A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension.
OBJECTIVE
The aim of this study was to retrospectively assess the relationship between radiological and hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We introduced a new CT-score to evaluate hemodynamic changes, only employing CT-pulmonary angiography (CTPA).


METHODS
145 patients affected by CTEPH underwent hemodynamic and CTPA evaluation. Among these 145 patients, 69 underwent pulmonary endarterectomy (PEA) and performed a CTPA evaluation even after surgery. Hemodynamic assessment considered the values of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), obtained through right heart catheterization (RHC). Radiological evaluation included CTPA signs of pulmonary hypertension.


RESULTS
A highly significant statistical correlation was observed between the new CT-score and both mPAP and PVR (p < 0.000) in the whole sample and also in the subgroup who underwent PEA. In addition, mPAP and PVR showed an important association with the severity of mosaic perfusion (p < 0.000). mPAP also correlated with main pulmonary artery diameter (p < 0.01); a significant association was found in both between PVR and tricuspid regurgitation(p < 0.000) and with PVR and presence of unilateral or bilateral pulmonary thromboembolic occlusion (p < 0.05).


CONCLUSIONS
Our results confirm the diagnostic role of CTPA in evaluating patients with CTEPH and in addition open a new horizon in assessing hemodynamic changes in patients with CTEPH, only employing a CTPA, especially when RHC is contraindicated or not possible.
Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy. leone.barbara@hotmail.it.
Maria Barbara
MB
Leone
Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy.
Marica
M
Giannotta
Institute of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy.
Massimiliano
M
Palazzini
Heart and Lung Transplantation Program, Cardiac Surgery Department, S. Orsola-Malpighi Hospital, Bologna, Italy.
Mariano
M
Cefarelli
Heart and Lung Transplantation Program, Cardiac Surgery Department, S. Orsola-Malpighi Hospital, Bologna, Italy.
Sofia
S
Martìn Suàrez
Institute of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy.
Enrico
E
Gotti
Department of Cardiovascular Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Maria Letizia
ML
Bacchi Reggiani
Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy.
Maurizio
M
Zompatori
Institute of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy.
Nazzareno
N
Galiè
D000792:Angiography; D006328:Cardiac Catheterization; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
A new CT-score for CTEPH; CT-pulmonary angiography; Chronic thromboembolic pulmonary hypertension; Pulmonary endarterectomy; Right heart catheterization