Pulmoner Hipertansiyonlu Hastalarda Ekokardiyografik Sistolik Pulmoner Arter Basıncının Bilgisayarlı tomografi ile Ölçülen Torasik Metriklerle İlişkisi

Abstract

Giriş: Şüpheli pulmoner hipertansiyon (PH)’lu hastaların değerlendirilmesinde Doppler ekokardiyografi ile ölçülen sistolik pulmoner arter basıncı (sPAB) ilk seçenek incelemedir. Bu araştırmada PH hastalarında kontrastlı toraks bilgisayarlı tomografi (BT) ile elde edilen pulmoner damar ve sağ kalp boşluklarının çapları ile ekokardiyografik sPAB arasındaki ilişkiyi belirlemeyi amaçladık.

Hastalar ve Yöntem: Araştırmaya sPAB > 35 mmHg olup ekokardiyografik inceleme ile 3 gün içerisinde BT çekilmiş olan toplam 68 hasta (44 kadın, 24 erkek) dahil edildi. Ana pulmoner erter (APA), sağ ve sol pulmoner arterler, sağ ve sol interlobar dal arterlerin çapları ile sağ ventrikül duvar kalınlıkları ve çapları birincil ölçümler idi. Pulmoner damar ölçümleri, asendan aorta, desendan aorta ve toraks çapına oranlanarak ikincil türev ölçümler elde edildi. sPAB ile birincil ve ikincil ölçümler arasındaki ilişki korelasyon analizi ile araştırıldı.

Bulgular: APA, sol ve sağ pulmoner arterler, sol ve sağ interlobar arter çapları ile sağ ventrikül çap ve duvar kalınlığı ölçümlerinin tamamı sPAB ile korele idi. İkincil türev ölçümler ise sPAB ile olan ilişkiyi zayıflattı. Çok değişkenli analizde sPAB ile tek bağımsız ilişkisi olan parametre APA çapı idi (R= 0.65, p< 0.001). Sol kalp patolojisine sekonder sPAB artışı olan hastalar hariç tutulduğunda, geriye kalan 48 (%71) hastanın alt grup analizinde APA çapı ile sPAB arasında daha güçlü bir korelasyon olduğu gözlendi.

Sonuç: Çeşitli toraks BT ölçütleri arasında sPAB ile en güçlü ve bağımsız ilişkili olanı APA çapıdır. Prekapiller PH hastalarında, sPAB ile APA çapı arasındaki ilişki daha da belirgindir.

Keywords

• Tomografi,emisyon-bilgisayarlı,pulmoner arter,hipertansiyon,pulmoner

The Relationship Between Computed Tomography Derived Thoracic Metrics and Echocardiographic Systolic Pulmonary Arterial Pressure in Patients with Pulmonary Hypertension

Abstract

Introduction: Doppler echocardiography-derived systolic pulmonary artery pressure (sPAP) is the first-line examination in evaluating patients with suspected pulmonary hypertension (PH). We aimed to determine the relationship between the contrast-enhanced chest computed tomography (CT)-derived dimensions of pulmonary vessels/right heart chambers and echocardiographic sPAP in patients with PH.

Patients and Methods: Overall, 68 patients (44 female, 24 male) with sPAP > 35 mmHg who underwent CT within 3 days of echocardiographic examination were included. The diameters of the main pulmonary artery (MPA), right and left pulmonary arteries, and right and left interlobar branch arteries and the wall thicknesses and diameters of the right ventricle were measured. Pulmonary arterial measurements were adjusted based on diameters of the ascending aorta, descending aorta, and thorax length. The right ventricular measurements were adjusted by left ventricular internal dimensions and wall thicknesses and by thorax length. The relationships between sPAP and all primary and adjusted measurements were assessed by correlation analyses.

Results: The dimensions of MPA, left and right pulmonary arteries, left and right interlobar arteries, right ventricular chamber, and wall thickness were all related to sPAP. Adjustment of these measurements lessened the relationship with sPAP. By multivariate analysis, MPA was the only independent variable related to sPAP (r= 0.65, p< 0.001). Subgroup analysis of 48 (71%) patients with sPAP elevation not caused by left heart pathology revealed a stronger correlation between MPA and sPAP (r= 0.72, p< 0.001).

Conclusion: MPA was the strongest single independent correlator of sPAP among various CT measurements. The relationship between sPAP and MPA was more pronounced in patients with precapillary PH.

Keywords

• Tomography,emission-computed,pulmonary artery,hypertension,pulmonary

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