TY - JOUR
T1 - CTA-derived left to right atrial size ratio distinguishes between pulmonary hypertension due to heart failure and idiopathic pulmonary arterial hypertension
AU - Huis in' t Veld, Anna
AU - Van Vliet, Alexander G.
AU - Spruijt, Onno A.
AU - Handoko, M. Louis
AU - Marcus, J. Tim
AU - Noordegraaf, Anton Vonk
AU - Bogaard, Harm-Jan
PY - 2016/11/15
Y1 - 2016/11/15
N2 - Background/objectives: Assessing atrial sizes by routine non-gated CT-angiography (CTA) could be of value in discriminating between pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF) and idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine how left (LA) and right atrial (RA) sizes on non-gated CTA can help discriminate between these patients. Methods and results: In an initial study, CMR was used in 15 IPAH and 15 PH-HFpEF patients to determine LA-and RA size throughout the cardiac cycle. While significant variations were noted in LA size over the cardiac cycle, the calculated ratio of left over right atrial size (LA/RA ratio) remained stable in both groups and discriminated between PH-HFpEF and IPAH. In a second study, routine non-gated CTA was used to validate the diagnostic use of a LA/RA ratio in 95 consecutive treatment-naive patients with a final diagnosis of either IPAH (n = 64) or PH-HFpEF (n = 31). ROC analyses were conducted to determine the discriminative properties of atrial size parameters. On a transversal view, LA size was 19 cm(2) (+/- 5) in the IPAH group versus 27 cm(2) (+/- 6) in the PH-HFpEF group (p <0.001). CTA derived LA/RA ratio was significantly higher in PH-HFpEF patients compared to IPAH patients and had good discriminative abilities (AUC = 0.833). Conclusions: Assessing LA/RA size ratio by non-gated CTA allows for accurate discrimination between PH-HFpEF and IPAH patients. Because CTA is often available in the early diagnostic work-up, a LA/RA size ratio may guide clinical and diagnostic decision-making, even before invasive hemodynamic measurements. (C) 2016 Elsevier Ireland Ltd. All rights reserved
AB - Background/objectives: Assessing atrial sizes by routine non-gated CT-angiography (CTA) could be of value in discriminating between pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF) and idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine how left (LA) and right atrial (RA) sizes on non-gated CTA can help discriminate between these patients. Methods and results: In an initial study, CMR was used in 15 IPAH and 15 PH-HFpEF patients to determine LA-and RA size throughout the cardiac cycle. While significant variations were noted in LA size over the cardiac cycle, the calculated ratio of left over right atrial size (LA/RA ratio) remained stable in both groups and discriminated between PH-HFpEF and IPAH. In a second study, routine non-gated CTA was used to validate the diagnostic use of a LA/RA ratio in 95 consecutive treatment-naive patients with a final diagnosis of either IPAH (n = 64) or PH-HFpEF (n = 31). ROC analyses were conducted to determine the discriminative properties of atrial size parameters. On a transversal view, LA size was 19 cm(2) (+/- 5) in the IPAH group versus 27 cm(2) (+/- 6) in the PH-HFpEF group (p <0.001). CTA derived LA/RA ratio was significantly higher in PH-HFpEF patients compared to IPAH patients and had good discriminative abilities (AUC = 0.833). Conclusions: Assessing LA/RA size ratio by non-gated CTA allows for accurate discrimination between PH-HFpEF and IPAH patients. Because CTA is often available in the early diagnostic work-up, a LA/RA size ratio may guide clinical and diagnostic decision-making, even before invasive hemodynamic measurements. (C) 2016 Elsevier Ireland Ltd. All rights reserved
KW - Atrial size
KW - Computed tomography
KW - Diagnostics
KW - Heart failure with preserved ejection fraction
KW - Pulmonary hypertension
U2 - https://doi.org/10.1016/j.ijcard.2016.08.314
DO - https://doi.org/10.1016/j.ijcard.2016.08.314
M3 - Article
C2 - 27573596
SN - 0167-5273
VL - 223
SP - 723
EP - 728
JO - International journal of cardiology
JF - International journal of cardiology
ER -