title: CT pulmonary angiography combined with echocardiography in suspected systemic sclerosis-associated pulmonary arterial hypertension.
abstract: OBJECTIVE
  Echocardiography is widely used in the investigation of patients with suspected SSc-associated pulmonary arterial hypertension (SSc-PAH). We investigated whether CT pulmonary angiography (CTPA) provides additive diagnostic value.
  
  
  METHODS
  Data for 89 consecutive patients with suspected SSc-PAH undergoing echocardiography, CTPA and right heart catheterization were reviewed. Pulmonary artery diameter (dPA) and ascending aorta diameter (dAA), right and left ventricular diameter (dRV and dLV) and grade of tricuspid regurgitation (TR(CT)) measured at CTPA and tricuspid gradient (TG(ECHO)) at echocardiography were retrieved. A predictive equation for mean pulmonary arterial pressure (mPAP) was derived using multivariate linear regression. Multivariate Cox regression analysis was then used to assess the prognostic strength of CTPA parameters and TG(ECHO).
  
  
  RESULTS
  Absolute measures of dPA and dRV correlated weakly with mPAP. However, dPA : dAA and dRV : dLV showed stronger correlations with mPAP (dPA : dAA r = 0.42, P < 0.001; dRV : dLV r = 0.51, P < 0.001). dRV : dLV correlated more strongly with pulmonary vascular resistance than did dPA : dAA (r = 0.63 vs 0.39, P both <0.001). dPA : dAA and TG(ECHO) were independent predictors of mPAP. A derived CT/echo composite index had a higher predictive accuracy (area under the curve = 0.95) than dPA : dAA or TG(ECHO) although negative predictive value (NPV) was only 77%. Combining the CT/echo composite index with presence or absence of TR(CT) increased NPV to 100% although this observation requires further validation. dRV : dLV was the strongest prognostic factor.
  
  
  CONCLUSIONS
  In suspected SSc-PAH, cardiac chamber and great vessel measurements at CTPA correlate with pulmonary haemodynamics and predict survival. In combination with echocardiography CTPA increases diagnostic accuracy and may identify other potential causes of breathlessness.
authors: Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK. robin.condliffe@sth.nhs.uk
authors: Robin
authors: R
authors: Condliffe
authors: Mark
authors: M
authors: Radon
authors: Judith
authors: J
authors: Hurdman
authors: Christine
authors: C
authors: Davies
authors: Catherine
authors: C
authors: Hill
authors: Mohammed
authors: M
authors: Akil
authors: Franco
authors: F
authors: Guarasci
authors: Smitha
authors: S
authors: Rajaram
authors: Andrew J
authors: AJ
authors: Swift
authors: Zena
authors: Z
authors: Wragg
authors: Edwin
authors: E
authors: van Beek
authors: Charlie A
authors: CA
authors: Elliot
authors: David G
authors: DG
authors: Kiely
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods*