TY - JOUR
T1 - Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension
T2 - results of the InShape III study
AU - Ende-Verhaar, Yvonne M.
AU - Meijboom, Lilian J.
AU - Kroft, Lucia J.M.
AU - Beenen, Ludo F.M.
AU - Boon, Gudula J.A.M.
AU - Middeldorp, Saskia
AU - Nossent, Esther J.
AU - Symersky, Petr
AU - Huisman, Menno V.
AU - Bogaard, Harm Jan
AU - Vonk Noordegraaf, Anton
AU - Klok, Frederikus A.
N1 - Copyright © 2019 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is often diagnosed after a long delay, even though signs may already be present on the computed tomography pulmonary angiogram (CTPA) used to diagnose a preceding acute pulmonary embolism (PE). In this setting of suspected acute PE, we evaluated the diagnostic accuracy of dedicated CTPA reading for the diagnosis of already existing CTEPH. METHODS: Three blinded expert radiologists scored radiologic signs of CTEPH on initial CTPA scans with confirmed acute PE in 50 patients who were subsequently diagnosed with CTEPH during follow-up (cases), and in 50 patients in whom sequential echocardiograms performed >2years after the acute PE diagnosis did not show any signs of pulmonary hypertension (controls). All 50 control index CTPA scans had signs of right ventricular (RV) overload. Sensitivity and specificity of expert CTPA reading was calculated, and best-predicting radiologic parameters were identified. RESULTS: The overall expert reading yielded a sensitivity of 72% (95% confidence interval [CI] 58%–84%) and a specificity of 94% (95% CI 83%–99%) for CTEPH diagnosis. Multivariate analysis identified 6 radiologic parameters as independent predictors: intravascular webs; pulmonary artery retraction or dilatation; bronchial artery dilatation; right ventricular (RV) hypertrophy; and interventricular septum flattening. The presence of 3 or more these parameters was associated with a sensitivity of 70% (95% CI 55%–82%), a specificity of 96% (95% CI 86%–100%), and a c-statistic of 0.92. CONCLUSIONS: Standardized reading of CTPA scans performed for acute PE can be useful for the diagnosis of CTEPH when structured identification of 6 characteristics is employed during interpretation. The use of this strategy may help reduce diagnostic delay of CTEPH.
AB - BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is often diagnosed after a long delay, even though signs may already be present on the computed tomography pulmonary angiogram (CTPA) used to diagnose a preceding acute pulmonary embolism (PE). In this setting of suspected acute PE, we evaluated the diagnostic accuracy of dedicated CTPA reading for the diagnosis of already existing CTEPH. METHODS: Three blinded expert radiologists scored radiologic signs of CTEPH on initial CTPA scans with confirmed acute PE in 50 patients who were subsequently diagnosed with CTEPH during follow-up (cases), and in 50 patients in whom sequential echocardiograms performed >2years after the acute PE diagnosis did not show any signs of pulmonary hypertension (controls). All 50 control index CTPA scans had signs of right ventricular (RV) overload. Sensitivity and specificity of expert CTPA reading was calculated, and best-predicting radiologic parameters were identified. RESULTS: The overall expert reading yielded a sensitivity of 72% (95% confidence interval [CI] 58%–84%) and a specificity of 94% (95% CI 83%–99%) for CTEPH diagnosis. Multivariate analysis identified 6 radiologic parameters as independent predictors: intravascular webs; pulmonary artery retraction or dilatation; bronchial artery dilatation; right ventricular (RV) hypertrophy; and interventricular septum flattening. The presence of 3 or more these parameters was associated with a sensitivity of 70% (95% CI 55%–82%), a specificity of 96% (95% CI 86%–100%), and a c-statistic of 0.92. CONCLUSIONS: Standardized reading of CTPA scans performed for acute PE can be useful for the diagnosis of CTEPH when structured identification of 6 characteristics is employed during interpretation. The use of this strategy may help reduce diagnostic delay of CTEPH.
KW - CT pulmonary angiography
KW - accuracy
KW - chronic thromboembolic pulmonary hypertension
KW - diagnosis
KW - pulmonary embolism
UR - http://www.scopus.com/inward/record.url?scp=85063799791&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063799791&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30962147
U2 - https://doi.org/10.1016/j.healun.2019.03.003
DO - https://doi.org/10.1016/j.healun.2019.03.003
M3 - Article
C2 - 30962147
SN - 1053-2498
VL - 38
SP - 731
EP - 738
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 7
ER -