The clinical relevance of chest computed tomography imaging in pulmonary hypertension associated with lung diseases.

PURPOSE OF REVIEW: The purpose of this review is to describe the use of chest computed tomography (CT) data to expand sub-phenotyping of pulmonary hypertension associated with chronic lung disease (Group 3 pulmonary hypertension) and inform identification of effective treatment.

RECENT FINDINGS: In the last 5 years, breakthroughs in clinical pulmonary hypertension research highlight the importance of chest CT data to inform disease trajectory and mortality risk. In presumed idiopathic pulmonary arterial hypertension (Group 1 pulmonary hypertension), a Group 1 'lung phenotype' with abnormal CT chest findings such as emphysema and fibrosis, experiences a mortality risk similar to that of Group 3 disease. Post hoc analyses of Group 3 pulmonary hypertension clinical trials highlight CT abnormalities to inform adverse treatment response, with implications for additional failed clinical trials to date. In fact, pulmonary hypertension guidelines emphasize the critical role for acquisition of standardized high-resolution CT data at pulmonary hypertension diagnosis and clinical trial enrollment.

SUMMARY: Chest CT imaging is critical in the clinical management of pulmonary hypertension associated with chronic lung disease. Future research will not only incorporate CT data into Group 3 pulmonary hypertension phenotyping research but also consider treatment effect visualization on the lung parenchyma and pulmonary arterial vasculature as a novel clinical trial endpoint.