The value of ventilation/perfusion scanning and CT pulmonary angiography in predicting chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a one-year follow-up study

• Published in: The international journal of cardiovascular imaging Vol. 38; no. 10; pp. 2249 - 2259
• Main Authors: Han, Xu, Han, Kai, Ma, Xinghong, Sun, Ruoxi, Wang, Lei, Fang, Wei
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2022; Springer Nature B.V
• Subjects: Angiography; Anticoagulants; Cardiac Imaging; Cardiology; Computed tomography; Diagnosis; Echocardiography; Embolism; Embolisms; Hypertension; Imaging; Medical imaging; Medicine; Medicine & Public Health; Obstructions; Original Paper; Performance prediction; Perfusion; Pulmonary arteries; Pulmonary artery; Pulmonary embolisms; Radiology; Regression analysis; Risk analysis; Risk factors; Scanning; Sensitivity; Thromboembolism; Ventilation; Ventilation/perfusion scanning; Chronic thromboembolic pulmonary hypertension; Acute pulmonary embolism; CT pulmonary angiography
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-022-02629-5

To investigate the value of ventilation/perfusion (V/Q) scanning and CT pulmonary angiography (PA) in predicting CTEPH development after acute pulmonary embolism (APE). This study was performed in APE patients who had undergone both V/Q and CT PA after 3-month anticoagulation. The residual pulmonary obstructions were assessed based on V/Q and CT PA, and then recorded as pulmonary perfusion detect score (PPDs) and CT pulmonary artery obstruction index (PAOI). The predictive performance of PPDs and CT PAOI for CTEPH were determined and risk factors for predicting CTEPH development were identified. A total of 235 patients with initial diagnosis of APE were included in this study. ROC analysis showed that the AUCs of the PPDs and CT PAOI were 0.957 and 0.895, with corresponding cut-off values of 20.50% and 17.50% for predicting CTEPH development. Neither sensitivity nor specificity differed significantly between PPDs and CT PAOI (Sensitivity: 92.00% vs. 80.00%, P  = 0.25; Specificity: 88.10% vs. 89.52%, P  = 0.69). The univariable and multivariable logistic regression analysis demonstrated that pulmonary arterial hypertension confirmed by echocardiography at initial APE diagnosis (OR: 6.16, 95%CI: 1.31–29.02, P  = 0.02), a PPDs of > 20.50% (OR: 22.95, 95%CI: 2.37–222.19, P  = 0.007), and a CT PAOI of > 17.50% (OR: 9.98, 95%CI: 2.06–48.49, P  = 0.004) were associated with CTEPH development. Both V/Q and CT PA after 3-month anticoagulation for APE showed great performance in predicting CTEPH development, and V/Q scanning has a tendency to be more sensitive but less specific than CT PA. The residual pulmonary embolism detected by V/Q and CT PA was associated with an increased risk of CTEPH development.