Diagnostic evaluation of Imaging findings, Causes of Pulmonary Hypertension and its correlation with 2D echocardiography: A CT Pulmonary Angiogram based study.

Abstract

BACKGROUND:Pulmonary arterial hypertension (PAH) is a common health problem resulting in morbidity and mortality. It is much more common than previously thought due to improved imaging techniques.. Diagnosing PAH is important for the prognosis and treatment planning in PH patients. Objective of our study was to systematically evaluate the signs and causes of PAH on CT Pulmonary angiography (CTPA) and its correlation with 2D echocardiography.MATERIALS AND METHODS:The study was conducted at Bolan Medical Complex Hospital over a time duration of 9 months. In this study, 40 patients underwent CTPA for evaluation of their pulmonary vasculature, pulmonary parenchyma and mediastinal structures to detect different diagnostic criteria, causes and associations of pulmonary arterial hypertension. All 40 patients underwent echocardiography.RESULTS:Total 40 patients underwent non ECG gated pulmonary angiography. 20 were males and 20 were females. 18 patients out of total 40 were positive for PAH on CTPA. Out of these 8 had mild PAH, 8 had moderate and 2 had severe PAH. Out of total 40 patients 10 were normal on echocardiography, 11 had mild pulmonary hypertension, 7 had moderate pulmonary hypertension, 12 had severe hypertension.. Combined CTPA and echo results showed that findings of only 28 patients out of 40 were positive for PH and correlated on both modalities including patients with and without PAH.2D echocardiography is operator, machine and patient body habitus dependent therefore it can over estimate results.  Sensitivity and specificity of echo is higher for negative cases. PA:AA ratio correlated well with Pulmonary hypertension.CONCLUSION:Echocardiography is usually more commonly carried out for PAH however it can also substantially lead to an underestimation or overestimation of  pulmonary arterial hypertension. Using CTPA and Echocardiography in combination is more reliable in determining PAH. In our study echocardiography over estimated patients for PH which were subsequently not positive on CTPA.