Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 1:260:172-177.
doi: 10.1016/j.ijcard.2018.02.114. Epub 2018 Mar 4.

CT derived left atrial size identifies left heart disease in suspected pulmonary hypertension: Derivation and validation of predictive thresholds

Benjamin J Currie  1 , Chris Johns  1 , Matthew Chin  1 , Thanos Charalampopolous  2 , Charlie A Elliot  2 , Pankaj Garg  1 , Smitha Rajaram  3 , Catherine Hill  3 , Jim W Wild  4 , Robin A Condliffe  2 , David G Kiely  5 , Andy J Swift  6
Affiliations

CT derived left atrial size identifies left heart disease in suspected pulmonary hypertension: Derivation and validation of predictive thresholds

Benjamin J Currie et al. Int J Cardiol. .

Abstract

Background: Patients with pulmonary hypertension due to left heart disease (PH-LHD) have overlapping clinical features with pulmonary arterial hypertension making diagnosis reliant on right heart catheterization (RHC). This study aimed to investigate computed tomography pulmonary angiography (CTPA) derived cardiopulmonary structural metrics, in comparison to magnetic resonance imaging (MRI) for the diagnosis of left heart disease in patients with suspected pulmonary hypertension.

Methods: Patients with suspected pulmonary hypertension who underwent CTPA, MRI and RHC were identified. Measurements of the cardiac chambers and vessels were recorded from CTPA and MRI. The diagnostic thresholds of individual measurements to detect elevated pulmonary arterial wedge pressure (PAWP) were identified in a derivation cohort (n = 235). Individual CT and MRI derived metrics were tested in validation cohort (n = 211).

Results: 446 patients, of which 88 had left heart disease. Left atrial area was a strong predictor of elevated PAWP>15 mm Hg and PAWP>18 mm Hg, area under curve (AUC) 0.854, and AUC 0.873 respectively. Similar accuracy was also identified for MRI derived LA volume, AUC 0.852 and AUC 0.878 for PAWP > 15 and 18 mm Hg, respectively. Left atrial area of 26.8 cm2 and 30.0 cm2 were optimal specific thresholds for identification of PAWP > 15 and 18 mm Hg, had sensitivity of 60%/53% and specificity 89%/94%, respectively in a validation cohort.

Conclusions: CTPA and MRI derived left atrial size identifies left heart disease in suspected pulmonary hypertension with high specificity. The proposed diagnostic thresholds for elevated left atrial area on routine CTPA may be a useful to indicate the diagnosis of left heart disease in suspected pulmonary hypertension.

Keywords: Computed tomography pulmonary angiography; Left atrial area; Left atrial volume; Left heart disease; Magnetic resonance imaging; Pulmonary hypertension.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
LA area region of interests in a patient with idiopathic pulmonary arterial hypertension (left) and a patient with pulmonary hypertension associated with left heart disease (right).
Fig. 2
Fig. 2
Correlation of left atrial (LA) area and pulmonary arterial wedge pressure (PAWP), left. And right, receiver operating characteristic curves for LA area, LA/RV area, Total PV area and LA/RA area ratio, AUC 0.854, 0.757, 0.681 and 0.601, respectively.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Galiè N., Humbert M., Vachiery J., Gibbs S., Lang I., Torbicki A., Simonneau G., Peacock A., Vonk Noordegraaf A., Beghetti M., Ghofrani A., Gomez Sanchez M., Hansmann G., Klepetko W., Lancellotti P., Matucci M., McDonagh T., Pierard L., Trindade P., Zompatori M., Hoeper M. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur. Heart J. 2015;37(1):67–119. - PubMed
    1. Galie N., Hoeper M., Humbert M., Torbicki A., Vachiery J., Barbera J., Beghetti M., Corris P., Gaine S., Gibbs J., Gomez-Sanchez M., Jondeau G., Klepetko W., Opitz C., Peacock A., Rubin L., Zellweger M., Simonneau G., Vahanian A., Auricchio A., Bax J., Ceconi C., Dean V., Filippatos G., Funck-Brentano C., Hobbs R., Kearney P., McDonagh T., McGregor K., Popescu B., Reiner Z., Sechtem U., Sirnes P., Tendera M., Vardas P., Widimsky P., Sechtem U., Al Attar N., Andreotti F., Aschermann M., Asteggiano R., Benza R., Berger R., Bonnet D., Delcroix M., Howard L., Kitsiou A., Lang I., Maggioni A., Nielsen-Kudsk J., Park M., Perrone-Filardi P., Price S., Domenech M., Vonk-Noordegraaf A., Zamorano J. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT) Eur. Heart J. 2009;30(20):2493–2537. - PubMed
    1. Guazzi M., Borlaug B. Pulmonary hypertension due to left heart disease. Circulation. 2012;126(8):975–990. - PubMed
    1. Califf R., Adams K., McKenna W., Gheorghiade M., Uretsky B., McNulty S., Darius H., Schulman K., Zannad F., Handberg-Thurmond E., Harrell F., Wheeler W., Soler-Soler J., Swedberg K. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: the Flolan international randomized survival trial (FIRST) Am. Heart J. 1997;134(1):44–54. - PubMed
    1. Vachiéry J., Adir Y., Barberà J., Champion H., Coghlan J., Cottin V., De Marco T., Galiè N., Ghio S., Gibbs J., Martinez F., Semigran M., Simonneau G., Wells A., Seeger W. Pulmonary hypertension due to left heart diseases. J. Am. Coll. Cardiol. 2013;62(25):D100–D108. - PubMed

Publication types

MeSH terms