Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition defined by a mean pulmonary artery pressure (mPAP) greater than 20 mmHg at rest, as confirmed by right heart catheterization (RHC) (1). The global prevalence of PH is estimated at approximately 1% of the adult population, rising to 10% or more in individuals over 65 years of age.Pre-capillary pulmonary hypertension, which includes pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), is characterized by a pulmonary arterial wedge pressure (PAWP) ≤15 mmHg and an elevated pulmonary vascular resistance (PVR) ≥2 Wood units (2)
Computed tomography pulmonary angiography (CTPA) is routinely performed in the diagnostic workup of PH and offers a non invasive alternative that can generate multiple quantitative metrics from a single scan (3). Traditional CTPA metrics, including main pulmonary artery diameter (MPAd), the ratio of MPAd to ascending aortic diameter, central pulmonary arteries, and right ventricular to left ventricular diameter (RV/LV ratio) were previously studied in PH patients (4,5,6) Most existing studies have evaluated CTPA metrics in isolation or within single PH subgroups, limiting generalizability across the broader pre-capillary PH population (7).
Therefore, this study aims to systematically investigate the correlation between multiple quantitative CTPA metrics and key invasive hemodynamic parameters derived from RHC in patients with confirmed pre-capillary pulmonary hypertension
None
WHO PH Group 2 (PH due to left heart disease) or Group 5 (PH with unclear/multifactorial mechanisms) .
Active malignancy.
Pregnancy, confirmed or suspected.
Contraindication to iodinated contrast agent: eGFR < 30 mL/min/1.73m² OR documented history of severe anaphylactic contrast reaction.
adults with precapillary PHTN with contraindications to CTPA
Other
Prospective
right heart catheter
Other intervention. Right Heart Catheterization : All right heart catheterization procedures will be performed in the Cardiac Catheterization Laboratory at Assiut University Hospital by an accredited cardiologist or chest physician with dedicated PH catheterization experience. The procedure will be conducted in accordance with the 2022 ESC/ERS Guidelines on PH. Equipment * 7-French balloon-tipped thermodilution Swan-Ganz catheter. * Multi-channel pressure transducer system, zeroed at mid-axillary line at the level of the right atrium. * Continuous ECG, SpO₂, and non-invasive blood pressure monitoring throughout. * Fluoroscopy with stored images confirming catheter position at RA, RV, PA, and PAWP RHC Hemodynamic Parameters: Right atrial pressure, Right Ventricular Pressure - systolic (RVSP), Right Ventricular End-Diastolic Pressure (RVEDP), Pulmonary Arterial Pressure - systolic (sPAP), Pulmonary Arterial Pressure - diastolic (dPAP), Mean Pulmonary Arterial Pressure (mPAP), Pulmonary Arterial Wedge Pre
To determine the correlation between CTPA-derived morphometric metrics - specifically the (mPAD) and the PA:Ao diameter ratio - and invasive haemodynamic parameters measured by right heart catheterization,
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