CT angiography findings and the hemodynamics of chronic thromboembolic pulmonary disease: a correlation study

Abstract Background Chronic thromboembolic pulmonary disease (CTEPD) as a relatively underdiagnosed condition poses a diagnostic and therapeutic challenge. Purpose This study explores the correlation between CT angiography findings and hemodynamic parameters in CTEPD patients. Methods and Material A retrospective review was conducted on 98 patients (49 male, 49 female) with a definitive diagnosis of CTEPD. Inclusion criteria were the availability of right heart catheterization (RHC) parameters, pulmonary perfusion scintigraphy, and computed tomography pulmonary angiography (CTPA) findings. Right ventricle-to-left ventricle end-diastolic diameter ratio (RV/LV), pulmonary trunk, segmental pulmonary, and bronchial artery diameters were measured. The presence of geographic perfusion pattern was checked. The correlation between parameters obtained from CTPA and RHC was evaluated using Pearson correlation coefficients. Results The mean age was 52.9 ± 16.6 years. Correlation studies revealed a significant positive correlation between PAD and both mean and systolic pulmonary artery pressure. The mean RV/LV diameter ratio was 1.4 ± 0.55. The right ventricular (RV) diameter and RV/LV consistently correlated with mean and systolic PAPs and pulmonary vascular resistance and negatively with cardiac output. Mosaic perfusion pattern was observed in 59% and was significantly associated with worse hemodynamic findings. Bronchial artery dilation was not seen at a different frequency among patients with worse hemodynamic findings. Conclusion CT angiographic findings, particularly RV diameter and RV/LV ratio, show significant associations with hemodynamic impairment in CTEPD but should be interpreted as supportive imaging indicators rather than diagnostic markers. Furthermore, the presence of geographic mosaic perfusion might be associated with worse hemodynamic parameters.