CHEST Pulmonary (Dec 2024)

Significance of Normal Lung Volume on Quantitative CT Imaging Analysis in Group 1 and Group 3 Pulmonary HypertensionTake-home Points

  • Tadasu Okaya, MD. PhD,
  • Ayako Shigeta, MD. PhD,
  • Nobuhiro Tanabe, MD. PhD,
  • Koichiro Tatsumi, MD. PhD,
  • Hajime Yokota, MD. PhD,
  • Akira Nishiyama, MD. PhD,
  • Akira Naito, MD. PhD,
  • Ayumi Sekine,
  • Toshihiko Sugiura, MD. PhD,
  • Seiichiro Sakao, MD. PhD,
  • Takuji Suzuki, MD. PhD

Journal volume & issue
Vol. 2, no. 4
p. 100062

Abstract

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Background: Patients with concurrent pulmonary hypertension (PH) and parenchymal lung diseases have a high risk of mortality. However, whether their outcomes are related to low normal lung volume (NLV) resulting from parenchymal lung diseases on chest high-resolution CT (HRCT) imaging remains unknown. Research Question: Would NLV on quantitative HRCT imaging affect disease behavior in patients with PH? Study Design and Methods: This retrospective observational study evaluated patients with physician-diagnosed group 1 and group 3 PH among 1,471 patients who underwent right heart catheterization. Using a 3-dimensional image analysis system for HRCT imaging, the percentage of NLV (–950 to –600 Hounsfield units) to the whole lungs (%NLV) was calculated. The optimal cutoff point of %NLV for predicting survival was examined using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method and Cox proportional hazards regression were used to detect the association between %NLV and prognosis. Multivariable logistic regression was performed to examine the association of %NLV with response to pulmonary vasodilators. Results: Overall, 157 patients (mean age, 53.1 ± 17.6 years; sex, n = 111 [70.7%] female patients) were included. ROC curve analysis showed that the optimal cutoff of %NLV for predicting survival was 83.2%. The patients with %NLV of ≥ 83.2% showed significantly higher 5-year survival than that of those with %NLV of < 83.2% (81.7% vs 36.6%; P < .0001). Multivariable logistic regression analysis revealed %NLV of < 83.2% as an independent prognostic factor (hazard ratio, 2.49 [95% CI, 1.14–5.44]; P = .022). Responders showed significantly higher %NLV than nonresponders (90.0 ± 5.1% vs 84.7 ± 9.2%; P = .0002). Multivariable regression analysis showed that only high %NLV predicted response (OR, 1.12 [95% CI, 1.01–1.23]; P = .016). Interpretation: Quantitative CT imaging analysis might allow numerical quantification of the lung condition and vasodilator-treatable area beyond subjective visual assessment in patients with PH. The %NLV could be a novel predictor of prognosis and treatment response in these patients.

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