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Original Research |

Identification of Pulmonary Hypertension Caused by Left Heart Disease (World Health Organization Group 2) Based on Cardiac Chamber Volumes Derived from Chest CT

Galit Aviram, MD; Zach Rozenbaum, MD; Tomer Ziv-Baran, PhD; Shlomo Berliner, MD, PhD; Yan Topilsky, MD; Dominik Fleischmann, MD; Yon K. Sung, MD; Roham T. Zamanian, MD; Haiwei Henry Guo, MD, PhD
Author and Funding Information

Funding: none.

Conflict of interest: Dr. Galit Aviram's institution received a research grant from Philips Medical Systems. Dr. Zamanian is a consultant to Selten, Bayer and Actelion and has stock option rights with Selten Pharmaceutical. He has served as principal investigator for research trials funded by Actelion and United Therapeutics. The other authors declare having no conflict of interests.

1Department of Radiology

2Department of Internal Medicine "D" and "E", Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

4Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

3Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

5Department of Radiology

6Department of Pulmonary and Critical Care Medicine

7Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford Health Care, Stanford University School of Medicine Stanford, CA, USA

Address for correspondence: Galit Aviram, MD, Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.184
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Abstract

Background  Evaluations of patients with pulmonary hypertension (PH) commonly include chest computed tomography (CT). We hypothesized that cardiac chamber volumes calculated from the same CT scans can yield additional information to distinguish left heart disease-related PH (WHO Group 2) from other PH subtypes.

Methods  Patients with right heart catheterization (RHC)-confirmed PH and contrast-enhanced chest CT studies were enrolled in this retrospective multicenter study. Cardiac chamber volumes were calculated using automated segmentation software and compared between Group 2 and non-Group 2 PH patients.

Results  This study included 114 PH patients, of whom 27 (24%) were classified as Group 2 based on their pulmonary capillary wedge pressure. Group 2 PH patients exhibited significantly larger median left atrial (LA) volumes (118 vs. 63 mL, P < 0.001), larger median left ventricular (LV) volumes (90 vs. 76 mL, P = 0.02), and smaller median right ventricular (RV) volumes (173 vs. 210 mL, P = 0.005) than non-Group 2 patients. On multivariate analysis adjusted to age, gender, and mean pulmonary arterial pressure, Group 2 PH was significantly associated with larger median LA and LV volumes (P < 0.001 and P = 0.008, respectively), and decreased volume ratios of RA/LA, RV/LV and RV/LA (P = 0.001, P = 0.004, and P < 0.001, respectively). Enlarged LA volumes demonstrated high discriminatory ability for Group 2 PH (AUC=0.92; 95%CI, 0.870-0.968).

Conclusions  Volumetric analysis of the cardiac chambers from non-gated chest CTs, particularly with findings of an enlarged LA, exhibited high discriminatory ability for identifying patients with PH due to left heart disease.


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