Right Ventricular to Left Ventricular Ratio at CT Pulmonary Angiogram Predicts Mortality in Interstitial Lung Disease.
- 作者列表："Bax S","Jacob J","Ahmed R","Bredy C","Dimopoulos K","Kempny A","Kokosi M","Kier G","Renzoni E","Molyneaux PL","Chua F","Kouranos V","George P","McCabe C","Wilde M","Devaraj A","Wells A","Wort SJ","Price LC
BACKGROUND:Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism. METHODS:Demographic characteristics, ILD subtype, echocardiography, and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterization at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored according to CT criteria. The RV:LV ratio at CTPA was evaluated by using three different methods. Cox proportional hazards analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS:A total of 92 patients were included (64% male; mean age 65 ± 11 years) with an FVC 57 ± 20% predicted, corrected transfer factor of the lung for carbon monoxide 22 ± 8% predicted, and corrected transfer coefficient of the lung for carbon monoxide 51 ± 17% predicted. PH was confirmed at right heart catheterization in 78%. Of all the CTPA-derived measures, an RV:LV ratio ≥ 1.0 strongly predicted mortality or transplantation at univariate analysis (hazard ratio, 3.26; 95% CI, 1.49-7.13; P = .003), whereas invasive hemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (hazard ratio, 3.19; 95% CI, 1.44-7.10; P = .004), adjusting for an ILD diagnosis of idiopathic pulmonary fibrosis and CT imaging-derived ILD severity. CONCLUSIONS:An increased RV:LV ratio measured at CTPA provides a simple, noninvasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow-up, more aggressive treatment, and consideration of lung transplantation.
背景: 间质性肺疾病 (ILD) 患者可能发展为肺动脉高压 (PH)，通常与ILD的严重程度不成比例。CT肺血管造影 (CTPA) 测量的右心室与左心室直径 (RV:LV) 比值已被证明为肺动脉高压患者提供有价值的信息，并预测急性肺栓塞的死亡或恶化。 方法: 收集2005年至2015年间在皇家布朗普顿医院接受CTPA和右心导管插入术的连续患者的人口统计学特征、ILD亚型、超声心动图和详细的CTPA测量。根据CT标准对纤维化严重程度进行正式评分。通过使用三种不同的方法评估CTPA的RV:LV比率。Cox比例风险分析用于评估CTPA衍生参数与预测死亡或肺移植的关系。 结果: 共纳入92例患者 (64% 例男性; 平均年龄65 ± 11岁)，FVC预测为57 ± 20%，校正的一氧化碳肺转移因子预测为22 ± 8%，校正的一氧化碳肺转移系数预测为51 ± 17%。在78% 的右心导管检查时确认PH。在所有CTPA衍生的指标中，RV:LV比值 ≥ 1.0在单变量分析中强烈预测了死亡率或移植 (风险比，3.26; 95% CI，1.49-7.13; P = .003)，而侵入性血流动力学数据没有。在多变量分析中，RV:LV比值仍然是独立的预测因子 (风险比，3.19; 95% CI，1.44-7.10; P = .004)，调整了特发性肺纤维化的ILD诊断和CT成像衍生的ILD严重程度。 结论: CTPA测量的RV:LV比值增加为疑似ild-ph患者提供了一种简单、无创的危险分层方法。这应该促使更密切的随访，更积极的治疗，并考虑肺移植。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.