8th Baltic Congress of Radiology

Thoracic Radiology

oral abstract

Pulmonary artery (PA) dilatation, as a well known long-term consequence of elevated pulmonary artery pressure is often seen in pulmonary hypertension (PH). The over-time dilatation of PA could demonstrate disease severity and duration. As survival is related to the stage of the disease, PA dilatation might be used as an additional potential radiologic prognostic factor. The levels of PA dilatation may vary corresponding to different etiologies of PH, therefore PH subgroup analysis is important for illustration of potential differences between PH etiological groups. This study evaluates the outcome of registry patients with idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and considers whether PA diameters at the time of diagnostic right heart catheterisation is associated with hemodynamic profile or mortality.

A single-center retrospective registry study of patients which were included between 2018 and 2022 with a cardiac catheterisation confirmed diagnosis of IPAH or CTEPH and a CT scan available for artery diameter measurement. RHC was performed within 3 months from the initial CT scan. Patients with marked deterioration during this interval were excluded. PA diameter, hemodynamic data and established predictors of survival were collected, such as mean pulmonary artery pressure (mPAP), NYHA (New York Heart Association) class, brain natriuretic peptide (BNP) level, and 6- minute walking distance (6MWD). Data were analysed using IBM SPSS program version 26. Non-parametric Spearman's rank correlation was used to determine intercorrelations between various data obtained during the research. Binary logistic regression was used to determine the impact of multiple independent variables presented simultaneously to predict mortality. The Kaplan-Meier method is used to analyse 'time-to-death' data. Non-parametric methods were used because data was not distributed normally.

In total 56 patients with IPAH (73% female; 77% NYHA class ≥III). During a median follow up of 26 ± 4 months, 18% of the patients died), and 23 patients with CTEPH were included (70% female; 70% NYHA class ≥III. During a median follow up of 18 ± 9 months, 26% of the patients died). In IPAH class the mean diameter of main PA was 37 mm (95% CI 35-39), right PA was 29 mm (95% CI 27-30), and left PA 28 mm (95% CI 26-29). In CTEPH class the mean diameter of main PA was 38 mm (95% CI 35-40), right PA was 28 mm (95% CI 26-30), and left PA 28 mm (95% CI 26-30). Overall survival for IPAH class for males was 78% at 1 and 2 years. Overall survival for females was 95% at 1 year and 88% at 2 years. Overall survival for CTEPH class for males was 100% at 1 year and 75% at 2 years. Overall survival for females was 80% at 1 year and 61% at 2 years. In IPAH population pulmonary artery size did not correlate with mPAP, however we found a weak correlation between main PA/AAo (ascending aorta) and main PA/DAo (descending aorta) diameter ratio and mPAP (r = 0.31, p = 0.02 and r = 0.33, p = 0.01 respectively.) In CTEPH population pulmonary artery size did not correlate with mPAP. In this study PA diameters, gender, higher age, shorter 6MWD and BNP levels were not independently associated with mortality in both IPAH and CTEPH groups. In IPAH group multivariate analysis with BNP corrected for age and 6MWD increased the likelihood of dying by 0.4% from every BNP unit increase (OR=1.008, p=0.014).

Dilatation of pulmonary arteries is found in almost all of IPAH and CTEPH patients, suggesting referral at a late stage of the disease, however there was no significant difference of level of dilatation between these groups. The prognosis of PAH and CTEPH subgroups is still poor. PA diameter at diagnosis was not associated with survival in both IPAH or CTEPH patients. A correlation between main PA/AAo and main PA/DAo diameter ratio and mPAP was found, suggesting a potential prognostic radiological finding, however further research still needs to be conducted.

Pulmonary artery (PA) dilatation, as a well known long-term consequence of elevated pulmonary artery pressure is often seen in pulmonary hypertension. The dilatation of PA could demonstrate disease severity and duration. A correlation between main PA/Ascending aorta and main PA/Descending aorta diameter ratio and mean pulmonary artery pressure was found, suggesting a potential prognostic radiological finding.

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