Prediction of pulmonary hypertension using central-to-peripheral pulmonary vascular volume ratio on three-dimensional cardiothoracic CT in patients with congenital heart disease

Abstract

Purpose: To evaluate whether the central-to-peripheral pulmonary vascular volume ratio measured using three-dimensional cardiothoracic CT can serve as a potential predictor of pulmonary hypertension (PH) in patients with congenital heart disease.

Methods: Cardiothoracic CT was used to quantify right and left total, central, and peripheral pulmonary vascular volumes segmented based on a three-dimensional threshold-based approach in 60 patients with congenital heart disease (group with PH, n = 30; group without PH, n = 30). The CT-based central-to-peripheral pulmonary vascular volume ratios were correlated with the echocardiography-based maximum velocity of tricuspid regurgitation (TR Vmax) and systolic pulmonary arterial pressure (PAP) values. The diagnostic ability of the central-to-peripheral pulmonary vascular volume ratio to predict PH was analyzed.

Results: The central-to-peripheral pulmonary vascular volume ratios were significantly higher in the group with PH compared to the group without PH (1.6 ± 0.9 vs. 0.8 ± 0.3 for the right side, p < 0.001; 2.4 ± 2.2 vs. 1.0 ± 1.4 for the left side, p < 0.004). The right central-to-peripheral pulmonary volume ratios were significantly positively correlated with the TR Vmax and estimated systolic PAP values (R = 0.627 and 0.633, respectively; p < 0.001) in patients with and without PH, while the ratios were moderately correlated with the TR Vmax and estimated systolic PAP values (R = 0.431 and 0.435, respectively; p < 0.020) in the group with PH. The right and left central-to-peripheral pulmonary vascular volume ratios demonstrated a good diagnostic ability for predicting the presence of PH (area under the receiver-operating characteristic curve = 0.867, p < 0.001 and 0.859, p < 0.001 for the right and left, respectively).

Conclusion: The CT-based central-to-peripheral pulmonary vascular volume ratio can be used to predict PH in patients with congenital heart disease.