Imaging |

Use of Chest Computed Tomography Angiogram as a Predictor of Diastolic Dysfunction and Pulmonary Hypertension FREE TO VIEW

Adam Lick; Raman Danrad; David Smith; Dana Aiello; Matthew Lammi
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Louisiana State University Health Sciences Center, New Orleans, LA

Chest. 2014;146(4_MeetingAbstracts):578A. doi:10.1378/chest.1983430
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SESSION TITLE: Ultrasound and Other Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Diastolic dysfunction (DD), an increasing problem, may result in heart failure with preserved ejection fraction, as well as an associated complication of pulmonary hypertension. A common method for earlier detection of these underdiagnosed disorders could be beneficial for patient outcome. We hypothesize that (1) there will be a correlation between left atrial (LA) size on chest computed tomography angiography (CTA) and echocardiography (Echo), (2) CTA LA size will be larger in those with DD, and (3) main pulmonary artery/Aorta (PA/Aorta) ratio will be larger in those with elevated PA pressures.

METHODS: We conducted a retrospective, cross sectional analysis using 127 hospitalized patients who underwent both CTA and Echo within 48 hours of each other. LA size was determined on CTA using the maximum anterior-posterior diameter of the midline in its middle 50%. PA sizes were measured using the widest diameter perpendicular to the long axis at the level of PA bifurcation. Ascending aorta diameter was measured at the same level, and used to calculate the PA/Aorta ratio as standardization. We statistically analyzed LA sizes, LA vs E/E’, LA size in normal diastolic function vs. mild, moderate or severe DD, and PA/Aorta in patients with normal vs. elevated estimated Echo PA pressure.

RESULTS: There was a strong correlation between LA sizes on CTA and Echo (r=0.7753 r2=0.6011 p<0.0001 n=127). A moderate correlation existed between CTA LA size and Echo E/E’ (r=0.4456 r2=0.1986 p<0.0001 n=76). The PA/Aorta measured on CTA in patients with elevated estimated PA pressures (>35 mmHg n=38) was 0.98±0.16, and was significantly different compared to patients with normal PA pressures (≤35 mmHg n=49), 0.89±0.12 (p=0.0028). ANOVA and post-hoc Tukey’s revealed a significant difference in CTA LA size between patients with normal diastolic function on Echo, 3.57±0.81 cm (n=65), vs. moderate DD, 4.25±0.66 cm (n=27), or severe DD, 4.56±0.43 cm (n=10) (p<0.0001), but not mild DD (4.12±0.62cm, p>0.05, n=10).

CONCLUSIONS: There is a strong correlation between LA sizes obtained on CTA and Echo. A moderate correlation exists between CTA LA size and Echo E/E’. CTA LA size can function as an indicator of moderate and severe DD. CTA serves as a reliable predictor of elevated PA pressures based on determinations of PA/Aorta ratio.

CLINICAL IMPLICATIONS: For patients admitted to the emergency department with chest pain and/or dyspnea, enlarged CTA LA size and PA/Aorta ratio may suggest the presence of DD or pulmonary hypertension, respectively.

DISCLOSURE: The following authors have nothing to disclose: Adam Lick, Raman Danrad, David Smith, Dana Aiello, Matthew Lammi

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