Akademik Veri Yönetim Sistemi
ECR 2023, Vienna, Avusturya, 1 - 05 Mart 2023, ss.8-13
To highlight the new data given in Pulmonary
Hypertension (PH) 2022 guideline and assess the differences of radiological
approach from the old version.
Methods or Background
Pulmonary hypertension (PH) is a heterogeneous disease
driven most often by pathogenic remodeling of distal pulmonary arterioles or a
congestive (functional) vasculopathy resulting from pulmonary venous
hypertension. (1) The latest 2022 ESC/ERS Guidelines divides PH into 5
categories:1- Pulmonary arterial hypertension2- PH associated with left heart
disease3- PH associated with lung diseases and/or hypoxia4- Chronic
thrombo-embolic pulmonary hypertension5- Pulmonary hypertension with unclear
and/or multifactorial mechanisms.
European Society of Cardiology (ESC) and European
Respiratory Society (ERS) has published a new guideline on PHT at August 2022.
In this guideline new criterias and approaches were described for radiologic
modalities.
Results or Findings
Right heart catheterization is the gold standard for PH
diagnosis but radiologic modalities (Ultrasound, CT, MRI, DSA) are
complementary tools for both diagnosis and classification.In the new guideline;
PA-to-aorta ratio cut-off level changed from 1 to 0.9 on Chest computed
tomography (CT) . A combination of three parameters (PA diameter ≥30 mm, RVOT
wall thickness ≥6 mm and septal deviation ≥140°) was described and defined as
highly predictive of PH (Table. 1). CT is also described as a useful tool for
determination of parenchymal lung disease and pulmonary veno-occlusive disease
findings. Measurement method of the septal deviation angle is applied as
connecting midpoint of interventricular septum to the intersections of RV
myocardium and interventricular septum (Fig. 1)(3).Digital subtraction
angiography and dual CT are recommended over computed tomography pulmonary
angiography for the diagnosis of chronic tromboembolic pulmonary hypertension
as opposed to the first version (Fig 2)(4).As a main difference from the
previous guideline, Cardiac MRI has been presented. MRI is useful to evaluate
atrial and ventricular size, morphology, and function and also primary modality
to measure right ventricular ejection fraction , stroke volume index and right
ventricular end-systolic volume index (Figure 3).Abdominal ultrasound should be
obtained to search for etiologic causes such as liver disease, portal
hypertension or portocaval shunt (Abernethy malformation) and to evaluate pulmonary
hypertention induced end organ dysfunction (Table 2).
Conclusion
ESC-ERS 2022 guideline adds new approaches and
suggestions for diagnosis and screening of PH. Radiologic modalities (USG, MR,
CT, DSA) are helpful for detecting underlying condition, classification and
screening.