Abdulaal, L., Maiter, A., Dwivedi, K. et al. (8 more authors) (2024) Lung parenchymal and cardiac appearances on CTPA impact survival in chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry. ERJ Open Research. ISSN 2312-0541
Abstract
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is commonly evaluated using CT pulmonary angiography (CTPA). We evaluated the frequency and impact of parenchymal and cardiac abnormalities on survival in CTEPH.
Methods
Patients were identified from the ASPIRE (Assessing-the-Spectrum-of-Pulmonary-Hypertension-Identified-at-a-Referral-Centre) Registry. Kaplan-Meier analysis was used to assess survival.
Results
290 patients (55% female, mean age 65±14 years) with CTEPH were included. Mosaic perfusion was noted in 83%, lung infarction in 73% and parenchymal lung disease in 28%. The severity of mosaic perfusion and lung infarction correlated with markers of disease severity (p<0.001). Whereas the presence of mosaic perfusion was associated with improved survival in all patients (p=0.03), it did not predict outcome in those undergoing pulmonary endarterectomy (PEA) (p=0.6) and those not undergoing PEA (p=0.22). The presence of lung infarction had no impact on mortality. The presence of co-existing lung disease was associated with a worse survival (p<0.008), in patients not undergoing PEA. Mosaic perfusion was less common in patients with parenchymal lung disease (65%) compared to those without parenchymal lung disease (90%), p<0.001. Increased right: left ventricular ratio and aortic diameter predicted worse outcome (p<0.002).
Conclusion
Lung parenchymal and cardiac changes on CTPA predict outcome in CTEPH. Co-existing parenchymal lung disease is not uncommon and when present may mask the presence of mosaic perfusion. This study highlights the importance of systematically evaluating the lung parenchyma and cardiac changes in patients with CTEPH.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The authors 2024 This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0 (https://creativecommons.org/licenses/by-nc/4.0/). For commercial reproduction rights and permissions contact permissions@ersnet.org |
Keywords: | Biomedical and Clinical Sciences; Cardiovascular Medicine and Haematology; Clinical Sciences; Lung; Biomedical Imaging; Cardiovascular; Heart Disease; Cardiovascular |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Department of Infection, Immunity and Cardiovascular Disease |
Funding Information: | Funder Grant number WELLCOME TRUST (THE) 205188/Z/16/Z Wellcome Trust 223521/Z/21/Z |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Jan 2025 12:19 |
Last Modified: | 10 Jan 2025 12:19 |
Status: | Published online |
Publisher: | European Respiratory Society (ERS) |
Refereed: | Yes |
Identification Number: | 10.1183/23120541.00732-2024 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:221518 |
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Filename: ERJ Open Res-2024-Abdulaal-23120541.00732-2024.pdf
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