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

Year 2016, Volume: 19 Issue: 1, 1 - 6, 04.04.2016

Sabahattin Gündüz , Nesrin Gündüz Ertuğrul Zencirci Banu Şahin Yıldız Mustafa Yıldız Mehmet Özkan

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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