scholarly journals Automatic Diagnosis of Chronic Thromboembolic Pulmonary Hypertension Based on Volumetric Data from SPECT Ventilation and Perfusion Images

2020 ◽  
Vol 10 (15) ◽  
pp. 5360 ◽  
Author(s):  
Alexander P. Seiffert ◽  
Adolfo Gómez-Grande ◽  
Patrick Pilkington ◽  
Paula Cara ◽  
Héctor Bueno ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Visual Analysis ◽  
Single Photon ◽  
Photon Emission ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Volumetric Data ◽  
Perfusion Image ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Difference ◽  
Ventilation And Perfusion

Chronic thromboembolic pulmonary hypertension (CTEPH) is confirmed by visual analysis of single-photon emission computer tomography (SPECT) ventilation and perfusion (V/Q) images. Defects in the perfusion image discordant with the ventilation image indicate obstructed segments and the positive diagnosis of CTEPH. A quantitative metric and classification algorithm are proposed based on volumetric data from SPECT V/Q images. The difference in ventilation and perfusion volumes (VV-P) is defined as a quantitative metric to identify discordant defects in the SPECT images. The algorithm was validated with 22 patients grouped according to their diagnosis: (1) CTEPH and (2) respiratory pathology. Volumetric data from SPECT perfusion images was also compared before and after treatment for CTEPH. CTEPH was detected with a sensitivity of 0.67 and specificity of 0.80. The performance of volumetric data from SPECT perfusion images for the evaluation of treatment response was studied for two cases and improvement of pulmonary perfusion was observed in one case. This study uses volumetric data from SPECT V/Q images for the diagnosis of CTEPH and its differentiation from respiratory pathologies. The results indicate that the defined metric is a viable option for a quantitative analysis of SPECT V/Q images.

Right atrial mechanics by strain echocardiography in chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ferreira Fonseca ◽  
R Baptista ◽  
G Samouco ◽  
P Soeiro ◽  
R Martins ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Photon Emission ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Systolic Velocity ◽  
Right Ventricular Outflow Tract ◽  
Right Atrial ◽  
Emission Computed Tomography ◽  
Right Heart ◽  
Thromboembolic Pulmonary Hypertension ◽  
Strain Echocardiography

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial. Purpose We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH. Methods A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC. Results There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p<0,001), and in a multivariate linear regression model, RASr was an independent predictor of Log-transformed BNP values (β=−0.448, 95% CI: −0.046 to −0.009; p=0.005). There was no correlation between RASr and the percentage of obstruction in V/Q SPECT (r=0.164, p=0.388). Conclusion 2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH. Right atrial strain components Funding Acknowledgement Type of funding source: None

scholarly journals Diagnosis of chronic thromboembolic pulmonary hypertension

2017 ◽  
Vol 26 (143) ◽  
pp. 160108 ◽  
Author(s):  
Deepa Gopalan ◽  
Marion Delcroix ◽  
Matthias Held
Keyword(s):  
Computed Tomography ◽  
Pulmonary Hypertension ◽  
Photon Emission ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical Signs ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Vasculature ◽  
Dual Energy Ct ◽  
Emission Computed Tomography ◽  
Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension. Rapid and accurate diagnosis is pivotal for successful treatment. Clinical signs and symptoms can be nonspecific and risk factors such as history of venous thromboembolism may not always be present. Echocardiography is the recommended first diagnostic step. Cardiopulmonary exercise testing is a complementary tool that can help to identify patients with milder abnormalities and chronic thromboembolic disease, triggering the need for further investigation. Ventilation/perfusion (V′/Q′) scintigraphy is the imaging methodology of choice to exclude CTEPH. Single photon emission computed tomography V′/Q′ is gaining popularity over planar imaging. Assessment of pulmonary haemodynamics by right heart catheterisation is mandatory, although there is increasing interest in noninvasive haemodynamic evaluation. Despite the status of digital subtraction angiography as the gold standard, techniques such as computed tomography (CT) and magnetic resonance imaging are increasingly used for characterising the pulmonary vasculature and assessment of operability. Promising new tools include dual-energy CT, combination of rotational angiography and cone beam CT, and positron emission tomography. These innovative procedures not only minimise misdiagnosis, but also provide additional vascular information relevant to treatment planning. Further research is needed to determine how these modalities will fit into the diagnostic algorithm for CTEPH.

scholarly journals Echocardiography in the diagnostic and prognostic evaluation of thromboembolic pulmonary hypertension

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Oscar Serafini ◽  
Francesco Greco ◽  
Gianfranco Misuraca ◽  
Mario Chiatto ◽  
Antonino Buffon
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Vasculature ◽  
Prognostic Evaluation ◽  
Natural Progression ◽  
Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Arterial ◽  
Prognostic Implications ◽  
The Difference

Pulmonary arterial hypertension frequently develops after a thromboembolic pulmonary event. The difference in degree of pulmonary artery pressure depends mainly on the size and location of the pulmonary embolus and presence of pre-existing cardiopulmonary diseases. Right ventricle (RV) afterloading from an acute obstruction of the pulmonary vasculature causes an increase of RV volume and dysfunction of right heart cavities, the varying levels of severity of which explain the multiple clinical expression of pulmonary embolism (PE). While the diagnostic approach, therapeutic management and prognostic evaluation are now well defined, the natural progression of PE is still not completely understood. In particular, insufficient data exist on the rate, timing and modalities of development of chronic thromboembolic pulmonary hypertension (CTPH). The aim of this review is to evaluate the role of echocardiography in detecting patients with CTPH, and in assessing hemodynamic consequences on RV and related prognostic implications.

IP-10 and IL-6 as biomarkers in Chronic Thromboembolic Pulmonary Hypertension

Pneumologie ◽  
2013 ◽  
Vol 67 (05) ◽  
Author(s):  
D Zabini ◽  
Z Bálint ◽  
C Nagarai ◽  
V Foris ◽  
G Kwapiszewska ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Pulmonary Hypertension
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