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Laterality of CT-measured hepatic extracellular volume fraction in patients with chronic thromboembolic pulmonary hypertension

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Abstract

Purpose

This study examines the hepatic extracellular volume fraction (ECV) disparity between the left and right lobes (ECV_left and ECV_right) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), its association with right heart catheterization (RHC) metrics, and with intolerance to increased pulmonary hypertension (PH)-targeted medication dosages.

Methods

We retrospectively analyzed 72 CTEPH-diagnosed patients who underwent equilibrium-phase abdominal dual-energy CT (DECT) and RHC. Hepatic ECVs, derived from DECT’s iodine maps using circular regions of interest in the liver and aorta, were correlated with RHC parameters via Spearman’s rank correlation and lobe differences through the Wilcoxon signed-rank test. Logistic regression assessed cases with ECV_left exceeding ECV_right by > 0.05, while receiver operating characteristic curve analysis gauged ECVs’ predictive power for medication intolerance.

Results

Of the 72 patients (57 females; median age 69), ECV_total (0.24, IQR 0.20–0.27) moderately correlated with RHC parameters (rs = 0.28, −0.24, 0.3 for mean pulmonary arterial pressure, cardiac index [CI], and pulmonary vascular resistance index, respectively). ECV_left significantly surpassed ECV_right (0.25 vs. 0.22, p < 0.001), with a greater ECV_left by > 0.05 indicating notably lower CI (p < 0.001). In 27 patients on PH medication, ECV_left effectively predicted medication intolerance (AUC = 0.84).

Conclusion

In CTEPH patients, hepatic ECV correlated with RHC metrics, where elevated left lobe ECV suggested reduced CI and potential medication intolerance.

Graphical Abstract

The hepatic extracellular volume fraction (ECV), measured via dual-energy CT, was notably higher in the left lobe compared to the right in patients with chronic thromboembolic pulmonary hypertension, with elevated ECV in the left lobe correlating with reduced cardiac index and intolerance to medication.

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Abbreviations

CTEPH:

Chronic thromboembolic pulmonary hypertension

CI:

Cardiac index

ECV:

Extracellular volume fraction

DECT:

Dual-energy computed tomography

PH:

Pulmonary hypertension

RHC:

Right heart catheterization

LR:

Left-right

IQR:

Interquartile range

ROC:

Receiver operating characteristic curve

AUC:

Areas under the ROC

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Acknowledgements

The authors thank CT technologists Yuji Matsuzaki, Shun Okuyama, and Masaki Sakurai for their support in image acquisition and processing, and Editage (https://www.editage.jp/) for English language editing.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan

    Tatsuya Nishii, Hiroki Horinouchi, Takara Namboku, Akiyuki Kotoku, Yasutoshi Ohta & Tetsuya Fukuda

  2. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Keitaro Sofue

  3. Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Ryotaro Asano & Takeshi Ogo

Authors
  1. Tatsuya Nishii
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tatsuya Nishii, Hiroki Horinouchi and Takara Namboku. The first draft of the manuscript was written by Tatsuya Nishii and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tatsuya Nishii.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This retrospective study was approved by the our Institutional Review Board (approval number: R19039-3).

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The requirement for obtaining written informed consent was waived due to the retrospective design of the study.

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Nishii, T., Horinouchi, H., Namboku, T. et al. Laterality of CT-measured hepatic extracellular volume fraction in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03119-6

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