A single, comprehensive non-invasive cardiovascular assessment in pulmonary arterial hypertension: combined computed tomography pulmonary and coronary angiography.
BACKGROUND
Comprehensive assessment of pulmonary arterial hypertension (PAH) should identify structural causes and subsequent cardiopulmonary consequences of PAH. This currently requires the use of several imaging modalities. Computed tomography (CT) is routinely used for pulmonary angiography (CTPA). Our aim was to assess whether combined pulmonary and coronary angiography (CTPCA) using ECG-gated, multi-detector CT (MDCT) would allow satisfactory pulmonary angiography, coronary angiography and ventriculography to be combined into a single acquisition using a single imaging modality.


METHODS
We assessed CTPCA in 30 consecutive adult patients (mean age 41+/-11 years) with a diagnosis of PAH. In addition to the standard assessment of lung parenchyma and pulmonary vasculature, we assessed the ability of CT to satisfactorily visualise coronary vessels and biventricular function. Functional analysis included: end-diastolic volume (EDV), end-systolic volume (EDV), stroke volume (SV) and ejection fraction (EF) and mass and these parameters were correlated with same day cardiovascular magnetic resonance (CMR).


RESULTS
Lung parenchyma, pulmonary and coronary vessels were fully visualised in all cases. Ventriculography correlated well with same day CMR (RVEDV r=0.94, +19.5+/-49.2 ml, RVESV r=0.93, +11.1+/-46.4 ml, RVSV r=0.60, +8.5+/-41.6 ml, RVEF r=0.77, -0.5+/-21.3% and RV mass r=0.73, -17.3+/-60.4 g, LVEDV r=0.68, +12.2+/-110 ml, LVESV r=0.69, +7.5+/-59.7 ml, LVSV r=0.54, +2.5+/-40.6 ml, LVEF r=0.73, -1.9+/-20.8% and LV mass r=0.87, -20.5+/-22.5 g (all p<0.001)). Associated congenital cardiovascular malformations were characterised in 22/30 cases.


CONCLUSIONS
A CTPCA protocol allows safe, fast, comprehensive, non-invasive assessment of the possible anatomical causes and cardiopulmonary sequelae of PAH in adult patients, demonstrating congenital heart abnormalities, coronary artery disease and cardiac function.
Nicol
Edward D
ED
Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, UK.
Kafka
Henryk
H
Stirrup
James
J
Padley
Simon P G
SP
Rubens
Michael B
MB
Kilner
Philip J
PJ
Gatzoulis
Michael A
MA
D000328:Adult; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult