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Diagnostic Accuracy of Echocardiography Combined With Chest CT in the Diagnosis of Pulmonary Hypertension FREE TO VIEW

Adil Shujaat, MD; Abubakr Bajwa, MD; Jason Bellardini, MD; Faisal Usman, MD; Lisa Jones, MD; James Cury, MD
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University of Florida at Jacksonville, Jacksonville, FL

Chest. 2013;144(4_MeetingAbstracts):860A. doi:10.1378/chest.1704792
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Transthoracic echocardiography (TTE) and computerized axial tomography (CT) are complementary imaging techniques. It is possible that a combination of the two imaging techniques may offer a better way of screening for pulmonary hypertension (PH) than either test alone.

METHODS: We performed a retrospective review of consecutive patients who underwent TTE, CT and right heart catheterization (RHC) between 7/1/2008 and 6/30/2012. PH was defined as systolic pulmonary artery pressure (PAP) > 40 mm Hg on TTE, ratio of diameter of pulmonary artery to ascending aorta (rPA) >1 on CT and mean PAP > 25 mm Hg on RHC. We identified 113 patients. We excluded 26 patients in whom either the tricuspid regurgitant jet was not visible on TTE or motion artifact precluded us from making measurements on CT.

RESULTS: The mean (SD) age of the 87 patients was 54.3 (15.9) years and 69 (79%) were female. The prevalence of PH was 75%. The various causes of PH were: Idiopathic (n = 8), connective tissue disease (n = 10), portal hypertension (n = 3), HIV (n = 6), congenital heart disease (n = 2), left heart disease (n = 7), obstructive sleep apnea (n = 3), COPD (n = 2), interstitial lung disease (n = 6), pulmonary embolism (n = 1), sarcoidosis (n = 1), and multiple causes (n = 16). Fifty per cent of the CT scans were done with intravenous contrast. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TTE alone and chest CT alone were: 95.3%, 21.7%, 77.2%, 62.5%, and 75%, 69.6%, 87.3%, 50%, respectively. The sensitivity, specificity, PPV and NPV of TTE combined with chest CT was: 100%, 14.3%, 78.6% and 100%, respectively.

CONCLUSIONS: The combination of TTE and chest CT can accurately rule out pulmonary hypertension.

CLINICAL IMPLICATIONS: The comibination of TTE and chest CT offers a better way of screening for PH than either test alone.

DISCLOSURE: The following authors have nothing to disclose: Adil Shujaat, Abubakr Bajwa, Jason Bellardini, Faisal Usman, Lisa Jones, James Cury

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