Quantitative CT Pulmonary Angiography and Echo Cardiography Analysis for Enhanced Cardiovascular Assessment of Right Ventricular Failure in Pulmonary Hypertension

Abstract

Background: Pulmonary hypertension (PH) with concomitant right ventricular (RV) dysfunction presents major clinical challenges. Computed tomography pulmonary angiography (CTPA) is a widely available, non-invasive tool for PH assessment. This study evaluated the diagnostic performance of selected CTPA-derived metrics for detecting RV dysfunction and severe PH. Methods: A cross-sectional study included 39 adults (mean age 51.46 +/- 2.71 years; 53.8 female) with newly diagnosed non-cardiogenic PH (World Health Organization groups 1, 3, 4, and 5). Key CTPA parameters were entered into backward stepwise logistic regression to predict RV dysfunction and severe PH (systolic pulmonary artery pressure >60 mmHg), using echocardiography as the reference standard. Adjusted odds ratios (ORs) with 95 confidence intervals (CIs) were calculated; statistical significance was set at P<0.05. Results: RV dysfunction was present in 28 patients (71.8) and severe PH in 20 (51.3). Independent predictors of RV dysfunction were anteroposterior right atrial (AP RA) diameter (OR 1.135; 95 CI 1.032-1.248; P=0.009) and short-axis ascending aortic (AA) diameter (OR 0.723; 95 CI 0.572-0.915; P=0.007), achieving combined sensitivity 92.9, specificity 72.7, and accuracy 87.2 (95 CI 76.7-97.7). Contrast medium reflux into the inferior vena cava or hepatic veins was the only independent predictor of severe PH (OR 6.857; 95 CI 1.627-28.899; P=0.009; accuracy 71.8). Conclusion: CTPA-derived AP RA and AA diameters are useful markers for RV dysfunction in non-cardiogenic PH, while contrast reflux reliably indicates severe disease. Larger prospective studies and right atrial shape analysis are warranted to confirm and refine these findings.