RESUMO
【Objective】 To compare the value of CT pulmonary angiography (CTPA) and echocardiography in predicting the degree pulmonary hypertension (PH). 【Methods】 Fifty-four patients in our hospital who underwent right heart catheterization, CTPA and echocardiography for suspected or confirmed PH from November 2013 to April 2021 were retrospectively recruited. Pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (PAMP) were measured by right heart catheterization. According to PAMP, the patients were divided into non-PH group and mild, moderate, and severe PH groups. The three-dimensional model of the pulmonary artery was obtained by computer-aided segmentation, and the best fitting circle diameter (Dfit), inscribed circle diameter (Dmin), circumscribed circle diameter (Dmax), hydraulic diameter (Dh), cross-sectional area (Area), circumference (Scf), and the largest area and largest short diameter of the right ventricle were measured. Echocardiography was used to estimate PASP. The differences in the above parameters between different PH groups were compared, the correlations of the above parameters with PASP and PAMP were analyzed, and statistically significant indicators were included to establish three predictive models of PAMP (Model 1: CTPA pulmonary artery; Model 2: CTPA pulmonary artery+CTPA right ventricle; Model 3: CTPA pulmonary artery+CTPA right ventricle+echocardiography), and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of the three models. 【Results】 Some parameters of main pulmonary artery (Dfit, Dmin, Dmax, Dh, Area, Scf), right pulmonary artery (Dmax, Dh, Area, Scf), left pulmonary artery (Dfit), and right ventricular short diameter increased with the increase of PAMP (P<0.05). Dfit, Dmin, Dh, and area of main pulmonary artery, right pulmonary artery and left pulmonary artery were positively correlated with PASP and PAMP (P<0.05). Right ventricular short diameter and right ventricular maximum area were positively correlated with PASP (P<0.05), and right ventricular short diameter was positively correlated with PAMP (P<0.05). The estimated value of pulmonary artery systolic blood pressure in echocardiography was positively correlated with PASP and PAMP (P<0.05). Model 1, Model 2 and Model 3 could all be used to identify mild PH and moderate PH, among which Model 3 had the best performance in identifying non-PH and mild PH, moderate PH and severe PH. 【Conclusion】 CTPA and echocardiography are helpful in assessing the degree of PH, and the combination of the two has better accuracy in distinguishing non-PH from mild PH, moderate and severe PH.
RESUMO
El cateterismo cardíaco derecho representa el principal estudio diagnóstico necesario para confirmar la presencia de hipertensión arterial pulmonar, entendida como enfermedad poco frecuente, discapacitante y de pronóstico variable. Su indicación principal tiene lugar ante todo paciente en el que exista una fuerte sospecha de hipertensión pulmonar, aunque sus usos se extienden más allá, siendo muy útil en la valoración de la respuesta al tratamiento y en el estudio de otras patologías como cardiopatías congénitas y pacientes sometidos a trasplante cardíaco. Para su realización requiere de una técnica sistemática y rigurosa, con el fin de obtener resultados confiables que puedan aplicarse a la práctica diaria. Su valor pronóstico es indiscutible, al aportar parámetros hemodinámicos determinantes para la estratificación de pacientes y la implementación de estrategias terapéuticas dirigidas en función del riesgo. Sin embargo, no está exento de complicaciones, algunas de ellas potencialmente mortales, aunque en términos generales resulta ser un procedimiento seguro con baja tasa de morbi-mortalidad en los principales centros donde se realiza.
Right heart catheterization represents the main diagnostic study necessary to confirm the presence of pulmonary arterial hypertension, understood as a rare, disabling disease with variable prognosis. Its main indication occurs before any patient in whom there is a strong suspicion of pulmonary hypertension, although its uses extend further, being very useful in the assessment of the response to treatment and in the study of other pathologies such as heart disease congenital and patients undergoing cardiac transplantation. To procedure it requires a systematic and rigorous technique, in order to obtain reliable results that can be applied to daily practice. Its prognostic value is indisputable, by providing precise hemodynamic parameters for the stratification of patients and the implementation of therapeutic strategies directed according to risk. However, it is not free of complications, some of them potentially fatal, although in general terms it turns out to be a safe procedure with a low rate of morbidity and mortality in the main centers where it is performed.
O cateterismo cardíaco direito representa o principal estudo diagnóstico necessário para confirmar a presença de hipertensão arterial pulmonar, entendida como uma doença rara e incapacitante com prognóstico variável. A sua principal indicação ocorre em todos os pacientes em que haja uma forte suspeita de hipertensão pulmonar, mas a sua utilização se estendem para além de ser muito útil na avaliação da resposta ao tratamento e o estudo de outras doenças tais como a doença cardíaca congênitos e pacientes submetidos a transplante cardíaco. Para realizá-lo, é necessária uma técnica sistemática e rigorosa, a fim de obter resultados confiáveis que possam ser aplicados na prática diária. Seu valor prognóstico é indiscutível, pois fornece parâmetros hemodinâmicos precisos para a estratificação dos pacientes e a implementação de estratégias terapêuticas direcionadas de acordo com o risco. Entretanto, não é isenta de complicações, algumas delas potencialmente fatais, embora em termos gerais se revele um procedimento seguro, com baixa taxa de morbidade e mortalidade nos principais centros onde é realizada.