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Pulmonary venous occlusion and death in pulmonary arterial hypertension: survival analyses using radiographic surrogates.

Takeda Y, Takeda Y, Yamamoto K, Tomimoto S, Tani T, Narita H, Ohte N, Kimura G - BMC Pulm Med (2011)

Bottom Line: Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively.The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. takeday@med.nagoya-cu.ac.jp

ABSTRACT

Background: Recent studies find that a considerable number of patients with pulmonary arterial hypertension (PAH) develop fibrous obstruction of the pulmonary veins. Such obstruction more commonly accompanies connective tissue disorder (CTD)-associated PAH than idiopathic PAH. However, few researchers have gauged the risk of death involving obstruction of the pulmonary veins.

Methods: Thirty-seven patients with PAH were enrolled (18 patients, idiopathic PAH; 19 patients, CTD-associated PAH). The patients were 49 ± 18 years and had a World Health Organization functional class of 3.2 ± 0.6. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were surrogates for obstruction of the pulmonary veins, and were detected by a 16-row multidetector computed tomography scanner.

Results: The follow-up period was 714 ± 552 days. Fifteen deaths occurred. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively. Cox proportional hazard analysis revealed an increased risk of death with each radiographic surrogate (mediastinal adenopathy: p < 0.0001, hazard ratio = 13.9; thickening of interlobular septa: p < 0.001, hazard ratio = 12.0; ground-glass attenuation: p = 0.02, hazard ratio = 3.7). The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.

Conclusions: The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

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Related in: MedlinePlus

The computed tomography scan of a 25-year-old woman with severe idiopathic pulmonary arterial hypertension reveals thickening of the interlobular septa (arrowheads) and small multifocal areas of centrilobular ground-glass attenuation.
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Figure 1: The computed tomography scan of a 25-year-old woman with severe idiopathic pulmonary arterial hypertension reveals thickening of the interlobular septa (arrowheads) and small multifocal areas of centrilobular ground-glass attenuation.

Mentions: Thickening of the interlobular septa, the presence of centrilobular ground-glass attenuation, and enlargement of the mediastinal lymph nodes were surrogates for obstruction of the pulmonary veins; these surrogates were detected with computed tomography (CT) scans (Figure 1) [5,7-9,11-16]. The details of these abnormalities are described elsewhere [15,17-19]. A 16-row multidetector CT scanner (IDT 16, Philips Electronic Japan Medical Systems, Tokyo, Japan) used the following scan parameters: simultaneous acquisition of 16 slices per rotation with a slice thickness of 0.75 mm, rotation time of 500 ms, pitch of 0.9 mm, tube voltage of 120 kV, and tube current of 200 mA. Cross-sectional images were reconstructed with a slice thickness of 3.0 mm at 3.0-mm intervals. Board-certified radiologists gave reports on the CT images within 24 hours after the scans. Our radiologists were not restricted from other clinical data. Two investigators assessed the CT images and the reports for the surrogates within a few days thereafter. Final decisions were reached by consensus if there was an inconsistency.


Pulmonary venous occlusion and death in pulmonary arterial hypertension: survival analyses using radiographic surrogates.

Takeda Y, Takeda Y, Yamamoto K, Tomimoto S, Tani T, Narita H, Ohte N, Kimura G - BMC Pulm Med (2011)

The computed tomography scan of a 25-year-old woman with severe idiopathic pulmonary arterial hypertension reveals thickening of the interlobular septa (arrowheads) and small multifocal areas of centrilobular ground-glass attenuation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198760&req=5

Figure 1: The computed tomography scan of a 25-year-old woman with severe idiopathic pulmonary arterial hypertension reveals thickening of the interlobular septa (arrowheads) and small multifocal areas of centrilobular ground-glass attenuation.
Mentions: Thickening of the interlobular septa, the presence of centrilobular ground-glass attenuation, and enlargement of the mediastinal lymph nodes were surrogates for obstruction of the pulmonary veins; these surrogates were detected with computed tomography (CT) scans (Figure 1) [5,7-9,11-16]. The details of these abnormalities are described elsewhere [15,17-19]. A 16-row multidetector CT scanner (IDT 16, Philips Electronic Japan Medical Systems, Tokyo, Japan) used the following scan parameters: simultaneous acquisition of 16 slices per rotation with a slice thickness of 0.75 mm, rotation time of 500 ms, pitch of 0.9 mm, tube voltage of 120 kV, and tube current of 200 mA. Cross-sectional images were reconstructed with a slice thickness of 3.0 mm at 3.0-mm intervals. Board-certified radiologists gave reports on the CT images within 24 hours after the scans. Our radiologists were not restricted from other clinical data. Two investigators assessed the CT images and the reports for the surrogates within a few days thereafter. Final decisions were reached by consensus if there was an inconsistency.

Bottom Line: Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively.The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. takeday@med.nagoya-cu.ac.jp

ABSTRACT

Background: Recent studies find that a considerable number of patients with pulmonary arterial hypertension (PAH) develop fibrous obstruction of the pulmonary veins. Such obstruction more commonly accompanies connective tissue disorder (CTD)-associated PAH than idiopathic PAH. However, few researchers have gauged the risk of death involving obstruction of the pulmonary veins.

Methods: Thirty-seven patients with PAH were enrolled (18 patients, idiopathic PAH; 19 patients, CTD-associated PAH). The patients were 49 ± 18 years and had a World Health Organization functional class of 3.2 ± 0.6. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were surrogates for obstruction of the pulmonary veins, and were detected by a 16-row multidetector computed tomography scanner.

Results: The follow-up period was 714 ± 552 days. Fifteen deaths occurred. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively. Cox proportional hazard analysis revealed an increased risk of death with each radiographic surrogate (mediastinal adenopathy: p < 0.0001, hazard ratio = 13.9; thickening of interlobular septa: p < 0.001, hazard ratio = 12.0; ground-glass attenuation: p = 0.02, hazard ratio = 3.7). The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.

Conclusions: The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

Show MeSH
Related in: MedlinePlus