The role of the combination of echo-HRCT score as a tool to evaluate the presence of pulmonary hypertension in idiopathi
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The role of the combination of echo‑HRCT score as a tool to evaluate the presence of pulmonary hypertension in idiopathic pulmonary fibrosis Rosa Metella Refini1 · Gloria Bettini2 · Esmeralda Kacerja1 · Paolo Cameli1 · Miriana d’Alessandro1 · Laura Bergantini1 · Ferdinando De Negri3 · Paola Rottoli1 · Piersante Sestini1 · Elena Bargagli1 · Maria Antonietta Mazzei4 Received: 31 July 2020 / Accepted: 12 October 2020 © The Author(s) 2020
Abstract Pulmonary hypertension (PH) is defined as an elevated mean pulmonary artery pressure at rest (mPAP ≥ 25 mmHg), evaluated by right heart catheterization (RHC). The aim of the present study was to evaluate HRCT findings in relation to transthoracic echocardiographic data to better characterize PH in IPF patients and to identify a non-invasive composite index with high predictive value for PH in these patients. 37 IPF patients were enrolled in this retrospective study. All patients underwent a complete assessment for PH, including transthoracic Doppler echocardiography, HRCT scan and right heart catheterization. Right heart catheterization was done in 19 patients (51.3%) as pre-lung transplant assessment and in 18 patients (48.6%) to confirm PH, suspected on the basis of echocardiography. Twenty out of 37 patients (54%) were confirmed to have PH by RHC. Multivariate regression showed that the combination of sPAP, PA area measured by HRCT and the ratio of the diameter of the segmental artery to that of the adjacent bronchus in the apicoposterior segment of the left upper lobe was strongly correlated with mPAP (R2 = 0.53; p = 0.0009). The ROC analysis showed that 931.6 was the ULN for PA area, with 86% sensitivity and 61% specificity (0.839 AUC); 20.34 was the ULN for the ratio of PA area to ascending aorta diameter, with 100% sensitivity and 50% specificity (0.804 AUC). The composite index proposed in the present study could help early detection of IPF patients suspected of PH requiring confirmation by RHC (if deemed clinically necessary). Keywords Pulmonary hypertension · Idiopathic pulmonary fibrosis · Algorithm · Right heart catheterization
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02539-1) contains supplementary material, which is available to authorized users. * Miriana d’Alessandro [email protected] 1
Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100 Siena, Italy
2
Radiology Unit, Department, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
3
Department of Internal Medicine, University of Pisa, Pisa, Italy
4
Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
Abbreviations ILD Interstitial lung disease RHC Right heart catheterization PH Pulmonary hypertension IPF Idiopathic pulmonary fibrosis HRCT High-re
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