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Pulmonary hypertension and right ventricular dysfunction in patients with left to right shunt coronary artery fistula: evaluation with cardiac CT

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Abstract

In this study, we aimed to evaluate whether patients with left to right shunt coronary artery fistula (LRSCAF) are predisposed to developing pulmonary hypertension and right ventricular dysfunction compared with healthy individuals. The value of cardiac CT findings in determining the necessity of intervention for these patients was investigated. We retrospectively studied 19 patients with LRSCAF and 19 healthy patients. Several parameters were observed on cardiac CT by two radiologists, including pulmonary trunk diameter (PA diameter), right ventricular diameter (RVD), left ventricular diameter (LVD), RVD/LVD ratio, septal bowing and CT score of right ventricular dysfunction (CSRVD). Data from both groups were compared. The inter- and intra-observer variabilities and correlations were examined. The disease group was further divided into intervention (n = 9) and non-intervention (n = 10) groups, and their data were compared. All cardiac CT findings showed significant intra- and inter-observer correlation without significant variability. Mann–Whitney U tests and χ2 analysis showed that PA diameter, RVD/LVD ratio acquired from two observers, and CSRVD were higher in the disease group than in the control group (all P values < 0.05 for χ2 and almost all P values < 0.05 for Mann–Whitney U). The RVD/LVD ratio and CSRVD were higher in the intervention group than in the non-intervention group (all P values < 0.05). Receiver operating curve analysis identified RVD/LVD = 1.036 and CSRVD = 3.5 as the best cut-off values to determine the necessity of further intervention. Patients with LRSCAF are more predisposed to pulmonary hypertension and right ventricular dysfunction compared with the normal population. RVD/LVD > 1.0 and CSRVD ≥ 4.0 may determine the necessity of intervention for patients with LRSCAF.

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Acknowledgments

Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, ROC. This study is partially supported by the Wong Vung-Hau Radiology Foundation, Taipei, Taiwan, ROC.

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Authors and Affiliations

  1. Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC

    Yu-Pin Chang, Si-Wa Chan, Jyh-Wen Chai, Jian-Ling Chen, Yen-Ting Lin, Ming-Chih Chen & Clayton Chi-Chang Chen

  2. E-Da Hospital, Kaohsiung, Taiwan, ROC

    Jeon-Ho Chen

  3. I-Shou University, Kaohsiung, Taiwan, ROC

    Jeon-Ho Chen

  4. Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC

    Yun-Ching Fu

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  1. Yu-Pin Chang
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Correspondence to Si-Wa Chan.

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Chang, YP., Chan, SW., Chai, JW. et al. Pulmonary hypertension and right ventricular dysfunction in patients with left to right shunt coronary artery fistula: evaluation with cardiac CT. Int J Cardiovasc Imaging 32 (Suppl 1), 91–104 (2016). https://doi.org/10.1007/s10554-016-0868-2

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