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CT-Based Biomarkers for Prediction of Chronic Thromboembolic Pulmonary Hypertension After an Acute Pulmonary Embolic
Giovanni Lorenz1,2, Mnahi Bin Saeedan1,2, Jennifer Bullen3
1Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, L-10, 413-4, 9500 Euclid Ave, Cleveland, OH 44195.
Insights
The degree of clot obstruction on initial CT scans may predict chronic thromboembolic pulmonary hypertension (CTEPH) development after acute pulmonary embolism. Mosaic attenuation and lung infarction also show potential predictive value for CTEPH.
Area of Science:
- Radiology
- Pulmonary Medicine
- Cardiovascular Imaging
Background:
- Acute pulmonary embolism (PE) can lead to chronic thromboembolic pulmonary hypertension (CTEPH).
- Identifying early CT markers for CTEPH development is crucial for timely intervention.
- Predictive markers can improve patient outcomes and resource allocation.
Purpose of the Study:
- To evaluate CT-based imaging features that predict the development of CTEPH following acute PE.
- To identify specific quantitative and qualitative CT findings associated with CTEPH progression.
Main Methods:
- Retrospective analysis of CT scans from 48 CTEPH patients and 113 controls with acute PE.
- Assessment of CT markers including clot obstruction, Walsh score, RV/LV ratio, and presence of lung infarction or mosaic attenuation.
- Classification and regression tree analysis for predictive model development and external validation.
Main Results:
- Increased clot obstruction, decreased Walsh score, lung infarction, and mosaic attenuation were associated with higher CTEPH probability.
- The final decision tree model identified occlusive clot as a key predictor.
- External validation showed the model correctly classified 33% of CTEPH cases and 86% of controls.
Conclusions:
- Occlusive clot on initial CT scans is a significant predictor of CTEPH development.
- Mosaic attenuation and lung infarction may also serve as predictive markers for CTEPH.
- Further research is warranted to validate these findings and refine predictive models.
Abstract:
OBJECTIVE. The purpose of this study is to assess CT-based markers predictive of the development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism. MATERIALS AND METHODS. Identified from a search of local registries, 48 patients who had CTEPH develop were included in the study group, and 113 patients who had complete resolution of acute pulmonary embolism were included in the control group. Baseline CT scans obtained at the time of the initial pulmonary embolism event were evaluated for the degree of clot-induced vessel obstruction, the quantitative Walsh score, the ratio of the right ventricle diameter to the left ventricle diameter, the right atrium diameter, the pulmonary artery diameter, right heart thrombus, pericardial effusion, lung infarction, and mosaic attenuation. Classification and regression tree analysis was used to create a decision tree. The decision tree was externally validated on an anonymized cohort of 50 control subjects and 50 patients with CTEPH. RESULTS. During univariable analysis, an increase in the degree occlusive clot on initial imaging, a decrease in the Walsh score, absence of pericardial effusion, presence of lung infarction, and the presence of mosaic attenuation were associated with an increased probability of CTEPH development. In the final decision tree, the occlusive nature of the clot remained. Two patients in the cohort used for external validation had nondiagnostic findings and were excluded. The decision process correctly classified 33% (16/48) of patients who had CTEPH develop and 86% (43/50) of patients who did not have CTEPH develop, for an odds ratio of 3.1 (95% CI, 1.1-8.3). CONCLUSION. The presence of an occlusive clot on initial imaging is associated with an increased probability of CTEPH development. Presence of mosaic attenuation and lung infarction may also predict CTEPH development, although additional studies are needed.
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