title: CT signs of right ventricular dysfunction correlated with echocardiography-derived pulmonary arterial systolic pressure: incremental value of the pulmonary arterial diameter index.
abstract: To investigate and compare the potential of right to left ventricular volume (RVV/LVV) and diameter ratios (RVD/LVD) for the prediction of pulmonary arterial hypertension (PH) over 40 mmHg, and then to evaluate the incremental value of the pulmonary artery diameter index (PADi; PAD/body surface area) in the prediction of PH over 40 mHg. We correlated the followings on chest CT with same-day echocardiography-derived pulmonary arterial systolic pressure (PASP) in 139 patients (64.8 ± 15.4 years; 63 male): PADi, RVD/LVD on axial (RVD axial/LVD axial) and four chamber (RVD 4CH/LVD 4CH) views, and RVV/LVV. Those were then adjusted (multiplied) by PADi. Areas under the curves (AUC) for predicting PASP > 40 mmHg were calculated. All patients had undergone non-ECG-gated, contrast enhanced chest CT on a 64-slice multi-detector CT system. The correlation of PASP with RVV/LVV (R(2) = 0.45) was stronger than with RVD axial/LVD axial (R(2) = 0.28) and RVD 4CH/LVD 4CH (R(2) = 0.34). When adjusted by PADi, the correlation improved; R(2) = 0.55, 0.41 and 0.47, respectively. The AUC of adjusted RVV/LVV was significantly higher than those of other CT measurements (P < 0.05) excluding adjusted RVD 4CH/LVD 4CH (P = 0.08). With 18.80 as the cutoff, its sensitivity and specificity for predicting PH > 40 mmHg were 83 and 87 %, respectively. Ventricular volume is superior to ventricular diameter ratios in the prediction of PH > 40 mmHg with better correlation with PASP. PADi adds incremental value to these measurements in the prediction of PH > 40 mmHg. Of those, adjusted RVV/LVV is most reliable and predicts PH > 40 mmHg with fairly high sensitivity and specificity.
authors.affiliation: Department of Radiology, Soonchunhyang University Hospital Bucheon, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Republic of Korea.
authors.forename: Soyeoun
authors.initials: S
authors.lastname: Lim
authors.forename: Heon
authors.initials: H
authors.lastname: Lee
authors.forename: Soo Jeong
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jae Kyun
authors.initials: JK
authors.lastname: Kim
authors.forename: Jon
authors.initials: J
authors.lastname: Suh
authors.forename: Eun Hye
authors.initials: EH
authors.lastname: Lee
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Paik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D062186:Arterial Pressure; D015150:Echocardiography, Doppler; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right