Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension

Abstract

Objectives

Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). However, the diagnostic and prognostic significance remains unclear. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance.

Methods

Consecutive patients with suspected PH undergoing routine CT pulmonary angiography and right heart catheterisation (RHC) were identified. Axial and reconstructed images were used to derive CT metrics. Multivariate regression analysis was performed in the derivation cohort to identify a diagnostic CT model to predict mPAP ≥ 25 mmHg (the existing ESC guideline definition of PH) and > 20 mmHg (the new threshold proposed at the 6th World Symposium on PH). In the validation cohort, sensitivity, specificity and compromise CT thresholds were identified with receiver operating characteristic (ROC) analysis. The prognostic value of the CT model was assessed using Kaplan-Meier analysis.

Results

Between 2012 and 2016, 491 patients were identified. In the derivation cohort (n = 247), a CT model was identified including pulmonary artery diameter, right ventricular outflow tract thickness, septal angle and left ventricular area. In the validation cohort (n = 244), the model was diagnostic, with an area under the ROC curve of 0.94/0.91 for mPAP ≥ 25/> 20 mmHg respectively. In the validation cohort, 93 patients died; mean follow-up was 42 months. The diagnostic thresholds for the CT model were prognostic, log rank, all p < 0.01.

Discussion

In suspected PH, a diagnostic CT model had diagnostic and prognostic utility.

Metadata

Item Type:	Article
Authors/Creators:	Swift, A.J. https://orcid.org/0000-0002-8772-409X Dwivedi, K. Johns, C. Garg, P. Chin, M. Currie, B.J. Rothman, A.M.K. Capener, D. Shahin, Y. Elliot, C.A. Charalampopolous, T. Sabroe, I. Rajaram, S. Hill, C. Wild, J.M. https://orcid.org/0000-0002-7246-8660 Condliffe, R. Kiely, D.G.
Copyright, Publisher and Additional Information:	© 2020 The Authors. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords:	Hypertension, pulmonary; Pulmonary artery; Heart ventricles; Diagnostic imaging
Dates:	Accepted: 30 March 2020 Published (online): 27 April 2020 Published: September 2020
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Sheffield Teaching Hospitals
Funding Information:	Funder Grant number WELLCOME TRUST (THE) 205188/Z/16/Z
Depositing User:	Symplectic Sheffield
Date Deposited:	04 May 2020 10:06
Last Modified:	23 Nov 2021 12:47
Status:	Published
Publisher:	Springer Science and Business Media LLC
Refereed:	Yes
Identification Number:	10.1007/s00330-020-06846-1
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:160084

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Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension

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