The presence of centrilobular ground-glass opacities (cGGO) on high resolution computed tomography (HRCT) adds prognostic value for patients with idiopathic pulmonary arterial hypertension (IPAH), according to a new study published in Respiratory Research.

The results showed that patients with cGGO had the shortest liver transplant (LTx)-free survival time compared to patients with panlobular ground-glass opacities (pGGO) or without ground-glass opacities (GGO); 3.4 vs 6.2 vs 5.8 years, respectively.

A total of 50% of the cGGO deaths or liver transplants observed during the study occurred in the first year of follow-up compared to 15% and 0% for pGGO and patients without GGO, respectively.

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Univariate analysis of predictive factors for death or transplant in 2 years found that cGGO yielded a hazard ratio (HR) of 5.01 [95% CI, 1.95-13.00; P =.0009]. World Health Organization functional class (P =.04), diffusion lung capacity for carbon monoxide (DLCO; P =.001), and N-terminal pro-brain natriuretic peptide (P =.003) were also negatively associated with negative 2-year outcomes.

Change of blood oxygen saturation (ΔSpO2) during the 6-Minute Walk Test (6MWT) was almost significantly associated (P =.05) with negative 2-year outcomes.

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In the multivariate analysis of all factors on 2-year outcomes, the presence of cGGO resulted in an HR of 6.22 (95% CI, 1.37-28.18; P =.018). Other significant prognostic factors on multivariate analysis included DLCO (P =.005) and 6MWT ΔSpO2 (P =.004).

“Presence of cGGO on HRCT scans of the lungs of IPAH patients has an add-on prognostic value for an outcome in a 2-year follow-up in reference to already well-established prognostic factors collected in the ESC/ERS multidimensional risk assessment tool, and could serve as a complementary element in making therapeutic decisions, e.g. the timing of referral for LTx assessment,” the authors concluded.

A total of 110 patients with IPAH were included in this retrospective study. The patients were 73% female with a median age of 44.5 years (range, 17.3-78.5). CGGO was found in 24 (22%) of patients and pGGO was found in 26 (24%).

The median follow-up time of the study was 5.0 years (range, 0.1-22.1 years) and during this time 73 patients died (66%), 8 underwent LTx, 11 were lost to follow-up, and 26 were still alive.


Kacprzak A, Burakowska B, Kurzyna M, et al. Predictive value of chest HRCT for survival in idiopathic pulmonary arterial hypertension. Respir Res. 2021;22(1):293. doi:10.1186/s12931-021-01893-8