Author:
Swift Andrew J.,Dwivedi Krit,Johns Chris,Garg Pankaj,Chin Matthew,Currie Ben J,Rothman Alex MK,Capener Dave,Shahin Yousef,Elliot Charlie A,Charalampopolous Thanos,Sabroe Ian,Rajaram Smitha,Hill Catherine,Wild Jim M.,Condliffe Robin,Kiely David G.
Abstract
Abstract
Objectives
Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). However, the diagnostic and prognostic significance remains unclear. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance.
Methods
Consecutive patients with suspected PH undergoing routine CT pulmonary angiography and right heart catheterisation (RHC) were identified. Axial and reconstructed images were used to derive CT metrics. Multivariate regression analysis was performed in the derivation cohort to identify a diagnostic CT model to predict mPAP ≥ 25 mmHg (the existing ESC guideline definition of PH) and > 20 mmHg (the new threshold proposed at the 6th World Symposium on PH). In the validation cohort, sensitivity, specificity and compromise CT thresholds were identified with receiver operating characteristic (ROC) analysis. The prognostic value of the CT model was assessed using Kaplan-Meier analysis.
Results
Between 2012 and 2016, 491 patients were identified. In the derivation cohort (n = 247), a CT model was identified including pulmonary artery diameter, right ventricular outflow tract thickness, septal angle and left ventricular area. In the validation cohort (n = 244), the model was diagnostic, with an area under the ROC curve of 0.94/0.91 for mPAP ≥ 25/> 20 mmHg respectively. In the validation cohort, 93 patients died; mean follow-up was 42 months. The diagnostic thresholds for the CT model were prognostic, log rank, all p < 0.01.
Discussion
In suspected PH, a diagnostic CT model had diagnostic and prognostic utility.
Key Points
• Diagnostic CT models have high diagnostic accuracy in a tertiary referral population of with suspected PH.
• Diagnostic CT models stratify patients by mortality in suspected PH.
Funder
Wellcome Trust
National Institute of Health Reseach
Medical Research Council
Publisher
Springer Science and Business Media LLC
Subject
Radiology Nuclear Medicine and imaging,General Medicine
Cited by
27 articles.
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