Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: predictive value of computed tomography.

Abstract

To evaluate the prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome (ARDS) and to asses the value of pulmonary artery trunk diameter (PAT) to predict pulmonary hypertension. Prospective study University teaching hospital and ARDS referral center. 103 patients with ARDS, who received both right heart catheterization and chest computed tomography. None. 95 patients (92.2%) with ARDS had pulmonary artery hypertension, 16 of them (16.8%) mild, 72 (75.8%) moderate, and 7 (7.4%) severe, as assessed by right heart catheterization. Of the patients with moderate and severe pulmonary hypertension, 43 had a pulmonary artery trunk diameter >or=29 mm yielding a sensitivity of 0.54 and a specificity of 0.63. Pulmonary artery trunk diameter correlated significantly but weakly with mean pulmonary artery pressure (r=0.34, p=0.0004). The positive predictive value was 0.83, and the negative predictive value was 0.28. The diagnosis of pulmonary hypertension by PAT diameter measurements was incorrect in 43.7% of patients with ARDS. Pulmonary artery hypertension has a high prevalence in patients with severe ARDS. Measurement of PAT diameter on admission CT scan is an unreliable tool for identification of ARDS patients with pulmonary hypertension.