title: ECG-gated computed tomography to assess pulmonary capillary wedge pressure in pulmonary hypertension.
abstract: OBJECTIVE
  We propose a non-invasive method for diagnosing post-capillary pulmonary hypertension (PH group 2). We evaluated pulmonary capillary wedge pressure (PCWP) by studying the left atrium (LA) on thoracic ECG-gated CT compared with right heart catheterisation (RHC).
  
  
  METHODS
  We retrospectively studied 54 patients with suspected PH or followed for PH who underwent thoracic ECG-gated CT and RHC within 15 days. The diagnostic accuracy of CT morphological and functional data of the LA for the detection of PCWP >15 mmHg, evaluated by two independent readers, was assessed using correlation and receiver-operating characteristic (ROC) analysis.
  
  
  RESULTS
  Interobserver agreement was high (r = 0.97-0.99). Correlations were found between PCWP and the morphological criteria of the LA such as anteroposterior diameter at 0 % of the R-R interval (r = 0.70, P ≤ 0.001) as well as at 40 % (r = 0.69, P ≤ 0.001). ROC curves constructed with a threshold value of PCWP > 15 mmHg showed an area under the curve between 0.88 and 0.91. Significant correlations were found between PCWP and functional criteria of the LA, including distensibility (r = -0.49, P ≤ 0.001) and ejection fraction (r = -0.58, P ≤ 0.001).
  
  
  CONCLUSIONS
  Thoracic ECG-gated CT in a PH workup helps distinguish between pre- and post-capillary PH.
  
  
  CONCLUSIONS
  • Computed tomography may help differentiate the various types of pulmonary hypertension (PH). • Post-capillary PH group 2 is due to left heart disease. • Right heart catheterisation is used to separate pre- and post-capillary PH. • Left atrium anteroposterior diameter measured on CT is of value. • ECG-gated CT helps clinicians to assess patients with PH non-invasively.
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble, BP 218, 38043, Grenoble cedex, France.
authors.forename: Nancy
authors.initials: N
authors.lastname: Sauvage
authors.forename: Emilie
authors.initials: E
authors.lastname: Reymond
authors.forename: Adrien
authors.initials: A
authors.lastname: Jankowski
authors.forename: Marion
authors.initials: M
authors.lastname: Prieur
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Ferretti
mesh_terms: D000465:Algorithms; D000792:Angiography / Q000379:methods*; D001795:Blood Pressure Determination / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*