title: Pulmonary Hypertension: A Nomogram Based on CT Pulmonary Angiographic Data for Prediction in Patients without Pulmonary Embolism.
abstract: OBJECTIVE
  To use cardiovascular data from computerized tomographic (CT) pulmonary angiography for facilitating the identification of pulmonary hypertension (PH) in patients without acute pulmonary embolism.
  
  
  METHODS
  The institutional human research committee approved this retrospective study; informed consent was waived. Patients without pulmonary embolism who underwent CT pulmonary angiography and echocardiography within 24 hours of each other between December 2008 and October 2012 were retrospectively identified. The diameters of the pulmonary artery, aorta, and right and left ventricles and the severity of reflux of contrast material were assessed. The volumes of each cardiac compartment were calculated. Doppler echocardiography served as a reference standard for PH. A prediction model for PH was built by using backward logistic regression and was presented on a nomogram. The prediction model was evaluated with 10-fold cross-validation, and a test group of patients was studied between November 2012 and June 2014.
  
  
  RESULTS
  The final study group included 182 patients, of whom 98 (54%) were given a diagnosis of PH on the basis echocardiographic results. Age of 67 years or older (odds ratio [OR] = 4.46), reflux grade of 3 or higher (OR = 2.63), right atrial volume of greater than or equal to 106 cm(3) (OR = 3.59), pulmonary artery diameter greater than or equal to 28 mm (OR = 2.52) and pulmonary artery diameter to aorta diameter ratio of greater than or equal to 0.86 (OR = 2.17) were independently associated with PH. The logistic model showed good discrimination ability (area under the curve = 0.844, discrimination slope = 0.359). Tenfold cross-validation showed 85.7% sensitivity, 60.7% specificity, 71.3% positive predictive value, and 76.1% negative predictive value for identification of PH, while the test group showed similar results (84.1%, 60.5%, 71.2%, and 76.7%, respectively).
  
  
  CONCLUSIONS
  Cardiovascular data derived from CT pulmonary angiography are associated with PH, and a nomogram can be created that may facilitate identification of PH after exclusion of acute pulmonary embolism.
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Hezzy
authors.initials: H
authors.lastname: Shmueli
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Sharon Z
authors.initials: SZ
authors.lastname: Adam
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Achiude
authors.initials: A
authors.lastname: Bendet
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Tomer
authors.initials: T
authors.lastname: Ziv-Baran
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Abraham Shlomo
authors.initials: AS
authors.lastname: Berliner
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Nachum
authors.initials: N
authors.lastname: Nesher
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Yanai
authors.initials: Y
authors.lastname: Ben-Gal
authors.affiliation: From the Departments of Radiology, Internal Medicine E, Cardiology, and Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weitzman St, Tel Aviv 64239, Israel (G.A., H.S., S.Z.A., A.D., A.S., S.B., N.N., Y.B.G., Y.T.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.Z.B.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed