Right ventricle to left ventricle ratio at CTPA predicts mortality in interstitial lung disease

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Title: Right ventricle to left ventricle ratio at CTPA predicts mortality in interstitial lung disease
Authors: Bax, S
Jacob, J
Ahmed, R
Bredy, C
Dimopoulos, K
Kempny, A
Kokosi, M
Kier, G
Renzoni, E
Molyneaux, PL
Chua, F
Kouranos, V
George, P
McCabe, C
Wilde, M
Devaraj, A
Wells, A
Wort, SJ
Price, LC
Item Type: Journal Article
Abstract: INTRODUCTION: Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to ILD severity. Right ventricle to left ventricle diameter ratio (RV:LV) measured at CT pulmonary angiography (CTPA), has been shown to provide valuable information in pulmonary arterial hypertension patients and to predict death or deterioration in acute pulmonary embolism. METHODS: Demographics, ILD subtype, echocardiography and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterisation (RHC) at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored using CT criteria. RV:LV ratio at CTPA was evaluated by three different methods. Cox-proportional hazard analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS: 92 patients were included: 64% male, mean age 65±11 years, with FVC 57±20% (predicted), TLCOc 22±8% (predicted) and KCOc 51±17% (predicted). PH was confirmed at RHC in 78%. Of all CTPA-derived measures, an RV:LV ratio ≥1.0 strongly predicted mortality or transplantation at univariate analysis (HR 3.26, 95%CI:1.49-7.13, p=0.003), whereas invasive haemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (HR: 3.19, CI:1.44-7.10, p=0.004), adjusting for an ILD diagnosis of IPF and CT derived ILD severity. CONCLUSION: An increased RV:LV ratio measured at CTPA provides a simple, non-invasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow up, more aggressive treatment and consideration of lung transplantation.
Issue Date: 24-Jul-2019
Date of Acceptance: 6-Jun-2019
URI: http://hdl.handle.net/10044/1/72290
DOI: https://dx.doi.org/10.1016/j.chest.2019.06.033
ISSN: 0012-3692
Publisher: Elsevier
Journal / Book Title: Chest
Copyright Statement: © 2019 Published by Elsevier Inc under license from the American College of Chest Physicians. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Respiratory System
1103 Clinical Sciences
Publication Status: Published online
Conference Place: United States
Embargo Date: 2020-07-24
Online Publication Date: 2019-07-24
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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