Clinical significance of lung cross-sectional area measured by computed tomography in chronic thromboembolic pulmonary hypertension: The correlation with pulmonary hemodynamics and the limitations

• Published in: Pulmonary circulation Vol. 13; no. 3; pp. e12287 - n/a
• Main Authors: Kuriyama, Ayaka, Kasai, Hajime, Sugiura, Toshihiko, Nagata, Jun, Naito, Akira, Sekine, Ayumi, Shigeta, Ayako, Sakao, Seiichiro, Ishida, Keiichi, Matsumiya, Goro, Tanabe, Nobuhiro, Suzuki, Takuji
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.07.2023; John Wiley and Sons Inc; Wiley
• Subjects: chronic thromboembolic pulmonary hypertension; Clinical significance; computed tomography; Hemodynamics; pulmonary arterial pressure; Pulmonary arteries; pulmonary endarterectomy; Pulmonary hypertension; right heart catheterization; Thromboembolism; Tomography; chronic thromboembolic pulmonary hypertension; computed tomography; right heart catheterization; pulmonary endarterectomy; pulmonary arterial pressure
• ISSN: 2045-8932; 2045-8940; 2045-8940
• DOI: 10.1002/pul2.12287

The percentage cross-sectional area of the lung under five (%CSA ) is the percentage of pulmonary vessels with <5 mm area relative to the total lung area on computed tomography (CT). The extent that %CSA is related to pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is unclear, as is the effect of pulmonary endarterectomy (PEA) on %CSA . Therefore, we aimed to evaluate the clinical significance of %CSA in patients with CTEPH. We studied 98 patients (64 females, mean age 62.5 ± 11.9 years), who underwent CT with %CSA measurement and right heart catheterization (RHC). Patients were classified into groups based on eligibility for PEA. We compared the %CSA with pulmonary hemodynamics measured by RHC in various groups. In 38 patients who underwent PEA, the relationship between %CSA and pulmonary hemodynamics was also evaluated before and after PEA. Significant correlations between %CSA and pulmonary vascular resistance, and compliance, and pulmonary artery pulse pressure were observed in all patients. Pulmonary hemodynamics in the patients who underwent or were eligible for PEA showed a significant correlation with %CSA . Additionally, %CSA was significantly lower in the postoperative than in the preoperative group. There was no correlation between changes in %CSA and pulmonary hemodynamics before and after PEA. Furthermore, %CSA did not correlate significantly with prognosis. %CSA may reflect pulmonary hemodynamics in CTEPH with central thrombosis. Furthermore, %CSA was reduced by PEA postoperatively. However, %CSA is not a prognostic indicator, its clinical usefulness in CTEPH patients is limited, and further validation is required.