Findings Associated with Pulmonary Hypertension: CT Angiography Based Study

Pulmonary hypertension (PH) is a complex disorder and may be related to a variety of diseases. It may arise in association with chronic thromboembolic pulmonary hypertension (CTEPH) or pulmonary embolism (PE). Knowledge of the radiological features is required to characterize and accurately diagnose the conditions and may improve the outcome. This study was designed to evaluate the clinical characteristics and the computerized tomography angiography findings in patients with PH, PE and CTEPH. Contrast-enhanced CT scans were acquired in 55 Sudanese patients with PE, 20 patients with PH, 25 patients with CTEPH and 50 normal subjects who were considered as control group. The CT diagnostic criteria for all cases were characterized. The clinical signs, parenchymal abnormalities, pulmonary tree and cardiac segments in all groups were characterized and compared with the control group. The results showed that the most common clinical characteristics were found to be chest pain, dyspnea, lower limb swelling, tachycardia and syncope which were correlated significantly with the presence of the disease. In all patients groups, the pulmonary vascular segments, cardiac segments and lung parenchyma changes were detected and were significantly different from the normal control subjects at p ≤ 0.01. It was found that CT angiography has a significant role in the diagnostic evaluation of these groups of patients. CT imaging is acceptably used in diagnosis, defining cause, quantifying heart segments and parenchyma changes in order to assess the feasibility of surgery, monitoring and therapeutic planning.

Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.