Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE. Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson’s tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant. Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH. Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA. |
- Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257-64. doi: 10.1056/NEJMoa032274. PubMed PMID: 15163775.
- Taboada D, Pepke-Zaba J, Jenkins DP, Berman M, Treacy CM, Cannon JE, et al. Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease. Eur Respir J. 2014;44:1635-45. doi: 10.1183/09031936.00050114. PubMed PMID: 25234805.
- Fedullo P, Kerr KM, Kim NH, Auger WR. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2011;183:1605-13. doi: 10.1164/rccm.201011-1854CI. PubMed PMID: 21330453.
- Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther. 2018;8:253-71. doi: 10.21037/cdt.2018.01.09. PubMed PMID: 30057874; PubMed Central PMCID: PMCPMC6039808.
- Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics. 2004;24:1219-38. doi: 10.1148/rg.245045008. PubMed PMID: 15371604.
- Castaner E, Gallardo X, Ballesteros E, Andreu M, Pallardo Y, Mata JM, et al. CT diagnosis of chronic pulmonary thromboembolism. Radiographics. 2009;29:31-50. doi: 10.1148/rg.291085061. PubMed PMID: 19168835.
- Renard B, Remy-Jardin M, Santangelo T, Faivre JB, Tacelli N, Remy J, et al. Dual-energy CT angiography of chronic thromboembolic disease: can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects? Eur J Radiol. 2011;79:467-72. doi: 10.1016/j.ejrad.2010.04.018. PubMed PMID: 20488639.
- Knobel Z, Kellenberger CJ, Kaiser T, Albisetti M, Bergstrasser E, Buechel ER. Geometry and dimensions of the pulmonary artery bifurcation in children and adolescents: assessment in vivo by contrast-enhanced MR-angiography. Int J Cardiovasc Imaging. 2011;27:385-96. doi: 10.1007/s10554-010-9672-6. PubMed PMID: 20652636.
- Chin M, Johns C, Currie BJ, Weatherley N, Hill C, Elliot C, et al. Pulmonary Artery Size in Interstitial Lung Disease and Pulmonary Hypertension: Association with Interstitial Lung Disease Severity and Diagnostic Utility. Front Cardiovasc Med. 2018;5:53. doi: 10.3389/fcvm.2018.00053. PubMed PMID: 29938208; PubMed Central PMCID: PMCPMC6003274.
- Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging. 1999;14:270-8. doi: 10.1097/00005382-199910000-00007. PubMed PMID: 10524808.
- Lange TJ, Dornia C, Stiefel J, Stroszczynski C, Arzt M, Pfeifer M, et al. Increased pulmonary artery diameter on chest computed tomography can predict borderline pulmonary hypertension. Pulm Circ. 2013;3:363-8. doi: 10.4103/2045-8932.113175. PubMed PMID: 24015337; PubMed Central PMCID: PMCPMC3757831.
- Shen Y, Wan C, Tian P, Wu Y, Li X, Yang T, et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore). 2014;93:e256. doi: 10.1097/MD.0000000000000256. PubMed PMID: 25501096; PubMed Central PMCID: PMCPMC4602811.
- Mahammedi A, Oshmyansky A, Hassoun PM, Thiemann DR, Siegelman SS. Pulmonary artery measurements in pulmonary hypertension: the role of computed tomography. J Thorac Imaging. 2013;28:96-103. doi: 10.1097/RTI.0b013e318271c2eb. PubMed PMID: 23096163.
- Yan C, Wang X, Su H, Ying K. Recent Progress in Research on the Pathogenesis of Pulmonary Thromboembolism: An Old Story with New Perspectives. Biomed Res Int. 2017;2017:6516791. doi: 10.1155/2017/6516791. PubMed PMID: 28484717; PubMed Central PMCID: PMCPMC5397627.
- Krieg VJ, Hobohm L, Liebetrau C, Guth S, Kolmel S, Troidl C, et al. Risk factors for chronic thromboembolic pulmonary hypertension - Importance of thyroid disease and function. Thromb Res. 2020;185:20-6. doi: 10.1016/j.thromres.2019.10.025. PubMed PMID: 31734602.
- Venetz C, Labarere J, Jimenez D, Aujesky D. White blood cell count and mortality in patients with acute pulmonary embolism. Am J Hematol. 2013;88:677-81. doi: 10.1002/ajh.23484. PubMed PMID: 23674436.
- Yang M, Deng C, Wu D, Zhong Z, Lv X, Huang Z, et al. The role of mononuclear cell tissue factor and inflammatory cytokines in patients with chronic thromboembolic pulmonary hypertension. J Thromb Thrombolysis. 2016;42:38-45. doi: 10.1007/s11239-015-1323-2. PubMed PMID: 26667361; PubMed Central PMCID: PMCPMC4877417.
- Zhang JX, Chen YL, Zhou YL, Guo QY, Wang XP. Expression of tissue factor in rabbit pulmonary artery in an acute pulmonary embolism model. World J Emerg Med. 2014;5:144-7. doi: 10.5847/wjem.j.1920-8642.2014.02.012. PubMed PMID: 25215165; PubMed Central PMCID: PMCPMC4129874.
- Kooiman J, den Exter PL, Kilicsoy I, Cannegieter SC, Eikenboom J, Huisman MV, et al. Association between micro particle-tissue factor activity, factor VIII activity and recurrent VTE in patients with acute pulmonary embolism. J Thromb Thrombolysis. 2015;40:323-30. doi: 10.1007/s11239-015-1180-z. PubMed PMID: 25665657; PubMed Central PMCID: PMCPMC4546691.
- Arvidsson M, Ahmed A, Bouzina H, Radegran G. Matrix metalloproteinase 7 in diagnosis and differentiation of pulmonary arterial hypertension. Pulm Circ. 2019;9:2045894019895414. doi: 10.1177/2045894019895414. PubMed PMID: 31908766; PubMed Central PMCID: PMCPMC6935882.
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