TY - JOUR T1 - Importance of computed tomography in defining segmental disease in chronic thromboembolic pulmonary hypertension JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00461-2020 VL - 6 IS - 4 SP - 00461-2020 AU - Micheal C. McInnis AU - David Wang AU - Laura Donahoe AU - John Granton AU - John Thenganatt AU - Kongteng Tan AU - John Kavanagh AU - Marc de Perrot Y1 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00461-2020.abstract N2 - Background Radiological assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is critical to decide whether patients should be treated with pulmonary endarterectomy (PEA). Although computed tomography pulmonary angiography (CTPA) is increasingly used for decision making in CTEPH, the value of CTPA to predict surgical findings and outcome has never been explored.Methods We retrospectively reviewed 100 consecutive patients with high-quality CTPA undergoing PEA for CTEPH between May 2015 and December 2017. The most proximal level of disease in the pulmonary artery on CTPA was classified by two blinded radiologists as level 1 (main pulmonary artery), 2a (lobar pulmonary artery), 2b (origin of basal segmental pulmonary artery), 3 (segmental pulmonary artery) or 4 (predominantly subsegmental pulmonary artery).Results CTPA demonstrated level 1 in 20%, level 2a in 43%, level 2b in 11%, level 3 in 23% and level 4 in 3%. A majority of males presented with level 1 (55%) and level 2 (57%), and a majority of females (83%) with level 3 (p=0.01). Levels 3 and 4 were associated with longer duration of circulatory arrest (p=0.03) and higher frequency of Jamieson type III disease at surgery (p<0.0001). Requirement for targeted pulmonary hypertension therapy after PEA was 28% at 3 years in level 2b/3/4 compared with 6% in level 2a and 13% in level 1 (p=0.002). Level 2b/3/4 was an independent predictor for targeted pulmonary hypertension therapy after PEA (hazard ratio 4.23, 95% CI 1.24–14.39; p=0.02).Conclusions High-quality CTPA provides accurate evaluation of CTEPH patients. The level of disease on CTPA can help guide peri-operative planning and post-operative monitoring.High-quality CTPA provides accurate evaluation of CTEPH patients. The level of disease on CTPA can predict surgical difficulty and the need for targeted PH therapy after PEA. https://bit.ly/317ZBSu ER -