Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Anand Devaraj; Robert Loveridge; Diana Bosanac; Konstantinos Stefanidis; William Bernal; Christopher Willars; Julia A. Wendon; Georg Auzinger; Sujal R. Desai

doi:10.1007/s00330-014-3289-4

Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Anand Devaraj, Robert Loveridge, Diana Bosanac, Konstantinos Stefanidis, William Bernal, Christopher Willars, Julia A. Wendon, Georg Auzinger, Sujal R. Desai^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Objectives
To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography.

Methods
Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA(meas)) and the mean left and right main PA diameter (RLPA(meas)). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA(vis)). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA(vis) combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis.

Results
There were moderate correlations between mPAP and both PA/AA(meas) and RLPA(meas) (r(s) = 0.41 and r(s) = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA(vis) and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001).

Conclusions
CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation.

Key Points

CT signs correlate with right-sided heart catheter data in portopulmonary hypertension

CT adds to the transthoracic echocardiography detection of portopulmonary hypertension

CT may have a complementary role in pre-liver transplantation triage

Original language	English
Pages (from-to)	2385-2393
Number of pages	9
Journal	European Radiology
Volume	24
Issue number	10
DOIs	https://doi.org/10.1007/s00330-014-3289-4
Publication status	Published - Oct 2014

Keywords

Tomography, x-ray computed
Transthoracic echocardiography
Hypertension, pulmonary
Cirrhosis, familial with pulmonary hypertension
PULMONARY ARTERIAL-HYPERTENSION
COMPUTED-TOMOGRAPHY
TRANSPLANT CANDIDATES
LIVER-TRANSPLANTATION
RIGHT HEART
GUIDELINES
ANGIOGRAPHY
DIAGNOSIS
DIAMETER
FIBROSIS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00330-014-3289-4

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@article{d3c8e1bd003f4844baf5e370f2004d68,

title = "Portopulmonary hypertension: Improved detection using CT and echocardiography in combination",

abstract = "Objectives To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography. Methods Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA(meas)) and the mean left and right main PA diameter (RLPA(meas)). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA(vis)). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA(vis) combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis. Results There were moderate correlations between mPAP and both PA/AA(meas) and RLPA(meas) (r(s) = 0.41 and r(s) = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA(vis) and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001). Conclusions CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation. Key Points CT signs correlate with right-sided heart catheter data in portopulmonary hypertension CT adds to the transthoracic echocardiography detection of portopulmonary hypertension CT may have a complementary role in pre-liver transplantation triage",

keywords = "Tomography, x-ray computed, Transthoracic echocardiography, Hypertension, pulmonary, Cirrhosis, familial with pulmonary hypertension, PULMONARY ARTERIAL-HYPERTENSION, COMPUTED-TOMOGRAPHY, TRANSPLANT CANDIDATES, LIVER-TRANSPLANTATION, RIGHT HEART, GUIDELINES, ANGIOGRAPHY, DIAGNOSIS, DIAMETER, FIBROSIS",

author = "Anand Devaraj and Robert Loveridge and Diana Bosanac and Konstantinos Stefanidis and William Bernal and Christopher Willars and Wendon, {Julia A.} and Georg Auzinger and Desai, {Sujal R.}",

year = "2014",

month = oct,

doi = "10.1007/s00330-014-3289-4",

language = "English",

volume = "24",

pages = "2385--2393",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "10",

}

TY - JOUR

T1 - Portopulmonary hypertension

T2 - Improved detection using CT and echocardiography in combination

AU - Devaraj, Anand

AU - Loveridge, Robert

AU - Bosanac, Diana

AU - Stefanidis, Konstantinos

AU - Bernal, William

AU - Willars, Christopher

AU - Wendon, Julia A.

AU - Auzinger, Georg

AU - Desai, Sujal R.

PY - 2014/10

Y1 - 2014/10

N2 - Objectives To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography. Methods Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA(meas)) and the mean left and right main PA diameter (RLPA(meas)). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA(vis)). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA(vis) combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis. Results There were moderate correlations between mPAP and both PA/AA(meas) and RLPA(meas) (r(s) = 0.41 and r(s) = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA(vis) and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001). Conclusions CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation. Key Points CT signs correlate with right-sided heart catheter data in portopulmonary hypertension CT adds to the transthoracic echocardiography detection of portopulmonary hypertension CT may have a complementary role in pre-liver transplantation triage

AB - Objectives To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography. Methods Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA(meas)) and the mean left and right main PA diameter (RLPA(meas)). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA(vis)). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA(vis) combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis. Results There were moderate correlations between mPAP and both PA/AA(meas) and RLPA(meas) (r(s) = 0.41 and r(s) = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA(vis) and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001). Conclusions CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation. Key Points CT signs correlate with right-sided heart catheter data in portopulmonary hypertension CT adds to the transthoracic echocardiography detection of portopulmonary hypertension CT may have a complementary role in pre-liver transplantation triage

KW - Tomography, x-ray computed

KW - Transthoracic echocardiography

KW - Hypertension, pulmonary

KW - Cirrhosis, familial with pulmonary hypertension

KW - PULMONARY ARTERIAL-HYPERTENSION

KW - COMPUTED-TOMOGRAPHY

KW - TRANSPLANT CANDIDATES

KW - LIVER-TRANSPLANTATION

KW - RIGHT HEART

KW - GUIDELINES

KW - ANGIOGRAPHY

KW - DIAGNOSIS

KW - DIAMETER

KW - FIBROSIS

U2 - 10.1007/s00330-014-3289-4

DO - 10.1007/s00330-014-3289-4

M3 - Article

SN - 0938-7994

VL - 24

SP - 2385

EP - 2393

JO - European Radiology

JF - European Radiology

IS - 10

ER -

Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Abstract

Keywords

UN SDGs

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