Toshihiko Sugiura, Presenter: Nothing to Disclose

Nobusada Funabashi MD, PhD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Takaoka MD, PhD, Abstract Co-Author: Nothing to Disclose

Masae Uehara MD, Abstract Co-Author: Nothing to Disclose

Nobuhiro Tanabe, Abstract Co-Author: Nothing to Disclose

Koichiro Tatsumi, Abstract Co-Author: Nothing to Disclose

Yoshio Kobayashi, Abstract Co-Author: Nothing to Disclose

In the ACCF Guidelines, quantitative evaluation of right ventricular (RV) function by ECG-gated CT is generally acceptable and can also evaluate coronary arteries (CA). To determine the clinical characteristics of subjects with chronic thromboembolic pulmonary hypertension (CTEPH), we performed 320-slice CT, transthoracic echocardiogram (TTE), and right heart catheterization (RHC).

33 consecutive subjects with CTEPH (11 male, 61±10 yrs, hypertension, 20%; diabetes mellitus, 15%; dyslipidemia, 30%; smokers, 21%. and obese, 15%) who were candidates for pulmonary endarterectomy, underwent retrospective ECG-gated 320-slice CT double volume scans (Aquilion one, Toshiba Medical) and RHC within one week without incident. CT images were reconstructed every 5% from 0-95% of the R-R interval, RV (RVV) and left ventricular (LV) volumes (LVV) were measured at each phase, and minimum and maximum RVV and LVV were determined. RV e/e’, and estimated RV systolic pressure (RVSP) from tricuspid regurgitation were measured by TTE, and systolic pulmonary arterial pressure (PAP) (sPAP), mean PAP (mPAP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured by RHC.

Minimum and maximum RVV and LVV and ejection fractions of the RV (RVEF) and LV (LVEF) were 29±11ml,93±27ml, 87±44ml, 157±49ml, 46±14%, and 69±8%, respectively. Two and 1 subjects had calcified and non-calcified plaques in the CA, respectively, and 2 subject revealed >50% stenosis in the CA. On TTE, RV e/e’ and RVSP were 5.3±2.9, and 62.8±25.5mmHg, respectively. On RHC, sPAP, mPAP, RAP and CO were 71.1±20.5mmHg, 41.0±11.4mmHg, 5.7±3.9mmHg, and 4.19±0.97l/min, respectively.

We presented basic clinical characteristics of 33 subjects with CTEPH based on 320-slice CT, TTE and RHC. As visualization of the RV was excellent, CT may be the best modality for evaluating RV function as well as CTEPH, because these subjects cannot tolerate the long acquisition times required for MRI. As coronary risk factors were rare in these subjects, CA diseases were also rare.

Before pulmonary endarterectomy, surgeons require information about CA. Most patients with CPTE have few coronary risk factors and normal CA. CT can rule out CA diseases without additional radiation.

Sugiura, T, Funabashi, N, Takaoka, H, Uehara, M, Tanabe, N, Tatsumi, K, Kobayashi, Y, Clinical Characteristics Including Ventricular Volume and Coronary Arteries of Subjects with Chronic Pulmonary Thromboembolism by ECG-gated 320-Slice CT, Echocardiogram, and Right Heart Catheterization.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034661.html