Diameter Of Pulmonary Trunk Research Articles

Potential of Transthoracic Echocardiography and Cardiac CT in Pulmonary Arteries Assessment in Children With Pulmonary Atresia With Ventricular Septal Defect

Objective: To assess and compare the potential of transthoracic echocardiography (TTE) and cardiac computed tomography (CT) in determining severity of pulmonary artery hypoplasia in children with pulmonary atresia with ventricular septal defect (PA-VSD) during preoperative planning.Materials and methods: The study included 38 children (mean age, 1.5 years; 97% of the patients younger than 1 year) with a clinical diagnosis of PA-VSD. All the patients underwent TTE; 36 of them underwent cardiac CT, while 33 children had direct angiocardiography. During all diagnostic methods we performed morphometry of the pulmonary trunk (if any) and proximal and distal parts of right and left pulmonary arteries, calculated z score for every vessel, Nakata index, and McGoon ratio. All the results were compared with fiof direct angiography and/or intraoperative data. The interval between TTE, cardiac CT, and angiocardiography or open surgery was less than 10 days. The criterion for hypoplasia of the pulmonary artery and its branches was z score deviation less than (−2) from reference values. Nakata index less than 200 mm2/m2 and McGoon ratio less than 1.0 were considered contraindications for radical correction.Results: We found no statistically significant difference (P > .05) when comparing the potential of TTE and cardiac CT with direct angiography/intraoperative data in terms of morphometry of the proximal parts of the right and left pulmonary arteries and calculating z scores. All the methods demonstrated high diagnostic efficacy. We found statistically significant differences when comparing the potential of TTE and cardiac CT in pulmonary trunk angiometry: the results of pulmonary trunk measurement using TTE were statistically significantly different from the findings of cardiac CT and angiography/intraoperative data with significant underestimation of vessel diameters (P < .05). The results of measurements of the distal parts of the pulmonary artery using TTE were statistically significantly different from those of cardiac CT and direct angiography/intraoperative data with significant underestimation of vessel diameters (P < .05). There were no statistically significant differences between CT and direct angiography/intraoperative data in assessing the diameters of the distal branches of the pulmonary artery. When assessing McGoon ratio and Nakata index using TTE, we found statistically significant differences (underestimation of values) in comparison with direct angiography (P < .05). Comparison of McGoon ratios measured by TTE and cardiac CT also demonstrated their statistically significant underestimation by TTE (P < .05). The calculated McGoon ratio during cardiac CT did not differ significantly from the direct angiography findings.Conclusions: TTE cannot be considered the final method for preoperative assessment of the pulmonary artery system development in children with PA-VSD due to the limited visualization of the distal parts of the right and left pulmonary arteries and significant underestimation of the pulmonary trunk diameter and indices. Cardiac CT proved its high effectiveness in assessment of hypoplasia severity and can be an alternative to direct angiography.

Analysis of the diagnostic and economic impact of the combined artificial intelligence algorithm for analysis of 10 pathological findings on chest computed tomography

BACKGROUND: Artificial intelligence technology can help solve the significant problem of missed findings in radiology studies. An important issue is assessing the economic benefits of implementing artificial intelligence.
 AIM: To evaluate the frequency of missed pathologies detection and the economic potential of artificial intelligence technology for chest computed tomography compared and validated by experienced radiologists.
 MATERIALS AND METHODS: This was an observational, single-center retrospective study. The study included chest computed tomography without IV contrast from June 1 to July 31, 2022, in Clinical Hospital in Yauza, Moscow. The computed tomography was processed using a complex artificial intelligence algorithm for 10 pathologies: pulmonary infiltrates, typical for viral pneumonia (COVID-19 in pandemic conditions); lung nodules; pleural effusion; pulmonary emphysema; thoracic aortic dilatation; pulmonary trunk dilatation; coronary artery calcification; adrenal hyperplasia; and osteoporosis (vertebral body height and density changes). Two experts analyzed computed tomography and compared results with artificial intelligence. Further routing was determined according to clinical guidelines for all findings initially detected and missed by radiologists. The hospital price list determined the potential revenue loss for each patient.
 RESULTS: From the final 160 computed tomographies, the artificial intelligence identified 90 studies (56%) with pathologies, of which 81 (51%) were missing at least one pathology in the report. The second-stage lost potential revenue for all pathologies from 81 patients was RUB 2,847,760 ($37,251 or CNY 256,218). Lost potential revenue only for those pathologies missed by radiologists but detected by artificial intelligence was RUB 2,065,360 ($27,017 or CNY 185,824).
 CONCLUSION: Using artificial intelligence as an assistant to the radiologist for chest computed tomography can dramatically minimize the number of missed abnormalities. Compared with the normal model without artificial intelligence, using artificial intelligence can provide 3.6 times more benefits. Using advanced artificial intelligence for chest computed tomography can save money.

Evaluation of the Correlation of Pulmonary Arterial Hypertension (PAH) with the Pulmonary Artery Trunk Diameter and Serum Level of N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) in Patients with PAH

Background: Due to its non-specific symptoms, pulmonary arterial hypertension (PAH) is difficult to diagnose via non-invasive methods. Various diagnostic tests are required to evaluate PAH patients. The increased diameter of the main pulmonary artery in computed tomography (CT) imaging represents a high probability of PAH. Moreover, N-terminal pro B-type natriuretic peptide (NT-proBNP) and pro B-type natriuretic peptide (proBNP) can be considered as prognostic predictors in patients with PAH. Objectives: This study aimed to evaluate the correlation of CT-based main pulmonary artery diameter (MPAD) and the serum level of NT-proBNP (as a strong pro-inflammatory factor) with the severity of PAH in echocardiography among patients with PAH. Patients and Methods: In this cross-sectional study, a total of 63 hospitalized patients with PAH due to chronic obstructive pulmonary disease were recruited from 2019 to 2020 after initial evaluations and collection of serum NT-proBNP measurements and echocardiographic findings. On the chest CT scans, the largest diameter of the pulmonary artery trunk was determined, and then, correlation of CT-based MPAD with both PAH severity on echocardiography and NT-proBNP level in patients with PAH were evaluated. Results: The results of the present study on 63 patients (70% male; mean age, 67.02 years) showed a significant positive correlation between the MPAD and NT-proBNP level (r = 0.444, P < 0.001). Moreover, a significant positive relationship was observed between the pulmonary artery pressure (PAP) and NT-proBNP (r = 0.353, P = 0.005) and also between MPAD and PAP (r = 0.306, P = 0.015). In PAH patients, the mean values of MPAD, PAP, and NT-proBNP were 32.58 mm, 47.9 mmHg, and 6563 pg/mL, respectively. Conclusion: Considering the significant positive correlation between PAP, MPAD, and NT-proBNP level in subgroup comparisons based on MPAD and PAP, if the MPAD is abnormal on CT scan, additional echocardiographic assessments and serum NT-proBNP measurements can be helpful.

Development and Texture of Pulmonary Trunk in Children

We have studied texture and sites of pulmonary trunk in children (from the birth to 12 years of life). Experiments were carried out on 55 children's corpses. The following results were obtained: pulmonary trunk develops continuously and asynchronously: rapid growth process develops in children of an early age, diameter of pulmonary trunk increases from the first days of its existence and subsequently develops in its length

Bilateral lung transplant with pulmonary artery reconstruction using donor aorta for pulmonary hypertension with a giant pulmonary arterial aneurysm.

Standard bilateral lung transplantation (BLT) is not feasible for patients with pulmonary arterial hypertension (PAH) complicated with a giant pulmonary arterial aneurysm (PAA). This study aimed to describe the outcomes of BLT with pulmonary artery reconstruction (PAR) using donor aorta for such patients. This is a retrospective single-centre study reviewing PAH patients with a PAA who received BLT with PAR using donor aorta from January 2010 through December 2020. We compared the characteristics and short- and long-term outcomes of recipients receiving PAR (PAR group) with those who had no PAA and received standard BLT (non-PAR group). Nineteen adult PAH patients underwent cadaveric lung transplantation during the study period. Among them, 5 patients with a giant PAA (median pulmonary artery trunk diameter, 69.9 mm) underwent BLT with PAR using donor aorta and the others received standard BLT. Although the operation time tended to be longer in the PAR group compared with the non-PAR group (1239 vs 958 mins, P = 0.087), 90-day mortality (PAR group: 0% vs non-PAR group: 14.3%, P > 0.99), and 5-year survival rate (PAR group: 100% vs non-PAR group: 85.7%, P = 0.74) was comparable between the groups. No dilatation, constriction or infection of the aortic grafts were recorded during the study period with a median follow-up time of 94 months in the PAR group. Lung transplantation with PAR using donor aorta is a valid surgical option for PAH patients complicated with a giant PAA.

Echocardiographic measurements and cardiac anatomy in healthy Western hognose snakes (Heterodon nasicus)

This study aims to describe the most important cardiac structures in the Heterodon nasicus through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler measurements were performed on twenty healthy adult Heterodon nasicus (10.10). The values of the ventricular length, aortic diameter, pulmonary trunk diameter, the mean thickness of the interventricular septum, and thicknesses of the wall of the cavum pulmonale (Cav. P) and cavum arteriosum (Cav. A), were measured. The aortic flow and pulmonary trunk flow were recorded. Two dead specimens (1.1) were dissected. The male’s pulmonary trunk diameter was bigger compared to the female’s in both the long and short axis. The reproductive ecology of Heterodon nasicus has yet to be fully elucidated upon, however, male territorialism and dispersal from the hibernacula, and multiple male courtships toward a single female were described, hence, the more active reproductive activity of the male and the consequent sexual selection toward a higher aerobic performance can be hypothesised. A moderate interventricular right to left shunt was noticed in the Cav. V of all the specimens, which is considered normal and should not confuse the clinician. Congenital defects, cardiomyopathies, valvulopathies, and pericardial diseases are known to occur in ophidians and other reptiles. Reliable data and profound knowledge of the anatomy and physiology of the ophidian heart are fundamental for the in vivo diagnosis of cardiac diseases in snakes.

МОБИЛЬНОЕ ПРИЛОЖЕНИЕ В ПРОГНОЗИРОВАНИИ СИСТОЛИЧЕСКОЙ ФУНКЦИИ ЛЕВОГО ЖЕЛУДОЧКА ПРИ ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ АНТРАЦИКЛИНАМИ

Purpose. To evaluate the effect of complex treatment of breast cancer (BC) on the parameters of systolic myocardial function, and the efficiency of the prescription of cardiotropic therapy (CT) – a fixed combination of valsartan and carvedilol – in the prevention of the identified changes. To develop a mobile application, namely, an electronic statistical calculator for calculating the left ventricular ejection fraction by Simpson during BC treatment with anthracyclines, using the baseline anthropometric and instrumental data of the patient. Methods. We evaluated the cardiovascular health of 100 women who received complex treatment of BC. The patients were divided into three groups, depending on the presence of arterial hypertension and the prescription of CT. In the study, all women received a complex evaluation of the cardiovascular health at the beginning and at the end of BC treatment Results. In the non-CT group af ter the end of complex BC treatment the following was found: a decrease in the shortening fraction (FS) from 41.0 (38.0; 45.0)% to 38.0 (35.0; 43.0)%, (p < 0.05), in ejection fraction (EF) by Teinholz from 72.0 (69.0; 76.0)% to 68.0 (64.0; 73.0)%, (p < 0.05); in ejection fraction by Simpson from 66.0 (62.0; 71.0)% to 60.0 (57.0; 66.0)%, (p < 0.05); an increase in the vagosympathetic interaction LF/HF index (ratio of lowfrequency (LF) to high-frequency (HF) components) from 0.8 (0.7; 1.0) to 1.05 (0.8; 1.2), (p < 0.05); reduction of brachial artery diameter change from 12.5 (11.0; 16.0)% to 9.0 (6.0; 12.0)%, (p < 0.05). A model of the prognosis of EF by Simpson during BC treatment was proposed, which included a total dose of doxorubicin calculated per body surface area, early diastolic rate of transtricuspid blood flow, diameter of the trunk of the pulmonary artery, the rate of circular shortening of myocardial fibers, thickness of the intima-media complex of the left carotid arteries, HF, % of brachial artery diameter change. The prognosis model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines. We proposed a model for prediction of LVEF by Simpson against during breast cancer treatment, which included the total doxorubicin dose calculated per body surface area, early diastolic rate of transtricuspidal blood flow, pulmonary artery trunk diameter, myocardial fiber circular shortening rate, left carotid artery intima-media complex thickness, HF, percentage of brachial artery diameter change. The prognostic model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines.

The Prognostic Significance of Pulmonary CT Angiography in Predicting the Outcomes of Acute Pulmonary Thromboembolism

Background: Pulmonary embolism (PE) is a potentially fatal condition. Knowledge of the prognostic factors for PE may facilitate the management of these patients. Pulmonary computed tomography (CT) angiography (PCTA) can play an effective role in their management. Objectives: To evaluate the prognostic value of certain PCTA-derived indicators of right ventricular dysfunction in patients with acute PE. Patients and Methods: A total of 61 hemodynamically stable patients with acute PE underwent PCTA and were followed-up for 60 days. The Qanadli index and 60-day mortality represented the PE severity and prognostic endpoints, respectively. The clinical significance of the following variables in predicting PE severity and mortality was examined: An abnormally positioned interventricular septum, right ventricular to left ventricular diameter ratio (RVD/LVD) on the axial plane, contrast medium reflux into the inferior vena cava (IVC), transverse diameter of the pulmonary trunk, and bolus-time curve indicators. Results: The 60-day mortality was estimated at 14.8% in this study. An abnormal interventricular septum morphology, RVD/LVD ratio, and contrast medium reflux into the IVC were significantly correlated with the Qanadli index. The pulmonary trunk diameter was the only predictor of 60-day mortality (optimal cutoff value, 33.5 mm; sensitivity, 66.7%; and specificity, 65.4%). The bolus-time curve indicators did not have any significant predictive value. Conclusion: Some PCTA-derived indicators of right ventricular dysfunction may serve as severity/prognostic predictors in hemodynamically stable patients with acute PE.

P118 THE ROLE OF PULMONARY ACT IN THE PATIENT WITH SARS–COV–2 INFECTION

Already from the first data in China it emerged that patients with cardiovascular comorbidities had an increased risk of contracting SARS–CoV–2 infection and a more unfavourable clinical course. From March to May 2020, 85 patients affected by COVID–19 were enrolled, hospitalized at the Hospital of Reggio Calabria. All patients underwent anamnesis, clinical evaluation, chest CT, ECG and measurement of markers of cardiovascular damage (Troponin I, CK–MB, LDH, D–dimer, BNP) and of inflammation (PCR, IL–6, and PCT). Thirty–one patients underwent echocardiography. In particular, we evaluated parietal dimensions and thicknesses, biventricular function and transvalvular tricuspid and pulmonary flows and correlated the data obtained with ECG, radiological, clinical, and biohumoral parameters. The aim of our study was to evaluate the prognostic impact of cardiovascular involvement in COVID– 19, investigating the effect of cardiovascular risk factors, levels of cardiovascular damage markers and newly emerging ECG and echocardiographic changes on a composite primary endpoint, consisting of the combination of death and the need for intensive care (ICU). The enrolled patients were divided into two subpopulations: those with better prognosis and those with poorer prognosis (ICU/exitus). We analysed the reciprocal correlation of each of the parameters and searched for the presence of echocardiographic signs of repercussion on the right sections of the pulmonary pathology. All markers of cardiovascular damage had significantly higher values in the most critically ill patients and similar behaviour had indices of inflammation. Patients with poorer prognosis had significantly lower lung AcT values, which correlated with higher D–dimer levels and more complicated hospital stays. There were no statistically significant differences between PAPs, right ventricular size, TAPSE and pulmonary trunk diameter in the two subpopulations. Larger right ventricular diameters were associated with more dilated lung trunks and higher IL–6 levels. The most interesting data of our study is the behaviour of pulmonary AcT: lower values of AcT were associated with higher levels of D–dimer, expression of a greater pulmonary microthrombotic burden, and a poorer prognosis, in the presence of PAPs normal. The dynamic analysis of this parameter, which is easy to calculate in the patient’s bed, can play a crucial role in the instrumental follow–up of patients hospitalized for SARS–CoV–2 infection.

Pulmonary vascular volume is associated with DLCO and fibrotic score in idiopathic pulmonary fibrosis: an observational study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a disease that primarily occurs in elderly individuals. However, it is difficult to diagnose and has a complex disease course. High-resolution computed tomography (HRCT) and lung function testing are crucial for its diagnosis and follow-up. However, the correlation of HRCT findings with lung function test results has not been extensively investigated.MethodsThis study retrospectively analysed the medical records and images of patients with IPF. Patients with evident emphysema and lung cancer were excluded. The diagnosis of all the included cases was confirmed following a discussion among specialists from multiple disciplines. The correlation of HRCT findings, including fibrotic score, HRCT lung volume, pulmonary artery trunk (PA) diameter and pulmonary vascular volume (PVV), with lung function test parameters, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), was analysed.ResultsA total of 32 patients were included. Higher fibrotic and PVV scores were significantly correlated with lower DLCO (r = − 0.59, p = 0.01; r = − 0.43, p = 0.03, respectively) but not with FVC. Higher PVV score significantly correlated with higher fibrotic score (r = 0.59, p < 0.01) and PA diameter (r = 0.47, p = 0.006).ConclusionOur study demonstrated the structural and functional correlation of IPF. The extent of lung fibrosis (fibrotic score) and PVV score were associated with DLCO but not with FVC. The PA diameter, which reflects the pulmonary artery pressure, was found to be associated with the PVV score.

Assessment of probability of pulmonary arterial hypertension among HIV-1 infected patients on haart and its relationship with Cd4 cells Count and viral load.

Background: HIV patients are more likely to develop cardiovascular disease than the general population and have a 2500-fold increased risk of developing pulmonary artery hypertension (PAH). HIV associated pulmonary hypertension was said to be more severe and is associated with higher mortality. Methodology: Across-sectional conducted among consecutive HIV patients age greater than 18 years receiving treatment at the antiretroviral therapy (ART) clinic of the Federal Medical Centre Nguru Yobe State Northeastern Nigeria. Results: One hundred and twenty (120) subjects were recruited into the study, thirteen had incomplete data and were excluded from the analysis. There was a significant negative correlation between CD4 cells count with tricuspid regurgitant flow velocity (TRv), pulmonary regurgitant flow velocity (PRv), pulmonary artery trunk diameter (PATd), right ventricular to left ventricular internal diameter (RV/LV) ratio, left ventricular eccentricity index (LVEI), and right atrial area (RAA), while the correlation between CD4 cells count and right ventricular acceleration time (RVAT) was positive and significant. On the other hand, the correlations between viral load and TRv, PRv, PATd, RV/LV ratio, and RAA were positive and significant while that between viral load and RVAT was negative and significant. Conclusions: This study revealed that HIV patients with low CD4 cell count and high viral load had a high probability of developing PAH ( significant negative relationship between variables associated with the probability of PAH with CD4 cell count and significant positive relationship with viral load), In HIV patients the probability of developing PAH decreases with adequate treatment (that suppress viral replication and increases CD4 count). We, therefore, recommend routine assessment of the probability of PAH in patients with HIV infection particularly those with low CD4 cell count and high viral load and encourage early commencement of HAART to prevent the development of pulmonary arterial hypertension.

466 The role of pulmonary act in the patient with SARS-CoV-2 infection

Already from the first data in China in early 2020 it emerged that patients with cardiovascular comorbidities had an increased risk of contracting SARS-CoV-2 infection and a more unfavourable clinical course. From March to May 2020, 85 patients affected by COVID-19 were enrolled, hospitalized at the Great Metropolitan Hospital of Reggio Calabria. The mean age was 63.6 ± 16.5 years. All patients underwent anamnesis, clinical evaluation, chest CT, ECG and measurement of markers of cardiovascular damage (Troponin I, CK-MB, LDH, D-dimer, BNP) and of inflammation (PCR, IL-6, and PCT). Thirty-one patients underwent echocardiography to look for signs of left ventricular dysfunction and/or repercussions of lung disease on the right sections. In particular, we evaluated parietal dimensions and thicknesses, biventricular function and transvalvular tricuspid and pulmonary flows and correlated the data obtained with ECG, radiological, clinical, and biohumoral parameters. The aim of our study was to evaluate the prognostic impact of cardiovascular involvement in COVID-19, investigating the effect of cardiovascular risk factors, levels of cardiovascular damage markers and newly emerging ECG and echocardiographic changes on a composite primary endpoint, consisting of the combination of exitus and the need for intensive care (ICU). For this purpose, the enrolled patients were divided into two subpopulations: those with better prognosis and those with poorer prognosis (ICU/exitus). We then analysed the reciprocal correlation of each of the investigated parameters and searched for the presence of echocardiographic signs of repercussion on the right sections of the pulmonary pathology. Among the patients with the poorest prognosis, 81.2% were hypertensive, 12.5% diabetic, 25% dyslipidaemic. Comparing the two subpopulations analysed, it emerged that patients with the worst prognosis were known hypertensive (P 0.02). Longer QTc intervals were associated with higher levels of CRP (P < 0.0001) and PCT (P 0.005). All markers of cardiovascular damage had significantly higher values in the most critically ill patients (P 0.001 for d-dimer, P < 0.001 for baseline and peak Troponin, P 0.001 for CK-MB, P 0.007 for BNP) and similar behaviour had indices of inflammation (P < 0.001 for PCR and IL-6). Patients with poorer prognosis had significantly lower lung AcT values ( P 0.002), which correlated with higher d-dimer levels (P 0.01) and more complicated hospital stays (P 0.02). There were no statistically significant differences between PAPs, right ventricular size, TAPSE, and pulmonary trunk diameter in the two subpopulations. Larger right ventricular diameters were associated with more dilated lung trunks (P 0.009) and higher IL-6 levels (P 0.004). The most interesting data of our study is the behaviour of pulmonary AcT: lower values of AcT were associated with higher levels of d-dimer, as an expression of a greater pulmonary microthrombotic burden, and a poorer prognosis, in the presence of PAPs basically normal. The dynamic analysis of this parameter, which is easy to calculate in the patient's bed, can play a crucial role in the instrumental follow-up of patients hospitalized for SARS-CoV-2 infection.

Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant.Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months±2 weeks after discharge from the hospital. The mean age of participants was 47±16 years (19-84 years); 49% of subjects were women.Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8±26,8 ml vs 93,5±29,4 ml; 37,7±13,0 ml vs 31,3±14,2 ml; 77,2±17,8 ml vs 62,2±18,7 ml, respectively, p&lt;0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004; 21,7±3,6 mm vs 18,7±2,5 mm, p&lt;0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] m&gt;&lt;0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p&lt;0,001) a&gt;&lt;0,001) and maximum width (36,1±4,6 mm vs 34,5±6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7±6,8 mm vs 48,6±7,1 mm, p=0,021).Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load.

Segmental evaluation of right ventricular systolic function in atrial septal defect (ASD) type II patients

Abstract Introduction A left to right (LR) shunt in atrial septal defect (ASD) may cause right heart and pulmonary overfilling, at the expense of the systemic circulation. Purpose The study objective was to evaluate the impact of LR shunt on left (LV) and right ventricular (RV) filling, function, and myocardial strain by using cardiovascular magnetic resonance imaging (CMR). Methods Thirty-five ASD type secundum patients (42±18 y.o.) were compared to a control group (n=40). Cine imaging was used to calculate ventricular volumes and ejection fraction (EF), global longitudinal (GLS) and circumferential (GCS), free wall (FW) and interventricular septal (IVS) longitudinal strain. Phase-contrast imaging was used to calculate pulmonary flow to systemic flow ratio (Qp/Qs). Results Qp/Qs was 2.2±0.60 (range 1.3–3.6), which resulted in higher RV end-diastolic volume/BSA (EDVi, 152±42 vs. 82±11 ml/m2), lower LV EDVi (72±17 vs. 83±10 ml/m2), and higher RV/LV EDVi ratio (2.1±0.5 vs. 1±0.1) compared to controls (all p&amp;lt;0.001) [Figure 1]. Patients also presented with higher RV, but lower LV indexed stroke volumes (both p&amp;lt;0.001), and a strong trend toward lower RVEF (p=0.08). They demonstrated significantly lower RV GLS (p=0.03) and longitudinal IVS strain (p&amp;lt;0.001) [Figure 2]. RV FW strain or RV GCS did not differ among study groups. Shunt severity correlated with RV size and stroke volume, right atrial size and pulmonary trunk diameter (all p&amp;lt;0.001). In contrast, no correlation was identified with functional nor strain parameters. Conclusion Cardiac remodeling in ASD patients with long-standing LR shunt negatively affects RV systolic performance, which is likely related to longitudinal septal dysfunction. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Comparison of echocardiographic parameters of patients with COVID-19 pneumonia in hospital and three months after discharge

Abstract Background COVID-19 affects firstly the respiratory system of patients however cardiovascular system is also damaged. To study the impact of a novel coronavirus infection on the cardiovascular system, in particular on echocardiographic parameters after SARS-CoV-2 is very important. Purpose To compare echocardiographic parameters in patients with COVID-19 pneumonia in hospital and 3 months after hospital discharge. Methods A total of 106 patients with confirmed COVID-19 pneumonia were included in the period from April to July 2020 within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. All patients underwent clinical examination including transthoracic echocardiography in hospital and 3 months ± 2 weeks after discharge. Mean age of patients was 47±16 years (19–84 years), mean body mass index was 28.2±5.7 kg/m2, females were 49%. During hospitalization, chest computed tomography detected mild lesions in 29.2%, moderate lesions in 31.1%, severe lesions in 27.4% and critical lesions in 5.7%. Cardiovascular pathology detected in 52% of patients. Results Three months after discharge significant dynamics of mean echocardiographic parameters was observed. Left ventricular end-diastolic, end-systolic and stroke volume decreased (113.8±26.8 vs 93.5±29.4 ml; 37.7±13.0 vs 31.3±14.2 ml; 77.2±17.8 vs 62.2±18.7 ml, respectively; all p&amp;lt;0.001). End-diastolic right ventricular outflow tract diameter, pulmonary artery trunk diameter decreased (26.0 [24.0–9.3] vs 25.0 [23.0–27.0] mm, p=0.004; 21.7±3.6 vs 18.7±2.5 mm, p&amp;lt;0.001), as well as pulmonary artery systolic pressure (28.0 [25.0–32.25] vs 21.5 [17.0–25.0] mmHg) and rate of moderate to severe tricuspid regurgitation (52.4 vs 19.8%, both p&amp;lt;0.001). Right atrium volume (42.0 [37.0–50.0] vs 31.0 [22.0–36.5] ml, p&amp;lt;0.001) and width decreased (36.1±4.6 vs 34.5±6.5 mm, p=0.023), however right atrium length increased (46.7±6.8 vs 48.6±7.1, p=0.021). Conclusions In patients after COVID-19 pneumonia echocardiography showed decrease of the load predominantly on the right heart 3 months after discharge. A subgroup analysis is planned depending on the severity of lung damage and presence of cardiovascular pathology. Funding Acknowledgement Type of funding sources: None.

Preoperative CT Findings for Predicting Acute Exacerbation of Interstitial Pneumonia After Lung Cancer Surgery: A Multicenter Case-Control Study.

BACKGROUND. Acute exacerbation (AE) is a life-threatening complication of inter-stitial pneumonia (IP). Thoracic surgery may trigger AE. OBJECTIVE. The purpose of this study is to explore the role of preoperative CT findings in predicting postoperative AE in patients with IP and lung cancer. METHODS. This retrospective case-control study included patients from 22 institutions who had IP and underwent thoracic surgery for lung cancer. AE was diagnosed on the basis of symptoms and imaging findings noted within 30 days after surgery and the absence of alternate causes. For each patient with AE, two control patients without AE were identified. After exclusions, the study included 92 patients (78 men and 14 women; 31 with AE [the AE group] and 61 without AE [the no-AE group]; mean age, 72 years). Two radiologists independently reviewed preoperative thin-slice CT examinations for pulmonary findings and resolved differences by consensus. The AE and no-AE groups were compared using the Fisher exact and Mann-Whitney U tests. Multivariable logistic regression was performed. Interreader agreement was assessed by kappa coefficients. RESULTS. A total of 94% of patients in the AE group underwent segmentectomy or other surgery that was more extensive than wedge resection versus 75% in the no-AE group (p = .046). The usual IP pattern was present in 58% of the AE group versus 74% of the no-AE group (p = .16). According to subjective visual scoring, the mean (± SD) ground-glass opacity (GGO) extent was 6.3 ± 5.4 in the AE group versus 3.9 ± 3.8 in the no-AE group (p = .03), and the mean consolidation extent was 0.5 ± 1.2 in the AE group versus 0.1 ± 0.3 in the no-AE group (p = .009). Mean pulmonary trunk diameter was 28 ± 4 mm in the AE group versus 26 ± 3 mm in the no-AE group (p = .02). In a model of CT features only, independent predictors of AE (p < .05) were GGO extent (odds ratio [OR], 2.8), consolidation extent (OR, 9.4), and pulmonary trunk diameter (OR, 4.2); this model achieved an AUC of 0.75, a PPV of 71%, and an NPV of 77% for AE. When CT and clinical variables were combined, undergoing segmentectomy or more extensive surgery also independently predicted AE (OR, 8.2; p = .02). CONCLUSION. The presence of GGO, consolidation, and pulmonary trunk enlargement on preoperative CT predicts AE in patients with IP who are undergoing lung cancer surgery. CLINICAL IMPACT. Patients with IP and lung cancer should be carefully managed when predictive CT features are present. Wedge resection, if possible, may help reduce the risk of AE in these patients. TRIAL REGISTRATION. University Hospital Medical Information Clinical Trial Registry UMIN000029661.

Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism.

Computed tomographic pulmonary angiography (CTPA) is the first-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA findings can predict 30-day mortality of patients with APE in Emergency Department. This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010-2019). These CTPA findings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis. The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values < 0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values < 0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained significant with an HR = 2.5 (95% CI 1.1-5.6) and HR = 1.9 (95% CI 0.95-3.7), respectively. CTPA quantification of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.

Right ventricular echocardiographic parameters associated with prothrombotic abnormalities in normotensive patients with acute pulmonary embolism

BackgroundIn acute pulmonary embolism (PE) right ventricular (RV) pressure overload negatively affects prognosis. Recently we have shown that RV dilatation is associated with a prothrombotic state in PE. We investigated which RV echocardiographic parameters best indicate prothrombotic alterations in acute PE. MethodsIn 121 normotensive, noncancer PE patients, markers of RV dilatation and dysfunction were evaluated on admission using transthoracic echocardiography, along with prothrombotic state markers, i.e. increased endogenous thrombin generation (ETP), low fibrin clot permeability (Ks, a measure of clot density), and prolonged clot lysis time (CLT). ResultsRV parasternal long axis (RVOT PLAX) >30 mm was associated with ETP (OR 3.86; 95% CI 1.55–9.62; p = 0.004) and CLT (OR 4.08; 95% CI 1.58–10.54; p = 0.004) in the top quartiles, but not with Ks. RV short parasternal axis (RVOT PSAX) >27 mm showed similar associations with higher ETP (OR 3.54; 95% CI 1.50–8.37; p = 0.004) and prolonged CLT (OR 2.78; 95% CI 1.17–6.62; p = 0.021). RV basal diameter >41 mm solely predicted prolonged CLT (OR 2.93; 95% CI 1.23–6.99; p = 0.016). The right atrium area, pulmonary trunk diameter, and tricuspid regurgitation maximum velocity were not related to prothrombotic markers, except for tricuspid annular plane systolic excursion weakly associated with ETP. Multivariable analysis showed that RVOT PSAX is independently associated with prolonged CLT (OR 1.16; 95% CI 1.04–1.30; p = 0.007), low Ks (OR 1.21; 95% CI 1.02–1.44; p = 0.029), and higher ETP (OR 1.14; 95% CI 1.03–1.26; p = 0.009). ConclusionsAmong RV echocardiographic parameters, the RVOT dilatation measured in PSAX best predicts prothrombotic alterations in PE patients.

Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography

PurposeThe aim of the study was to investigate the potential of electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) as a predictor of disease severity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). MethodForty-five CTEPH patients with a mean age of 63.8 years±12.7 y (±standard deviation) who had undergone ECG-gated CTPA and right heart catheterization (RHC) were included in the study. Right ventricular to left ventricular volume ratio (RVV/LVV), diameter ratio on 4-chamber view (RVD4CH/LVD4CH), pulmonary trunk (PT) diameter, PT to aortic diameter ratio (PT/A), and septal angle were correlated to mean pulmonary artery pressure (mPAP). Moreover, RVV/LVV and RVD4CH/LVD4CH were adjusted to pulmonary diameter index (PADi) and PT/A index. Areas under the curve (AUC) for predicting mPAP above 40 mmHg, 35 mmHg, and 30 mmHg were calculated. ResultsRVD4CH/LVD4CH revealed the strongest correlation to mPAP before (r = 0.6507) and after (r = 0.7650; p < 0.0001) PT/A adjustment. The AUCs for predicting pH with mPAP over 40 mmHg and 30 mmHg were 0.9229 and 0.864, respectively. A cutoff value of 1.298 enabled prediction of pH with mPAP over 40 mmHg with a sensitivity, specificity, positive predictive, and negative predictive value of 80.00 %, 95.83 %, 88.46 %, and 94.12 %, respectively. Intra- and interobserver variability were excellent for all parameters. ConclusionCombining different and easily evaluable ECG-gated CTPA parameters enables excellent prediction of pulmonary hemodynamics in CTEPH patients. Ventricular diameter ratio on 4-chamber view adjusted by the PT/A ratio yielded the best correlation to mPAP.

Importance of computed tomography pulmonary angiography for predict 30-day mortality in acute pulmonary embolism patients

ObjectiveThe purpose of the present study was to assess the implications of different parameters of computed tomography pulmonary angiography (CTPA) to predict 30-day mortality in acute pulmonary embolism (APE) patients. Material and MethodPatients who had clinical suspicion of APE and underwent CTPA were recruited in a retrospective cohort study. The findings of the CTPA included the parameters of right ventricular dysfunction (RVD), the severity of obstruction to the pulmonary artery by CT obstruction index, and the ratio of pulmonary trunk diameter and aorta. The endpoint of the study was established as the 30-day mortality associated with APE. ResultsA total of 238 patients with a confirmed APE diagnosis with CTPA were included in the study; 26 (10.9 %) of those patients died within 30 days. In patients with cancer and the Pulmonary Embolism Severity Index (PESI) class 5, the mortality rate was significantly higher. Compared with survivors, the mean CT obstruction index in the non-survivor group was significantly higher (p < 0.001). Higher mortality was associated with all RVD parameters identified by CTPA, such as the RV/LV ratio (p < 0.001), interventricular septum deviation grade 3 (p < 0.001), increased RV diameter (p < 0.001), and IVC contrast reflux (p < 0.001). The highest adjusted odds ratio was RV diameter at 1.094, followed by PESI and the CT obstruction index at 1.040. ConclusionCTPA-detected RVD parameters and CT obstruction index can predict a 30-day mortality rate in APE patients and be used for risk stratification. In APE patients, the RV diameter of 53 mm or greater and the CT obstruction index >70% is associated with increased 30-day mortality.