The Potential Value of Qanadli Computed Tomography Index for Pulmonary Endarterectomy: a Semi-quantitative Analysis of the Relationship between the Pulmonary Artery Occlusion Severity and Pulmonary Hemodynamics

Jiade Zhu, Sheng Liu, Yunhu Song, Haiping Wang

Chinese Academy of Medical Science,Fuwai Hospital, Beijing, China

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

Objective:Trying to quantify the relationship between the pulmonary artery hemodynamic changes and the Qanadli computed tomography(CT) index,so as to specificly quantify the effect of pulmonary endarterectomy surgery on perioperative hemodynamic changes by only using pre-surgery CT scanning.

Methods:Enhanced CT scanning and perfusion angiography have been done for each patients,Qanadli CT index is calculated before and after surgery, result of Right heart catheterization within 2 weeks before and after surgery are collected.And we use another scoring system to estimate pulmonary andarterectomy degree and predict the hemodynamics changes before surgery for another 20 cases of chronic thrombo-embolic pulmonary hypertension patients.

Results: Qandadli CT index is reduced from 0.552±0.107 to 0.210±0.124 (P<0.001),systolic pulmonary artery pressure decreased by 56.42±17.02%,mean pulmonary artery pressure decreased by 51.73±15.15% after surgery.Peri-operative Qanadli scoring change percentage and the mean pulmonary artery pressure change percentage as well as systolic pulmonary artery pressure change percentage is strongly linear correlated (Pearson correlation coefficient =0.765,0.709 respectively，p=0.002,0.007 respectively). Linear regression analysis shows that the mean pulmonary arterial pressure change percentage=0.535* pulmonary embolism oclussion index change percentage+0.189.Paired t test suggests that male were more likely to encounter an incomplete pulmonary endarterectomy procedure (p=0.045), multivariate analysis showed that the number of pulmonary segmental occlusion or lession diameter<5mm is the only factor contribute to the incomplete pulmonary endarterectomy procedure(p=0.037).The prediction for mPAP is highly effective when a deviation of 10 mmHg is permited(ROC area=0.929).

Conclusion:There is a strong linear relationship between the change percent of Qanadli score and pulmonary hemodynamics,we can partially estimate the pulmonary hemodynamic result and may be able to predict its changes before operation by using our strictly-designed scoring system adapted to evaluate the pulmonary endarterectomy degree before surgery.While another scoring system to evaluate stripping degree and a more detailed method to assess the embolism quantity is supposed to established to get a more unambiguous result.