Left main coronary artery compression by dilated pulmonary artery in pulmonary arterial hypertension: a systematic review and meta-analysis

Badea, Ruxandra; Dorobantu, Dan Mihai; Sharabiani, Mansour T. A.; Predescu, Lucian; Coman, Ioan Mircea; Ginghină, Carmen

doi:10.1007/s00392-022-01999-z

Cited by 2 publications

(6 citation statements)

References 22 publications

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“…In line with previous studies, LMCo was predicted by PA size, PA/aorta ratio 3,11,12,14–16 . The novel finding is the added value of RV end‐diastolic area to PA size and PA/aorta to better predict LMCo.…”

Section: Discussionsupporting

confidence: 89%

“…In line with previous studies, LMCo was predicted by PA size, PA/aorta ratio. 3 , 11 , 12 , 14 , 15 , 16 The novel finding is the added value of RV end‐diastolic area to PA size and PA/aorta to better predict LMCo. In contrast to previous suggestions we did not find significant associations between LMCo and chest pain, sex, age, body conformation, PH duration, PA pressures or PVR.…”

Section: Discussionmentioning

confidence: 99%

“…Studies for predictive parameters of LMCo are essential for best management given that ischemia testing has a limited role in LMCo detection in a population with limited exercise tolerance, abnormal baseline ECG and with generally contraindicated stress tests if suspected LM stenosis. 3 , 14 , 18 , 19 , 20…”

Section: Discussionmentioning

confidence: 99%

“…A main complication of PH is PA dilation, which is progressive and leads to other complications by compressing adjacent structures. One of these complications, LMCo, not only contributes to excess morbi‐mortality (angina, acute coronary syndromes, ventricular dysfunction, arrhythmia, death), but is reversible through interventional or surgical correction, with accumulating data on good outcomes 3–6 . After decades of literature on LMCo and extrapolating management from atherosclerosis, specific recommendations still lack in recent PH guidelines 1 .…”

Section: Introductionmentioning

confidence: 99%

“…One of these complications, LMCo, not only contributes to excess morbi-mortality (angina, acute coronary syndromes, ventricular dysfunction, arrhythmia, death), but is reversible through interventional or surgical correction, with accumulating data on good outcomes. [3][4][5][6] After decades of literature on LMCo and extrapolating management from atherosclerosis, specific recommendations still lack in recent PH guidelines. 1 Our study aims to assess LMCo prevalence, characteristics, predictors, prognosis and management in a real-life cohort of precapillary PH patients receiving pulmonary vasodilators in a PH referral center, with a long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Left main coronary artery compression in precapillary pulmonary hypertension

Badea,

Enache,

Predescu

et al. 2024

Pulm. circ.

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Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty‐five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow‐up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%–90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease‐associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA‐to‐aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end‐diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre‐capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA‐to‐aorta, RV end‐diastolic area and PH etiology) and long‐term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

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Section: Discussionsupporting

confidence: 89%