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Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study

Background: Computed tomography (CT) of the aorta and cardiac vessels, which is performed in patients with severe aortic valve stenosis (AS) before transcatheter aortic valve replacement (TAVR), offers the possibility of non-invasive detection of pulmonary hypertension (PH), for example, by determin...

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Autores principales: Boxhammer, Elke, Scharinger, Bernhard, Kaufmann, Reinhard, Brandtner, Herwig, Schmidbauer, Lukas, Kammler, Jürgen, Kellermair, Jörg, Reiter, Christian, Akbari, Kaveh, Hammerer, Matthias, Blessberger, Hermann, Steinwender, Clemens, Hergan, Klaus, Hoppe, Uta C., Lichtenauer, Michael, Hecht, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600691/
https://www.ncbi.nlm.nih.gov/pubmed/36292052
http://dx.doi.org/10.3390/diagnostics12102363
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author Boxhammer, Elke
Scharinger, Bernhard
Kaufmann, Reinhard
Brandtner, Herwig
Schmidbauer, Lukas
Kammler, Jürgen
Kellermair, Jörg
Reiter, Christian
Akbari, Kaveh
Hammerer, Matthias
Blessberger, Hermann
Steinwender, Clemens
Hergan, Klaus
Hoppe, Uta C.
Lichtenauer, Michael
Hecht, Stefan
author_facet Boxhammer, Elke
Scharinger, Bernhard
Kaufmann, Reinhard
Brandtner, Herwig
Schmidbauer, Lukas
Kammler, Jürgen
Kellermair, Jörg
Reiter, Christian
Akbari, Kaveh
Hammerer, Matthias
Blessberger, Hermann
Steinwender, Clemens
Hergan, Klaus
Hoppe, Uta C.
Lichtenauer, Michael
Hecht, Stefan
author_sort Boxhammer, Elke
collection PubMed
description Background: Computed tomography (CT) of the aorta and cardiac vessels, which is performed in patients with severe aortic valve stenosis (AS) before transcatheter aortic valve replacement (TAVR), offers the possibility of non-invasive detection of pulmonary hypertension (PH), for example, by determining the diameter of the main pulmonary artery (PA), the right pulmonary artery (RPA) or the left pulmonary artery (LPA). An improvement of the significance of these radiological parameters is often achieved by indexing to the body surface area (BSA). The aim of this study was to compare different echocardiographic systolic pulmonary artery pressure (sPAP) values with radiological data in order to define potential clinical cut-off values for the presence or absence of PH. Methods: A total of 138 patients with severe AS undergoing TAVR underwent pre-interventional transthoracic echocardiography with determination of sPAP values and performance of CT angiography (CTA) of the aorta and femoral arteries. Radiologically, the PA, RPA, LPA, and ascending aorta (AA) diameters were obtained. Vascular diameters were not only indexed to BSA but also ratios were created with AA diameter (for example PA/AA-ratio). From these CT-derived vascular parameters, AUROC curves were obtained regarding the prediction of different sPAP values (sPAP 40–45–50 mmHg) and finally correlation analyses were calculated. Results: The best AUROC and correlation analyses were generally obtained at an sPAP ≥ 40 mmHg. When considering diameters alone, the PA diameter was superior to the RPA and LPA. Indexing to BSA generally increased the diagnostic quality of the parameters, and finally, in a synopsis of all results, PA/BSA had the best AUC 0.741 (95% CI 0.646–0. 836; p < 0.001; YI 0.39; sensitivity 0.87; specificity 0.52) and Spearman’s correlation coefficient (r = 0.408; p < 0.001) at an sPAP of ≥40 mmHg. Conclusions: Features related to pulmonary hypertension are fast and easily measurable on pre-TAVR CT and offer great potential regarding non-invasive detection of pulmonary hypertension in patients with severe AS and can support the echocardiographic diagnosis. In this study, the diameter of the main pulmonary artery with the additionally determined ratios were superior to the values of the right and left pulmonary artery. Additional indexing to body surface area and thus further individualization of the parameters with respect to height and weight can further improve the diagnostic quality.
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spelling pubmed-96006912022-10-27 Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study Boxhammer, Elke Scharinger, Bernhard Kaufmann, Reinhard Brandtner, Herwig Schmidbauer, Lukas Kammler, Jürgen Kellermair, Jörg Reiter, Christian Akbari, Kaveh Hammerer, Matthias Blessberger, Hermann Steinwender, Clemens Hergan, Klaus Hoppe, Uta C. Lichtenauer, Michael Hecht, Stefan Diagnostics (Basel) Article Background: Computed tomography (CT) of the aorta and cardiac vessels, which is performed in patients with severe aortic valve stenosis (AS) before transcatheter aortic valve replacement (TAVR), offers the possibility of non-invasive detection of pulmonary hypertension (PH), for example, by determining the diameter of the main pulmonary artery (PA), the right pulmonary artery (RPA) or the left pulmonary artery (LPA). An improvement of the significance of these radiological parameters is often achieved by indexing to the body surface area (BSA). The aim of this study was to compare different echocardiographic systolic pulmonary artery pressure (sPAP) values with radiological data in order to define potential clinical cut-off values for the presence or absence of PH. Methods: A total of 138 patients with severe AS undergoing TAVR underwent pre-interventional transthoracic echocardiography with determination of sPAP values and performance of CT angiography (CTA) of the aorta and femoral arteries. Radiologically, the PA, RPA, LPA, and ascending aorta (AA) diameters were obtained. Vascular diameters were not only indexed to BSA but also ratios were created with AA diameter (for example PA/AA-ratio). From these CT-derived vascular parameters, AUROC curves were obtained regarding the prediction of different sPAP values (sPAP 40–45–50 mmHg) and finally correlation analyses were calculated. Results: The best AUROC and correlation analyses were generally obtained at an sPAP ≥ 40 mmHg. When considering diameters alone, the PA diameter was superior to the RPA and LPA. Indexing to BSA generally increased the diagnostic quality of the parameters, and finally, in a synopsis of all results, PA/BSA had the best AUC 0.741 (95% CI 0.646–0. 836; p < 0.001; YI 0.39; sensitivity 0.87; specificity 0.52) and Spearman’s correlation coefficient (r = 0.408; p < 0.001) at an sPAP of ≥40 mmHg. Conclusions: Features related to pulmonary hypertension are fast and easily measurable on pre-TAVR CT and offer great potential regarding non-invasive detection of pulmonary hypertension in patients with severe AS and can support the echocardiographic diagnosis. In this study, the diameter of the main pulmonary artery with the additionally determined ratios were superior to the values of the right and left pulmonary artery. Additional indexing to body surface area and thus further individualization of the parameters with respect to height and weight can further improve the diagnostic quality. MDPI 2022-09-29 /pmc/articles/PMC9600691/ /pubmed/36292052 http://dx.doi.org/10.3390/diagnostics12102363 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Boxhammer, Elke
Scharinger, Bernhard
Kaufmann, Reinhard
Brandtner, Herwig
Schmidbauer, Lukas
Kammler, Jürgen
Kellermair, Jörg
Reiter, Christian
Akbari, Kaveh
Hammerer, Matthias
Blessberger, Hermann
Steinwender, Clemens
Hergan, Klaus
Hoppe, Uta C.
Lichtenauer, Michael
Hecht, Stefan
Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title_full Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title_fullStr Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title_full_unstemmed Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title_short Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study
title_sort comparability between computed tomography morphological vascular parameters and echocardiography for the assessment of pulmonary hypertension in patients with severe aortic valve stenosis—results of a multi-center study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600691/
https://www.ncbi.nlm.nih.gov/pubmed/36292052
http://dx.doi.org/10.3390/diagnostics12102363
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