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 37(1):183–188

    CAS  Article  Google Scholar 

  4. 4.

    Rosenkranz S, Gibbs JS, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiery JL (2016) Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37(12):942–954

    Article  Google Scholar 

  5. 5.

    Janda S, Shahidi N, Gin K, Swiston J (2011) Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis. Heart 97(8):612–622

    Article  Google Scholar 

  6. 6.

    Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH (1984) CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 19(1):16–22

    CAS  Article  Google Scholar 

  7. 7.

    Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW (1998) Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Chest 113(5):1250–1256

    CAS  Article  Google Scholar 

  8. 8.

    Ng CS, Wells AU, Padley SP (1999) CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 14(4):270–278

    CAS  Article  Google Scholar 

  9. 9.

    Chan AL, Juarez MM, Shelton DK, MacDonald T, Li CS, Lin TC, Albertson TE (2011) Novel computed tomographic chest metrics to detect pulmonary hypertension. BMC Med Imaging 11:7

    Article  Google Scholar 

  10. 10.

    Davarpanah AH, Hodnett PA, Farrelly CT et al (2011) MDCT bolus tracking data as an adjunct for predicting the diagnosis of pulmonary hypertension and concomitant right-heart failure. AJR Am J Roentgenol 197(5):1064–1072

    Article  Google Scholar 

  11. 11.

    Truong QA, Massaro JM, Rogers IS et al (2012) Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham Heart Study. Circ Cardiovasc Imaging 5(1):147–154

    Article  Google Scholar 

  12. 12.

    Eberhard M, Mastalerz M, Pavicevic J et al (2017) Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 33(10):1637–1651

    Article  Google Scholar 

  13. 13.

    Colin GC, Gerber BL, de Meester de Ravenstein C et al (2018) Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure. Eur Radiol 28(11):4643–4653

    Article  Google Scholar 

  14. 14.

    O’Sullivan CJ, Montalbetti M, Zbinden R et al (2018) Screening for pulmonary hypertension with multidetector computed tomography among patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Front Cardiovasc Med 5:63

    Article  Google Scholar 

  15. 15.

    Scelsi CL, Bates WB, Melenevsky YV, Sharma GK, Thomson NB, Keshavamurthy JH (2018) Egg-and-banana sign: a novel diagnostic CT marker for pulmonary hypertension. AJR Am J Roentgenol 210(6):1235–1239

    Article  Google Scholar 

  16. 16.

    Li M, Wang S, Lin W et al (2018) Cardiovascular parameters of chest CT scan in estimating pulmonary arterial pressure in patients with pulmonary hypertension. Clin Respir J 12(2):572–579

    Article  Google Scholar 

  17. 17.

    Devaraj A, Wells AU, Meister MG, Corte TJ, Wort SJ, Hansell DM (2010) Detection of pulmonary hypertension with multidetector CT and echocardiography alone and in combination. Radiology 254(2):609–616

    Article  Google Scholar 

  18. 18.

    Spruijt OA, Bogaard HJ, Heijmans MW et al (2015) Predicting pulmonary hypertension with standard computed tomography pulmonary angiography. Int J Cardiovasc Imaging 31(4):871–879

    Article  Google Scholar 

  19. 19.

    Rengier F, Wörz S, Melzig C et al (2016) Automated 3D volumetry of the pulmonary arteries based on magnetic resonance angiography has potential for predicting pulmonary hypertension. PLoS One 11(9):e016251

    Article  Google Scholar 

  20. 20.

    Melzig C, Wörz S, Egenlauf E et al (2019) Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 29(11):6059–6068

    Article  Google Scholar 

  21. 21.

    Revel MP, Faivre JB, Remy-Jardin M, Delannoy-Deken V, Duhamel A, Remy J (2009) Pulmonary hypertension: ECG-gated 64-section CT angiographic evaluation of new functional parameters as diagnostic criteria. Radiology 250(2):558–566

  22. 22.

    Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 27:2129–2200

    Article  Google Scholar 

  23. 23.

    Stamm G (2012) Collective radiation dose from MDCT: critical review of surveys studies. In: Tack D, Kalra MK, Gevenois PA (eds) Radiation dose from multidetector CT, 2nd edn. Springer-Verlag, Heidelberg, pp 209–229

    Google Scholar 

  24. 24.

    Tji-Joong Gan C, Lankhaar JW, Westerhof N et al (2007) Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest 132(6):1906–1912

    Article  Google Scholar 

  25. 25.

    Sanz J, Kariisa M, Dellegrottaglie S et al (2009) Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging 2(3):286–295

  26. 26.

    Sanz J, Kuschnir P, Rius T et al (2007) Pulmonary arterial hypertension: noninvasive detection with phase-contrast MR imaging. Radiology 243(1):70–79

    Article  Google Scholar 

  27. 27.

    Kasai H, Sugiura T, Tanabe N et al (2014) Electrocardiogram-gated 320-slice multidetector computed tomography for the measurement of pulmonary arterial distensibility in chronic thromboembolic pulmonary hypertension. PLoS One 9(11):e111563

    Article  Google Scholar 

  28. 28.

    Abel E, Jankowski A, Pison C, Luc Bosson J, Bouvaist H, Ferretti GR (2012) Pulmonary artery and right ventricle assessment in pulmonary hypertension: correlation between functional parameters of ECG-gated CT and right-side heart catheterization. Acta Radiol 53(7):720–727

    Article  Google Scholar 

  29. 29.

    Jardim C, Rochitte CE, Humbert M et al (2007) Pulmonary artery distensibility in pulmonary arterial hypertension: an MRI pilot study. Eur Respir J 29:476–481

    CAS  Article  Google Scholar 

  30. 30.

    Porter TR, Taylor DO, Fields J et al (1993) Direct in vivo evaluation of pulmonary arterial pathology in chronic congestive heart failure with catheter-based intravascular ultrasound imaging. Am J Cardiol 71:754–757

    CAS  Article  Google Scholar 

  31. 31.

    Andersen OS, Smiseth OA, Dokainish H et al (2017) Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol 69(15):1937–1948

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Geoffrey C. Colin.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Geoffrey C Colin.

Conflict of interest

The 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

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Colin, G.C., Verlynde, G., Pouleur, A. et al. Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06959-7

Download citation

Keywords

  • Pulmonary hypertension
  • Computed tomography
  • Echocardiography
  • Heart failure