Abstract
ABSTRACTObjective To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation.Methods A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists.Results This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%.Conclusion Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness.
Highlights
Pulmonary hypertension (PH) may result from chronic parenchymal lung disease and is a marker of disease severity.[1,2] Pulmonary hypertension affects up to 90% of patients with chronic obstructive pulmonary disease (COPD) GOLD IV, and more than 60% of patients with end-stage idiopathic pulmonary fibrosis.[3]. PH is a common comorbidity in patients referred for lung transplantation, with potential implications for perioperative management and negative impacts on post-transplant survival.[4,5,6]
This practice is supported by specialists, who recommend right heart catheterization in patients with advanced lung disease whenever the diagnosis may directly interfere with therapeutic planning.[3] catheterization is the gold standard for PH diagnosis in these individuals.[3] it is an invasive procedure with limited availability and high costs
The accuracy of these measurements varies considerable among publications.[2,9,10,11] In many of these studies, PH is defined as mean pulmonary artery pressure higher than 25mmHg
Summary
Pulmonary hypertension (PH) may result from chronic parenchymal lung disease and is a marker of disease severity.[1,2] Pulmonary hypertension affects up to 90% of patients with chronic obstructive pulmonary disease (COPD) GOLD IV, and more than 60% of patients with end-stage idiopathic pulmonary fibrosis.[3]. Right heart catheterization is routinely used in several lung transplant centers worldwide to screen transplant candidates suffering from interstitial lung disease (ILD) or COPD for PH This practice is supported by specialists, who recommend right heart catheterization in patients with advanced lung disease whenever the diagnosis may directly interfere with therapeutic planning.[3] catheterization is the gold standard for PH diagnosis in these individuals.[3] it is an invasive procedure with limited availability and high costs. Since 2019, PH is defined as mPAP ≥25mmHg or between 21 and 24mmHg, with evidence of increased pulmonary vascular resistance (PVR >3 Wood units).(3)
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