title: Pulmonary hypertension and right ventricular dysfunction in patients with left to right shunt coronary artery fistula: evaluation with cardiac CT.
abstract: In this study, we aimed to evaluate whether patients with left to right shunt coronary artery fistula (LRSCAF) are predisposed to developing pulmonary hypertension and right ventricular dysfunction compared with healthy individuals. The value of cardiac CT findings in determining the necessity of intervention for these patients was investigated. We retrospectively studied 19 patients with LRSCAF and 19 healthy patients. Several parameters were observed on cardiac CT by two radiologists, including pulmonary trunk diameter (PA diameter), right ventricular diameter (RVD), left ventricular diameter (LVD), RVD/LVD ratio, septal bowing and CT score of right ventricular dysfunction (CSRVD). Data from both groups were compared. The inter- and intra-observer variabilities and correlations were examined. The disease group was further divided into intervention (n = 9) and non-intervention (n = 10) groups, and their data were compared. All cardiac CT findings showed significant intra- and inter-observer correlation without significant variability. Mann-Whitney U tests and χ(2) analysis showed that PA diameter, RVD/LVD ratio acquired from two observers, and CSRVD were higher in the disease group than in the control group (all P values < 0.05 for χ(2) and almost all P values < 0.05 for Mann-Whitney U). The RVD/LVD ratio and CSRVD were higher in the intervention group than in the non-intervention group (all P values < 0.05). Receiver operating curve analysis identified RVD/LVD = 1.036 and CSRVD = 3.5 as the best cut-off values to determine the necessity of further intervention. Patients with LRSCAF are more predisposed to pulmonary hypertension and right ventricular dysfunction compared with the normal population. RVD/LVD > 1.0 and CSRVD ≥ 4.0 may determine the necessity of intervention for patients with LRSCAF.
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Yu-Pin
authors.initials: YP
authors.lastname: Chang
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC. chan.siwa@gmail.com.
authors.forename: Si-Wa
authors.initials: SW
authors.lastname: Chan
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Jyh-Wen
authors.initials: JW
authors.lastname: Chai
authors.affiliation: E-Da Hospital, Kaohsiung, Taiwan, ROC.|I-Shou University, Kaohsiung, Taiwan, ROC.
authors.forename: Jeon-Ho
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Fu
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Jian-Ling
authors.initials: JL
authors.lastname: Chen
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Yen-Ting
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chen
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
authors.forename: Clayton Chi-Chang
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D062186:Arterial Pressure; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016157:Vascular Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Congenital heart disease; Coronary disease; Multidetector computed tomography; Pulmonary hypertension