| Objective:To investigate the value of ventilation/perfusion(V/Q)scanning and CT pulmonary angiography(PA)in predicting chronic thromboembolic pulmonary hypertension(CTEPH)development after acute pulmonary embolism(APE).Materials and Methods:This study was performed in APE patients who had undergone both V/Q and CT PA after 3-month anticoagulation.The residual pulmonary obstructions were assessed based on V/Q and CT PA,and then recorded as percentage of perfusion defects(PPDs)and CT pulmonary artery obstruction index(PAOI).The predictive performance of PPDs and CT PAOI for CTEPH were determined by receiver operating characteristic(ROC)curves,and the areas under the curves(AUC)were calculated.Univariate and multivariable regression models were established to identify independent risk factors for predicting CTEPH development.Results:A total of 235 patients with initial diagnosis of APE were included in this study.Within the 1-year follow-up,25 patients developed to CTEPH.ROC analysis showed that the AUCs of the PPDs and CT PAOI were 0.957 and 0.895,with corresponding cut-off values of 20.50%and 17.50%for predicting CTEPH development.Neither sensitivity nor specificity differed significantly between PPDs and CT PAOI(Sensitivity:92.00%vs.80.00%,P=0.25;Specificity:88.10%vs.89.52%,P=0.69).The univariable and multivariable logistic regression analysis demonstrated that pulmonary arterial hypertension confirmed by echocardiography at initial APE diagnosis(OR=6.16,95%CI=1.308-29.015,P=0.021),a PPDs of>20.50%(OR=22.952,95%CI=2.371-222.19,P=0.007),and a CT PAOI of>17.50%(OR=9.984,95%CI=2.056-48.486,P=0.004)were associated with CTEPH development.Conclusion:V/Q scan has a tendency to be more sensitive but less specific than CT PA in predicting CTEPH development.The residual pulmonary embolism detected by V/Q and CT PA was significantly associated with an increased risk of CTEPH development.Objective:We studied the efficacy of balloon pulmonary angioplasty(BPA)on pulmonary blood flow and the predictive value of ventilation/perfusion(V/Q)scanning in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Materials and Methods:We retrospectively reviewed the clinical database,which included patients diagnosed with CTEPH who had received BPA.All patients undergone V/Q scanning to quantify the extent of pulmonary perfusion abnormality before and after BPA.Pulmonary hemodynamics were assessed by right heart catheterization,and cardiac function and exercise capacity were evaluated at baseline and post-BPA.For analysis of predictive parameters for response to BPA,univariate and multivariate analyses with logistic regression were used.Results:A total of 120 CTEPH patients were included for analysis.BPA significantly alleviated mean pulmonary arterial pressure(48.0 ± 12.9 mmHg vs 34.7±10.3 mmHg,P<0.001)and pulmonary vascular resistance(8.8±4.1 Wood units vs 5.2±3.0 Wood units,P<0.001),and improved cardiac function(N-terminal pro B-type natriuretic peptide:1628.7±2887.2 pg/mL vs 400.4±669.3 pg/mL,P<0.001)and exercise capacity(6-minute walking distance:386±122 m vs 461±86 m,P<0.001).The extent of pulmonary perfusion abnormality represented by the percentage of perfusion defects(PPDs)was improved after BPA(50.1±13.6%vs 35.6+14.2%,P<0.001),with the right and inferior lung lobes benefiting the most.PPDs<35.5 at baseline and greater restoration of PPDs after BPA(Δ PPDs>20.6)were associated with a better response to BPA(PPDs<35.5%:odds ratio[OR]=10.857,95%confidence interval[CI]=1.393-84.635,P=0.023;Δ PPDs>20.6%:OR=1.035,95%CI=1.002-1.068,P=0.036).Conclusion:BPA significantly restored pulmonary blood flow,predominantly in the right and inferior lobes.V/Q scanning has the potential to predict the therapeutic response to BPA for CTEPH. |
PDF Full Text Request