Axial CT measured main pulmonary artery diameter to predict the presence and degree of pulmonary hypertension

We performed this study to investigate if main pulmonary artery (mPA) diameter measured by axial chest computed tomography (CT) can predict the presence and degree of echocardiography-measured pulmonary hypertension (ePH) among emergency department (ED) patients. This retrospective cross-sectional study enrolled patients who underwent both chest CT and echocardiography within 24 h at the ED. The ePH was estimated using right ventricular systolic pressure (RVSP). RVSP <40 mmHg was classified as normal; 40–49 mmHg, mild ePH; 50–75 mmHg, moderate ePH; and ≥76 mmHg, severe ePH. Among 485 adult patients, 297 (61.2%) had normal RVSP and mean mPA of 30.3 mm. The numbers of patients with mild, moderate and severe ePH were 92 (19.0%), 85 (17.5%) and 11 (2.3%) with corresponding mean mPA diameters of 32.4, 34.5 and 35.9 mm, respectively. The best mPA diameters for predicting mild, moderate and severe ePH were 30.6, 31.8 and 33.8 mm, with area under the receiver operating characteristic curve of 0.697, 0.727 and 0.797 and sensitivities of 72.9%, 71.9% and 81.8%, respectively. Axial CT-measured mPA diameter can predict the presence and degree of ePH among ED patients. If the CT-measured mPA diameter is greater than 30.6 mm, the possibility of pulmonary hypertension should be considered and applied to the patient’s treatment.

Pulmonary artery; Pulmonary hypertension; Computed tomography; Thoracic radiography

[1] Chang KY, Duval S, Badesch DB, Bull TM, Chakinala MM, De Marco T, et al. Mortality in pulmonary arterial hypertension in the modern era: early insights from the pulmonary hypertension association registry. Journal of the American Heart Association. 2022; 11: e024969.

[2] Mehta S, Vachiéry J. Pulmonary hypertension: the importance of correctly diagnosing the cause. European Respiratory Review. 2016; 25: 372–380.

[3] Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022; 43: 3618–3731.

[4] Mandras SA, Mehta HS, Vaidya A. Pulmonary hypertension: a brief guide for clinicians. Mayo Clinic Proceedings. 2020; 95: 1978–1988.

[5] Peacock A, Ross K. Pulmonary hypertension: a contraindication to the use of b-adrenoceptor blocking agents. Thorax. 2010; 65: 454–455.

[6] Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, et al. Delay in recognition of pulmonary arterial hypertension. Chest. 2011; 140: 19–26.

[7] Gelzinis TA. Pulmonary hypertension in 2021: part I—definition, classification, pathophysiology, and presentation. Journal of Cardiothoracic and Vascular Anesthesia. 2022; 36: 1552–1564.

[8] Marra AM, Attanasio U, Cuomo A, Rainone C, D’Agostino A, Carannante A, et al. Mildly elevated pulmonary hypertension: gray zone or already a disease? Heart Failure Clinics. 2023; 19: 1–9.

[9] Janda S, Shahidi N, Gin K, Swiston J. Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis. Heart. 2011; 97: 612–622.

[10] Ni J, Yan P, Liu S, Hu Y, Yang K, Song B, et al. Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension: a systematic review and meta-analysis. BMJ Open. 2019; 9: e033084.

[11] Freitas D, Alner S, Demetrescu C, Antonacci G, Proudlove N. Time to be more efficient: reducing wasted transthoracic echocardiography (TTE) diagnostic appointment slots at Guy’s and St Thomas’ NHS Trust. BMJ Open Quality. 2023; 12: e002317.

[12] Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes Aravena S, Javidan-Nejad C, Bhalla S. Approach to pulmonary hypertension: from CT to clinical diagnosis. RadioGraphics. 2018; 38: 357–373.

[13] Alhamad EH, Al-Boukai AA, Al-Kassimi FA, Alfaleh HF, Alshamiri MQ, Alzeer AH, et al. Prediction of pulmonary hypertension in patients with or without interstitial lung disease: reliability of CT findings. Radiology. 2011; 260: 875–883.

[14] Wilcox SR, Faridi MK, Camargo CA. Intensive care unit admission for patients with pulmonary hypertension presenting to U.S. emergency departments. The American Journal of Emergency Medicine. 2021; 50: 237–241.

[15] Wilcox SR, Faridi MK, Camargo CA Jr. Demographics and outcomes of pulmonary hypertension patients in United States emergency departments. The Western Journal of Emergency Medicine. 2020; 21: 714–721.

[16] Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143: 29–36.

[17] Bujang MA, Sa’at N, Tg Abu Bakar Sidik TMI, Chien Joo L. Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data. Malaysian Journal of Medical Sciences. 2018; 25: 122–130.

[18] Seo HS, Lee H. Assessment of right ventricular function in pulmonary hypertension with multimodality imaging. Journal of Cardiovascular Imaging. 2018; 26: 189.

[19] Mandoli GE, Landra F, Chiantini B, Sciaccaluga C, Pastore MC, Focardi M, et al. Tricuspid regurgitation velocity and mean pressure gradient for the prediction of pulmonary hypertension according to the new hemodynamic definition. Diagnostics. 2023; 13: 2619.

[20] Soofi MA, Shah MA, AlQadhi AM, AlAnazi AM, Alshehri WM, Umair A. Sensitivity and specificity of pulmonary artery pressure measurement in echocardiography and correlation with right heart catheterization. Journal of the Saudi Heart Association. 2021; 33: 228–236.

[21] Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. Journal of the American Society of Echocardiography. 2007; 20: 857–861.

[22] Moceri P, Baudouy D, Chiche O, Cerboni P, Bouvier P, Chaussade C, et al. Imaging in pulmonary hypertension: focus on the role of echocardiography. Archives of Cardiovascular Diseases. 2014; 107: 261–271.

[23] Truong QA, Massaro JM, Rogers IS, Mahabadi AA, Kriegel MF, Fox CS, et al. Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography. Circulation: Cardiovascular Imaging. 2012; 5: 147–154.

[24] Frazier AA, Burke AP. The imaging of pulmonary hypertension. Seminars in Ultrasound, CT and MRI. 2012; 33: 535–551.