arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2021-27-3-333-340arthyper-2092Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESИспользование компьютерной томографии в оценке степени тяжести пациентов с хронической тромбоэмболической легочной гипертензиейСomputed tomography in assessing the severity of patients with chronic thromboembolic pulmonary hypertensionhttps://orcid.org/0000-0002-7817-3847ПищуловК. А.PishchulovK. A.

Пищулов Константин Анатольевич — клинический ординатор кафедры внутренних болезней

ул. Аккуратова, д. 2, Санкт-Петербург, 197341. Тел.: 8(812)702–68–16

Konstantin A. Pishchulov, MD, Resident, Department of Internal Diseases

2 Akkuratov street, St Petersburg, 197347. Phone: 8(812)702–68–16

Pishchulov_KA@almazovcentre.ruhttps://orcid.org/0000-0001-9478-1941СимаковаМ. А.SimakovaM. A.

Симакова Мария Александровна — кандидат медицинских наук, старший научный сотрудник научно-исследовательской лаборатории кардиомиопатий

Санкт-Петербург

Maria A. Simakova, MD, PhD, Senior Researcher, Noncoronary Heart Disease Department

St Petersburg

Simakova_MA@almazovcentre.ruhttps://orcid.org/0000-0001-9528-9377КарповаД. В.KarpovaD. V.

Карпова Дарья Владимировна — заведующая отделением компьютерной томографии

Санкт-Петербург

Daria V. Karpova, MD, Head, Computed Tomography Department

St Petersburg

Karpova_DV@almazovcentre.ruhttps://orcid.org/0000-0002-7817-3847МоисееваО. М.MoiseevaO. M.

Моисеева Ольга Михайловна — доктор медицинских наук, заведующая научно-исследовательским отделом некоронарогенных заболеваний сердца

Санкт-Петербург

Olga M. Moiseeva, MD, PhD, DSc, Professor, Head, Noncoronary Heart Disease Department

St Petersburg

Moiseeva_OM@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202108042021273333340Copyright © Пищулов К.А., Симакова М.А., Карпова Д.В., Моисеева О.М., 20212021Пищулов К.А., Симакова М.А., Карпова Д.В., Моисеева О.М.Pishchulov K.A., Simakova M.A., Karpova D.V., Moiseeva O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2092

Цель исследования — изучение возможности применения компьютерной томографии для оценки степени тяжести пациентов с хронической тромбоэмболической легочной гипертензией (ХТЭЛГ). Материалы и методы. В исследование включен 41 пациент с верифицированным диагнозом ХТЭЛГ. Многосрезовая компьютерно-томографическая ангиография (МСКТ-АПГ) проводилась как по стандартному протоколу, так и в режиме двухэнергетического сканирования. В зависимости от уровня тромботического поражения легочной артерии пациенты были разделены на 2 группы: пациенты с проксимальным и пациенты с дистальным типом поражения легочной артерии. Результаты. Такие расчетные показатели, как индекс Кванадли и индекс Score, демонстрировали значимую отрицательную взаимосвязь со значением сердечного выброса (СВ) (r = –0,591, p < 0,05; r = –0,531, p < 0,001 соответственно), сатурации смешанной венозной крови (SvO2) (r = –0,457, p = 0,065; r = –0,595, p < 0,001 соответственно). Для индекса Score установлены отрицательные взаимосвязи как со значением СВ (r = –0,531, p < 0,001), показателем SvO2 (r = –0,595, p < 0,001), так и со значением N-терминального фрагмента мозгового натрийуретического пропептида NTproBNP (r = –0,537, р = 0,003). Корреляции сохраняются при анализе внутри сравниваемых групп. При этом в группе с проксимальным типом поражения выявлены статистически значимые взаимосвязи индекса Кванадли со средним давлением в легочной артерии (r = 0,825, р = 0,012). У 39 % (n = 16) пациентов встречалась аневризма легочной артерии, при этом у пациентов с дистальным типом поражения была показана положительная взаимосвязь наличия аневризмы легочной артерии с функциональным классом ХТЭЛГ (r = 0,526, р = 0,007). Заключение. Такие расчетные показатели МСКТ-АПГ, как индекс Кванадли и индекс Score, представляются перспективными для оценки степени тяжести пациентов с ХТЭЛГ.

Objective. To evaluate the role of computed tomography in the assessment of chronic thromboembolic pulmonary hypertension (CTEPH) severity. Design and methods. We included 41 patients. Chest dual-energy CT-computed tomographic angiography was performed according to the standard protocol and in some cases Dual Energy mode was used. The patients were divided into 2 groups: with proximal and distal types of pulmonary artery lesions. Results. Quanadli index and Score index showed a significant negative correlation with the value of cardiac output (CO) (r = –0,591, p < 0,05; r = –0,531, p < 0,001, respectively), mixed venous blood saturation (SvO2) (r = –0,457, p = 0,065; r = –0,595, p < 0,001, respectively). For the Score index, significant negative correlations were established with both the CO value: r = –0,531, p < 0,001, the SvO2 r = –0,595, p < 0,001, and with the N-terminal pro-B type natriuretic peptide (NTproBNP) value (r = –0,537, p = 0,003). Correlations are also found in the analysis within the compared groups. The Quanadli index correlated with the mean pressure in the pulmonary artery in the group with the proximal type of lesion (r = 0,825, p = 0,012). Pulmonary artery aneurysms were detected in 39 % (n = 16) patients. There was a positive correlation between the presence of a pulmonary artery aneurysm and the functional class of CTEPH (r = 0,526, p = 0,007) in patients with the distal lesion. Conclusions. Quanadli and Score indices are promising tools for CTEPH severity assessment.

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The authors declare that there are no conflicts of interest present.