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COMPUTED TOMOGRAPHIC PULMONARY ARTERY DIAMETERS IN PREDICTING MODERATE OR SEVERE PULMONARY HYPERTENSION IN PATIENTS WITH ACUTE PULMONARY EMBOLISM FREE TO VIEW

Shirin Sanal, MD*; Wilbert S. Aronow, MD; Gautham Ravipati, MD; George P. Maguire, MD; Robert N. Belkin, MD; Stuart G. Lehrman, MD
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New York Medical College, Valhalla, NY


Chest


Chest. 2005;128(4_MeetingAbstracts):198S. doi:10.1378/chest.128.4_MeetingAbstracts.198S
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Abstract

PURPOSE:  To determine the accuracy of computer tomographic (CT) measurements of main pulmonary artery diameter (MPAD) and MPAD/ascending aorta diameter (AAD) in predicting moderate or severe pulmonary hypertension (PHT) in acute pulmonary embolism (PE).

METHODS:  Ninety-eight women and 92 men, mean age 59±15 years, had acute PE diagnosed by contrast-enhanced CT. A pulmonary artery systolic pressure of ≥50 mm Hg measured by Doppler echocardiography was considered moderate or severe PHT. MPAD of >28.6 mm and MPAD/AAD ratio of ≥1.00 measured by CT were considered abnormal. All measurements of MPAD and of MPAD/AAD were made blindly without knowledge whether PHT was present.

RESULTS:  Moderate or severe PHT occurred in 51 of 190 patients (27%). MPAD of >28.6 mm occurred in 38 of 51 patients (75%) with and in 35 of 139 patients (25%) without moderate or severe PHT (p<0.001). MPAD/AAD ratio of ≥1.00 occurred in 30 of 51 patients (59%) with and in 25 of 139 patients (18%) without moderate or severe PHT (p<0.001). MPAD >28.6 mm had a 75% sensitivity and specificity, a 52% positive predictive value, a 89% negative predictive value, a 3.0 likelihood ratio of a positive test, and a 0.33 likelihood ratio of a negative test. MPAD/AAD ratio of ≥1.00 had a 59% sensitivity, a 82% specificity, a 55% positive predictive value, a 84% negative predictive value, a 3.3 likelihood ratio of a positive test, and a 0.50 likelihood ratio of a negative test.

CONCLUSION:  A MPAD of >28.6 mm had a higher sensitivity, a lower specificity, a similar positive predictive value, a higher negative predictive value, a slightly lower likelihood ratio of a positive test, and a higher likelihood ratio of a negative test than a MPAD/AAD ratio of ≥1.00 in predicting moderate or severe PHT in acute PE.

CLINICAL IMPLICATIONS:  Doppler echocardiography remains the procedure of choice in diagnosing PHT in patients with acute PE.

DISCLOSURE:  Shirin Sanal, None.

2:30 PM - 4:00 PM


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