Clinicoradiological profile and its association with severity of pulmonary hypertension in post-tuberculosis sequelae: a cross-sectional study.

Dr. Perapagu  Jhansi; Nithin Joseph   Beera; Monika    Jonnalagadda; S Deepan  Raj

doi:10.51168/sjhrafrica.v6i9.2153

Authors

Dr. Perapagu Jhansi Senior Resident, Department of Pulmonary Medicine, Government Medical College, Suryapet, Telangana, India.
Dr. Beera Nithin Joseph Assistant Professor, Department of Pulmonary Medicine, Government Medical College, Suryapet, Telangana, India.
Dr. Jonnalagadda Monika Associate Consultant in Pulmonary Medicine, Yashoda Hospital, Secunderabad, Telangana, India
Dr. S Deepan Raj Department of Pulmonary Medicine, Arundhathi Institute of Medical Sciences, Dundigal, Medchal Malkajgiri District, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.2153

Keywords:

Post-tuberculosis sequelae, pulmonary hypertension, spirometry, High-Resolution Computed Tomography, echocardiography, lung function impairment

Abstract

Background
Pulmonary tuberculosis (PTB) remains a major global health challenge. Even after microbiological cure, many patients develop sequelae involving parenchyma, airways, and vasculature, predisposing them to pulmonary hypertension (PH). Evaluating the relationship between clinicoradiological changes and PH severity is essential for improved management.

Objectives
To assess the clinicoradiological profile of post-PTB sequelae and its association with the severity of PH using spirometry, high-resolution computed tomography (HRCT), and echocardiography.

Methods
This hospital-based cross-sectional study included 100 patients with PH previously treated for PTB at a tertiary care center. Clinical symptoms, signs, radiological patterns, spirometry, and echocardiographic findings were recorded. HRCT was used to calculate the Total Lung Score (TLS). PH severity was determined by right ventricular systolic pressure (RVSP) on 2D echocardiography. Statistical associations between TLS, spirometry indices, and PH severity were tested using chi-square and ANOVA, with p<0.05 considered significant.

Results
The cohort comprised 66 males and 34 females with a mean age of 46.6 ± 10.5 years. Dyspnea (97%) and cough (79%) were the predominant symptoms. Radiological sequelae included mixed fibrosis with bronchiectasis (30%), fibro-cavitary lesions (27%), and fibrosis (23%). HRCT showed cardiomegaly in 42% and pulmonary artery dilatation in 25–31%. All patients had abnormal spirometry: mixed pattern (49%), obstructive (29%), and restrictive (22%). FEV1 impairment was moderate in 28%, moderately severe in 26%, and severe in 22%. Echocardiography revealed mild PH in 52%, moderate in 30%, and severe in 18%. TLS correlated significantly with PH severity (p<0.001). Mean FEV1% and FVC% predicted decreased with higher TLS categories (p=0.03 and p=0.002).

Conclusion
Post-PTB sequelae frequently lead to mixed ventilatory impairment and pulmonary hypertension, with the extent of radiological involvement strongly predicting PH severity.

Recommendations
Routine follow-up with HRCT, spirometry, and echocardiography should be integrated into post-PTB care to allow early detection and intervention.

Author Biographies

Dr. Perapagu Jhansi, Senior Resident, Department of Pulmonary Medicine, Government Medical College, Suryapet, Telangana, India.

MD Senior Resident, Department of Respiratory Medicine, Government Medical College, Suryapet, Telangana, India. Dr. P. Jhansi completed her MBBS from Gandhi Medical College, Secunderabad, in the batch of 2014. She pursued her postgraduate training (MD in Respiratory Medicine) at the same institution, graduating in the batch of 2021. She is presently serving as a Senior Resident in the Department of Respiratory Medicine at Government Medical College, Suryapet. Her clinical and research interests include pulmonary infections, obstructive airway diseases, interstitial lung disorders, and advancements in bronchoscopic diagnostic techniques. She is committed to evidence-based respiratory care and medical education, contributing actively to academic and clinical excellence in pulmonary medicine.ORCID iD:https://orcid.org/0009-0007-2780-4921

Dr. Beera Nithin Joseph , Assistant Professor, Department of Pulmonary Medicine, Government Medical College, Suryapet, Telangana, India.

MD Assistant Professor, Department of Pulmonology, Government Medical College, Suryapet, Telangana, India. Dr. Beera Nithin Joseph obtained his MBBS degree from Prathima Institute of Medical Sciences, Karimnagar (2009–2014), and completed his MD in Pulmonology at Mamata Medical College, Khammam (2018–2021). He is currently serving as an Assistant Professor in the Department of Pulmonology at Government Medical College, Suryapet. His professional interests include interventional pulmonology, sleep-related breathing disorders, tuberculosis and drug-resistant TB management, and chronic obstructive pulmonary disease. Dr. Joseph is dedicated to advancing pulmonary healthcare through evidence-based clinical practice, academic teaching, and collaborative research in respiratory medicine. ORCID iD:https://orcid.org/0009-0008-2826-1057

Dr. Jonnalagadda Monika , Associate Consultant in Pulmonary Medicine, Yashoda Hospital, Secunderabad, Telangana, India

MD Associate Consultant, Department of Respiratory Medicine, Yashoda Hospital, Secunderabad, Telangana, India. Dr. Jonnalagadda Monika is presently serving as an Associate Consultant in the Department of Respiratory Medicine at Yashoda Hospital, Secunderabad. She completed her MBBS from Gandhi Medical College under Dr. NTR University of Health Sciences, Andhra Pradesh (Batch 2013–2014; graduated in 2018). She obtained her MD in Respiratory Medicine from Gandhi Medical College and Hospital, Secunderabad (Batch 2020–2021; completed in 2023).

Following her postgraduate training, she worked as a Senior Resident in the Department of Respiratory Medicine at Government Medical College, Nalgonda (September 2023–July 2024) and subsequently at Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad.

Her clinical expertise includes the diagnosis and management of a broad spectrum of respiratory disorders such as bronchial asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and pulmonary infections. She has a strong academic interest in critical care pulmonology, bronchoscopy, sleep-related breathing disorders, and advanced ventilatory support. Dr. Monika is deeply committed to evidence-based respiratory care, medical education, and clinical research aimed at improving outcomes in pulmonary medicine.ORCID iD: https://orcid.org/0009-0001-2865-2399

Dr. S Deepan Raj , Department of Pulmonary Medicine, Arundhathi Institute of Medical Sciences, Dundigal, Medchal Malkajgiri District, Telangana, India

MD Assistant Professor, Department of Respiratory Medicine, Arundhathi Institute of Medical Sciences, Dundigal, Telangana, India. Dr. Deepan Raj S is currently serving as an Assistant Professor in the Department of Respiratory Medicine at Arundhathi Institute of Medical Sciences, Dundigal. He completed his MBBS from Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry (Batch 2013–2014; graduated 2017). He pursued his MD in Respiratory Medicine at Gandhi Medical College and Hospital, Secunderabad (Batch 2020–2021; completed 2023). Following his postgraduate training, he served as a Senior Resident in the Department of Respiratory Medicine at Government Medical College, Suryapet (September 2023–September 2024).

His professional expertise encompasses the management of a broad range of respiratory disorders, including bronchial asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and pleural pathologies. His areas of academic interest include critical care pulmonology, bronchoscopy, pulmonary rehabilitation, and tuberculosis control strategies. Dr. Deepan Raj S is committed to advancing respiratory medicine through evidence-based clinical practice, active teaching, and collaborative research contributing to the improvement of pulmonary health care.ORCID iD:https://orcid.org/0009-0003-0578-107X

References

Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022 Oct 11;43(38):3618-3731. doi: 10.1093/eurheartj/ehac237. Erratum in: Eur Heart J. 2023 Apr 17;44(15):1312. doi: 10.1093/eurheartj/ehad005. PMID: 36017548.

Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019 Jan 24;53(1):1801913. doi: 10.1183/13993003.01913-2018. PMID: 30545968; PMCID: PMC6351336.

Augustine DX, Coates-Bradshaw LD, Willis J, Harkness A, Ring L, Grapsa J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2018 Sep;5(3):G11-G24. doi: 10.1530/ERP-17-0071. PMID: 30012832; PMCID: PMC6055509.

Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022 Jul 13;60(1):2101499. doi: 10.1183/13993003.01499-2021. PMID: 34949706.

Meghji J, Simpson H, Squire SB, Mortimer K. A Systematic Review of the Prevalence and Pattern of Imaging Defined Post-TB Lung Disease. PLoS One. 2016 Aug 12;11(8):e0161176. doi: 10.1371/journal.pone.0161176. PMID: 27518438; PMCID: PMC4982669.

Gupte AN, Paradkar M, Selvaraju S, Thiruvengadam K, Shivakumar SVBY, Sekar K, et al. Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PLoS One. 2019 May 23;14(5):e0217289. doi: 10.1371/journal.pone.0217289. Erratum in: PLoS One. 2019 Dec 5;14(12):e0226389. doi: 10.1371/journal.pone.0226389. PMID: 31120971; PMCID: PMC6532904.

Panda A, Bhalla AS, Sharma R, Mohan A, Sreenivas V, Kalaimannan U, et al. Correlation of chest computed tomography findings with dyspnea and lung functions in post-tubercular sequelae. Lung India. 2016 Nov-Dec;33(6):592-599. doi: 10.4103/0970-2113.192871. PMID: 27890986; PMCID: PMC5112814.

Santra A, Dutta P, Manjhi R, Pothal S. Clinico-Radiologic and Spirometric Profile of an Indian Population with Post-Tuberculous Obstructive Airway Disease. J Clin Diagn Res. 2017 Mar;11(3):OC35-OC38. doi: 10.7860/JCDR/2017/24555.9529. Epub 2017 Mar 1. PMID: 28511433; PMCID: PMC5427359.

Ivanova O, Hoffmann VS, Lange C, Hoelscher M, Rachow A. Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people. Eur Respir Rev. 2023 Apr 19;32(168):220221. doi: 10.1183/16000617.0221-2022. PMID: 37076175; PMCID: PMC10113954.

Taylor J, Bastos ML, Lachapelle-Chisholm S, Mayo NE, Johnston J, Menzies D. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. EClinicalMedicine. 2023 May 8;59:101979. doi: 10.1016/j.eclinm.2023.101979. PMID: 37205923; PMCID: PMC10189364.

van Heerden JK, Louw EH, Thienemann F, Engel ME, Allwood BW. The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis. Eur Respir Rev. 2024 Jan 17;33(171):230154. doi: 10.1183/16000617.0154-2023. PMID: 38232991; PMCID: PMC10792440.

Bhattacharyya P, Saha D, Bhattacherjee PD, Das SK, Bhattacharyya PP, Dey R. Tuberculosis associated pulmonary hypertension: The revelation of a clinical observation. Lung India. 2016 Mar-Apr;33(2):135-9. doi: 10.4103/0970-2113.177433. PMID: 27051098; PMCID: PMC4797429.