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

Yıl 2016, Cilt: 19 Sayı: 1, 1 - 6, 04.04.2016

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al; ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009;30:2493-537.
• 2. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc, and the Pulmonary Hypertension Association. Circulation 2009;119:2250-94.
• 3. Lettieri CJ, Nathan SD, Barnett SD, Ahmad S, Shorr AF. Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 2006;129:746-52.
• 4. McGoon M, Gutterman D, Steen V, Barst R, McCrory DC, Fortin TA, et al; American College of Chest Physicians. Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004;126(Suppl 1):14S-S34.
• 5. Raymond RJ, Hinderliter AL, Willis PW, Ralph D, Caldwell EJ, Williams W, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 2002;39:1214-9.
• 6. Yock PG, Popp RL. Noninvasive evaluation of intracardiac pressures using Doppler ultrasound: a case study of panvalvular regurgitation. Clin Cardiol 1985;8:565-71.
• 7. Berger M, Haimowitz A, Van Tosh A, Berdoff RL, Goldberg E. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985;6:359-65.
• 8. Fisher MR, Criner GJ, Fishman AP, Hassoun PM, Minai OA, Scharf SM, et al; NETT Research Group. Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J 2007;30:914-21.
• 9. Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 2003;167:735-40.
• 10. Sciomer S, Badagliacca R, Fedele F. Pulmonary hypertension: echocardiographic assessment. Ital Heart J 2005;6:840-5.
• 11. Haimovici JB, Trotman-Dickenson B, Halpern EF, Dec GW, Ginns LC, Shepard JA, et al. Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program. Acad Radiol 1997;4:327-34.
• 12. Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 1999;14:270-8.
• 13. Devaraj A, Wells AU, Meister M, Corte TJ, Wort SJ, Hansell DM. Detection of pulmonary hypertension with multidetector CT and echocardiography alone and in combination. Radiology 2010;254:609-16.
• 14. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
• 15. Scharf SM, Iqbal M, Keller, Criner G, Lee S, Fessler HE; National Emphysema Treatment Trial (NETT) Group. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 2002;166:314-22.
• 16. Ohno Y, Koyama H, Nogami M, Takenaka D, Matsumoto S, Onishi Y, et al. Dynamic perfusion MRI: capability for evaluation of disease severity and progression of pulmonary arterial hypertension in patients with connective tissue disease. J Magn Reson Imaging 2008;28:887-99.
• 17. Ghaye B, Szapiro D, Mastora I, Delannoy V, Duhamel A, Remy J, et al. Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis? Radiology 2001;219:629-36.
• 18. Matsuoka S, Washko GR, Dransfield MT, Yamashiro T, San Jose Estepar R, Diaz A, et al. Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD: correlations with emphysema and airflow limitation. Acad Radiol 2010;17:93-9.
• 19. Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest 1998;113:1250-6.
• 20. Murata I, Kihara H, Shinohara, Ito K. Echocardiographic evaluation of pulmonary arterial hypertension in patients with progressive systemic sclerosis and related syndromes. Jpn Circ J 1992;56:983-91.
• 21. Mettler FA Jr, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources. Radiology 2009;253:520-31.
• 22. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169:2078-86.