Pulmonary ventilation/perfusion scintigraphy in assessing residual pulmonary hypertension after pulmonary endarterectomy / 中华核医学与分子影像杂志

ABSTRACT

Objective:To analyze the relationships between baseline percentage of pulmonary perfusion defect scores (PPDs%) and residual pulmonary hypertension after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension (CTEPH) patients.Methods:A total of 37 CTEPH patients (21 males, 16 females, age (50±12) years) who had pre- and post-pulmonary endarterectomy ventilation/perfusion (V/Q) scans from January 2016 to January 2019 at Fuwai Hospital were retrospectively collected. Residual pulmonary hypertension was defined as post-surgery mean pulmonary artery pressure (mPAP) higher than 30 mmHg (1 mmHg=0.133 kPa). Semi-quantitative index PPDs% was calculated to represent the extent of impaired perfusion in the whole lung. Pre- and post-surgery pulmonary hemodynamic parameters including pulmonary arterial pressure and resistance and lung perfusion were compared. Factors that may be related residual pulmonary hypertension were analyzed using logistic regression analysis. Paired t test and independent-sample t test were also used. Results:Pulmonary endarterectomy significantly decreased mPAP ((50.22±11.72) vs (26.41±10.61) mmHg; t=12.599, P<0.001) and pulmonary vascular resistance((10.06±5.48) vs (2.89±1.58) Wood unit; t=8.086, P<0.001). The number of defected lung segments (13.79±2.11 vs 5.52±2.82; t=11.593, P<0.001) was significantly reduced. Patients who had residual pulmonary hypertension ( n=11) exhibited significantly higher PPDs% before the surgery compared to those who were without residual pulmonary hypertension ( n=26; (57.48±5.88)% vs (47.77±11.09)%; t=-3.458, P=0.002). Baseline PPDs% was an independent factor for predicting residual pulmonary hypertension after pulmonary endarterectomy (odds ratio ( OR)=1.106, 95% CI 1.006-1.216, P=0.036). Conclusions:Pulmonary V/Q scan can assess the therapeutic effects of pulmonary endarterectomy. Extent of impaired lung perfusion assessed by V/Q scan is the influencing factor for post-surgery residual pulmonary hypertension.