Assessment of Pulmonary Artery Pulsatility by Multidetector Computed Tomography in Patients Affected by Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Preliminary Data
The aim was to assess if computed tomography is able to measure pulmonary artery pulsatility in patients affected by chronic obstructive pulmonary disease and to ascertain whether pulsatility is different in patients with and without pulmonary hypertension and whether it is related to haemodynamics. We selected two groups of patients, the first one with pulmonary hypertension and the second one without. In patient with hypertension, pulmonary artery pressure and resistance were increased with the increased diameters (transverse 36 ± 5？mm and axial 38 ± 4？mm versus 22 ± 3 and 25 ± 5, resp.), the increased cross-sectional area (10 ± 08 versus 4 ± 1？cm2), and the reduced pulsatility (21 ± 7 versus 10% ± 5%). Arterial stretching was decreased in patients with hypertension (10 ± 5 versus 21% ± 7%) and significantly related to pulmonary vascular resistances and pressure. Cardiac output measured by tomography was significantly related to that obtained by Fick method and was not different in the two groups. The diameters allow to identify patients with PH, assuming a cut-off of 28？mm and assuming a pulsatility of right branch of 26% as well. These preliminary observations indicate tomography as a suitable technique, being able to measure the pulsatility and the dimensions of the arteries and the right ventricular functional parameters. 1. Introduction The assessment of pulmonary hypertension (PH) during the chronic obstructive pulmonary disease (COPD) is important, since PH worsens quality of life, prognosis, effort tolerance, and outcome in acute respiratory failure [1–3]. Precapillary PH can be seen in 30% to 43% of patients affected by COPD, reaching values higher than 45？mmHg in 5% [1–3]. PH is determined by both functional vasoconstriction and vessels remodeling [3–5] that determine the right ventricular afterload leading to effort intolerance, poor quality of life, cardiac failure, and reduced life expectancy. The assessment of pulsatility (Puls) of pulmonary artery (PA) in PH looks like a promising tool, since it looks related to severity, progression of disease, functional capacity, prognosis, and survival [6–9]. The invasive right heart catheterization (RHC) is the gold standard for the diagnosis of PH, and the assessment of reversibility of PH with vasodilators, the measure of Puls by intravascular ultrasound (IVU) [10–14]. The noninvasive cardiac echocardiography (US) allows the measurement of the pulmonary artery dimensions, the right ventriculare shape, the ejection fraction, and the noninvasive estimation of the systolic pulmonary artery pressure
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