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To highlight the new data given in PulmonaryHypertension (PH) 2022 guideline and assess the differences of radiologicalapproach from the old version.Methods or BackgroundPulmonary hypertension (PH) is a heterogeneous diseasedriven most often by pathogenic remodeling of distal pulmonary arterioles or acongestive (functional) vasculopathy resulting from pulmonary venoushypertension. (1) The latest 2022 ESC/ERS Guidelines divides PH into 5categories:1- Pulmonary arterial hypertension2- PH associated with left heartdisease3- PH associated with lung diseases and/or hypoxia4- Chronicthrombo-embolic pulmonary hypertension5- Pulmonary hypertension with unclearand/or multifactorial mechanisms.European Society of Cardiology (ESC) and EuropeanRespiratory Society (ERS) has published a new guideline on PHT at August 2022.In this guideline new criterias and approaches were described for radiologicmodalities. Results or FindingsRight heart catheterization is the gold standard for PHdiagnosis but radiologic modalities (Ultrasound, CT, MRI, DSA) arecomplementary tools for both diagnosis and classification.In the new guideline;PA-to-aorta ratio cut-off level changed from 1 to 0.9 on Chest computedtomography (CT) . A combination of three parameters (PA diameter ≥30 mm, RVOTwall thickness ≥6 mm and septal deviation ≥140°) was described and defined ashighly predictive of PH (Table. 1). CT is also described as a useful tool fordetermination of parenchymal lung disease and pulmonary veno-occlusive diseasefindings. Measurement method of the septal deviation angle is applied asconnecting midpoint of interventricular septum to the intersections of RVmyocardium and interventricular septum (Fig. 1)(3).Digital subtractionangiography and dual CT are recommended over computed tomography pulmonaryangiography for the diagnosis of chronic tromboembolic pulmonary hypertensionas opposed to the first version (Fig 2)(4).As a main difference from theprevious guideline, Cardiac MRI has been presented. MRI is useful to evaluateatrial and ventricular size, morphology, and function and also primary modalityto measure right ventricular ejection fraction , stroke volume index and rightventricular end-systolic volume index (Figure 3).Abdominal ultrasound should beobtained to search for etiologic causes such as liver disease, portalhypertension or portocaval shunt (Abernethy malformation) and to evaluate pulmonaryhypertention induced end organ dysfunction (Table 2). ConclusionESC-ERS 2022 guideline adds new approaches andsuggestions for diagnosis and screening of PH. Radiologic modalities (USG, MR,CT, DSA) are helpful for detecting underlying condition, classification andscreening. |
