Increased pulmonary artery diameter on chest computed tomography can predict borderline pulmonary hypertension.
Increased pulmonary artery diameter on chest computed tomography can predict borderline pulmonary hypertension.
复制标题
胸部计算机断层扫描上肺动脉直径增加可以预测边缘性肺动脉高压。
DOI：
10.4103/2045-8932.113175
复制
发表时间：
2013-04
影响因子：
2.6
通讯作者：
Hamer OW
中科院分区：
文献类型：
--
作者：
Lange TJ;Dornia C;Stiefel J;Stroszczynski C;Arzt M;Pfeifer M;Hamer OW
肺动脉高压 (PH) 通常会导致肺动脉 (PA) 扩张，这可以通过胸部计算机断层扫描 (CT) 进行测量。虽然 PA 扩张的预测能力有助于区分 PH（平均 PA 压力 ≥25 mmHg）与正常值（平均 PA 压力 ≤ 20 mmHg），但临界 PH（平均 PA 压力 21-24 mmHg）的 CT 特征尚未描述。我们的目的是调查临界 PH 患者是否已经表现出 PA 扩张，并评估 PA 扩张对临界 PH 诊断的诊断准确性。 2003 年 4 月至 2008 年 9 月期间，连续进行右心导管检查时平均 PA 压力低于 25 mmHg、有胸部 CT 扫描的有症状患者被纳入回顾性研究。胸部 CT 的 PA 直径与血流动力学测量结果相关，并分析其预测临界 PH 的准确性。与 52 名无 PH 患者相比，26 名边缘 PH 患者的主 PA 直径显着更大（3.16 ± 0.53 vs. 2.78 ± 0.43 cm，P = 0.001）。 CT 上的主 PA 直径与平均 PA 压力（r = 0.496，P < 0.001）和肺血管阻力（r = 0.445，P < 0.001）相关，并且使用≥2.9 cm 的截止值预测临界 PH，敏感性、特异性、阴性和阳性预测值分别为 77%、62%、84% 和 50%。对平均 PA 压力低于 25 mmHg 的有症状患者的 CT 参数的首次系统研究表明，即使在临界 PH 患者中，也可能存在显着的 PA 扩张，这与 PA 压力和肺血管阻力有关。这有助于识别临界 PH 患者以进行进一步研究，并促进对可能的基础疾病进行进一步的诊断检查。
Pulmonary hypertension (PH) often leads to dilatation of the pulmonary artery (PA), which can be measured on chest computed tomography (CT). While the predictive capability of PA dilatation is useful to distinguish PH (mean PA pressure ≥25 mmHg) from normal (mean PA pressure ≤ 20 mmHg), CT characteristics of borderline PH (mean PA pressure 21-24 mmHg) have not been described. We aimed to investigate whether patients with borderline PH already show PA dilatation and to assess the diagnostic accuracy of PA dilatation for borderline PH diagnosis. Between April 2003 and September 2008, consecutive symptomatic patients with a mean PA pressure below 25 mmHg on right heart catheterization who had a chest CT available were retrospectively included. PA diameters from chest CT were correlated with hemodynamic measurements and analyzed with respect to their accuracy of predicting borderline PH. Main PA diameters were significantly larger in 26 patients with borderline PH compared with 52 patients without PH (3.16 ± 0.53 vs. 2.78 ± 0.43 cm, P = 0.001). The main PA diameter on CT correlated with mean PA pressure (r = 0.496, P < 0.001) and pulmonary vascular resistance (r = 0.445, P < 0.001), and predicted borderline PH with sensitivity, specificity, negative and positive predictive values of 77%, 62%, 84%, and 50%, respectively, using a cutoff ≥2.9 cm. This first systematic investigation of CT parameters in symptomatic patients with mean PA pressures less than 25 mmHg could show that, even in patients with borderline PH, significant PA dilatation can be present, which was related to PA pressure and pulmonary vascular resistance. This can be useful for identification of patients with borderline PH for further study and to prompt further diagnostic work-up of possible underlying diseases.
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