Author + information
- Ozgur Yasar Akbal,
- Cihangir Kaymaz,
- Fatih Yilmaz,
- Ibrahim Halil Tanboga,
- Aykun Hakgor,
- Canan Elif Yildiz,
- Hacer Ceren Tokgoz,
- Sevim Turkday,
- Durmus Demir,
- Seda Tanyeri and
- Nihal Ozdemir
Background: Although left main coronary artery (LMCA) compression (Co) by pulmonary artery (PA) aneurysms has been reported, clinical importance and management of this complication remain to be determined. In this single-center prospective study, we evaluated correlates, clinical impact and management strategies of LMCA-Co in patients (pts) with pulmonary hypertension (PH).
Methods: Study group comprised 269 pts (female 166, age 52.9±17.3 years) with confirmed PH who underwent coronary angiography (CA), because of PA aneurysm on echo, angina or incidentally detected LMCA-Co during diagnostic evaluation.
Results: Group 1, 2, 3 and 4 PH were noted in 134, 13, 36 and 77 pts. FC was III or IV in 90,6% of these pts, and median six-minute walk distance (6MWD) was 270 (163-345) meters. Mean values of PA systolic, diastolic and mean pressures (PASP, PADP, PAMP) were 82±29, 30±16 and 50±20 mmHg, and pulmonary and systemic vascular resistance (PVR, SVR) were 6.2 (4.1-11.5) and 22 (16.3-26) Wood units, respectively. The LMCA-Co>50% was documented in 22 pts (8.2%) who underwent CA, and 14 of these stenosis were between 70% and 90%. Hoarseness due to recurrent nerve compression by PA was noted in all pts with LMCA-Co. Bare-metal stents were implanted in 12 pts without complication, and 1 pt underwent cardiac surgery. The best plane intersecting the short axis of LMCA-Co was left anterior oplique or anterior views with or without cranial angulations. Univariate comparisons revealed that younger age, D-shaped septum, higher PASP, PAMP, PADP and PVR, larger PA diameter, smaller aortic diameter and presence of patent-ductus arterious (PDA), atrial and ventricular septal defects were significantly associated with LMCA-Co. ROC analysis showed that age (c-index:0.15, OR:0.93, 0.90-0.96), PAMP (c-index:0.84, OR:1.1, 1.0-1.1), PA diameter (c-index:0.84, OR:1.2, 1.1-1.3), PVR (c-index:0.71, OR:1.1,1.0-1.1) and PDA presence (OR:20, 6.4-66) were best indicators for LMCA-Co.
Conclusions: We demonstrate that LMCA-Co is not an unusual complication of severe PH, and requires awareness in specific circumstances. However, long-term benefit from stenting in this setting remains as a controversy.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Predicting the Future: Observations and Discoveries From Registries and Databases
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1230-007
- 2017 American College of Cardiology Foundation