Abstract
441
Objectives: Pulmonary hypertension (PH) influences pulmonary vasculature as well as bilateral ventricles. Comprehensive evaluation of the cardiopulmonary vascular unit requires integrated information from multimodalities. We aimed to investigate the association of disease severity from invasive hemodynomics with commonly used noninvasive methods, including first-pass radionuclide angiography (FP-RNA), ultrasonography and chest computed tomography (CT).
Methods: One hundred and three symptomatic patients (aged 48±15 y, 44 men) with suspected PH were consecutively enrolled since Aug. 2009. FP-RNA was performed immediately after exercise treadmill test (ETT) and at rest. Definite diagnosis was made by right heart catheterization (RHC). The parameters obtained from RHC, FP-RNA, ultrasonography and chest CT were correlated.
Results: There were 70 patients diagnosed as PH. Eighteen patients failed to complete ETT due to severe sickness. Compared to non-PH patients, PH subjects tended to have worse post-stress and rest lung mean transit, post-stress biventricular function in FP-RNA, greater ultrasonographic dimension of left atrium, interventricular septum, posterior wall, right ventricle (RV), higher tricuspid regurgitation maximal pressure gradient (TRmaxPG), and less mitral valve early to atrial filling ratio; all of the dimensional measurements in CT differed significantly in two groups as well. After multivariate linear regression, TRmaxPG was the only independent predictor of pulmonary vascular resistance (PVR) (R2=0.69, P<0.001) in the resting model, while post-stress RV function of FP-RNA assisted in the prediction of PVR besides TRmaxPG (R2=0.75).
Conclusion: Multimodal noninvasive approach can have incremental value to evaluate the disease severity in patients with PH. Table. The demographic and imaging data of the study population.