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

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Abstract

Objective

Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A meta-analysis of LMCo cases could fill the knowledge gaps in this topic.

Methods

Electronic databases were searched for all LMCo/PAH studies, abstracts and case reports including pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis was used to evaluate LMCo-associated factors. Specificity, sensitivity and accuracy of PA size thresholds for diagnosis of LMCo were calculated. Treatment options and outcomes were summarized.

Results

A total of five case–control cohorts and 64 case reports/series (196 LMCo and 438 controls) were included. LMCo cases had higher PA diameter (Hedge’s g 1.46 [1.09; 1.82]), PA/aorta ratio (Hedge’s g 1.1 [0.64; 1.55]) and probability of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA pressure or vascular resistance. A 40 mm cut-off for the PA diameter had balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after non-conservative treatment (n = 150, predominantly stenting) was 2.7% at up to 22 months of mean follow-up, with 83% survivors having no angina at follow-up.

Conclusion

PA diameter, PA/aorta ratio and CHD are associated with LMCo, while hemodynamic parameters are not. Data from this study support that a PA diameter cut-off between 40 and 44 mm can offer optimal accuracy for LMCo screening. Preferred treatment was coronary stenting, associated with low mid-term mortality and symptom relief.

Graphical abstract

Diagnosis and management of left main coronary artery compression (LMCo) in patients with pulmonary arterial hypertension (PAH).

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References

  1. Galiè N, Humbert M, Vachiery JL et al (2015) ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J Eur Respir Soc 46:903–975. https://doi.org/10.1183/13993003.01032-2015

    Article  CAS  Google Scholar 

  2. Demerouti EA, Manginas AN, Athanassopoulos GD, Karatasakis GT (2013) Complications leading to sudden cardiac death in pulmonary arterial hypertension. Respir Care 58(7):1246–1254. https://doi.org/10.4187/respcare.02252

    Article  PubMed  Google Scholar 

  3. Delcroix M, Naeije R (2010) Optimising the management of pulmonary arterial hypertension patients: emergency treatments. Eur Respir Rev 19(117):204–211. https://doi.org/10.1183/09059180.00004910

    Article  CAS  PubMed  Google Scholar 

  4. Lee SE, Im JH, Sung JM et al (2017) Detection of mechanical complications related to the potential risk of sudden cardiac death in patients with pulmonary arterial hypertension by computed tomography. Int J Cardiol 243:460–465. https://doi.org/10.1016/j.ijcard.2017.05.090

    Article  PubMed  Google Scholar 

  5. Humbert M, Sitbon O, Chaouat A et al (2010) Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation 122(2):156–163. https://doi.org/10.1161/CIRCULATIONAHA.109.911818

    Article  PubMed  Google Scholar 

  6. Alfonso F, Rivero F (2017) Left main coronary artery compression in patients with pulmonary arterial hypertension. J Am Coll Cardiol 69(23):2818–2820. https://doi.org/10.1016/j.jacc.2017.04.047

    Article  PubMed  Google Scholar 

  7. Galie N, Saia F, Palazzini M et al (2017) Left main coronary artery compression in patients with pulmonary arterial hypertension and angina. J Am Coll Cardiol 69(23):2808–2817. https://doi.org/10.1016/j.jacc.2017.03.597

    Article  PubMed  Google Scholar 

  8. Saia F, Dall’Ara G, Marzocchi A et al (2019) Left main coronary artery extrinsic compression in patients with pulmonary arterial hypertension: technical insights and long-term clinical outcomes after stenting. JACC Cardiovasc Interv 12(3):319–321. https://doi.org/10.1016/j.jcin.2018.08.002

    Article  PubMed  Google Scholar 

  9. Mesquita SMF, Castro CRP, Ikari NM, Oliveira SA, Lopes AA (2004) Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med 116(6):369–374. https://doi.org/10.1016/j.amjmed.2003.11.015

    Article  PubMed  Google Scholar 

  10. Akbal OY, Kaymaz C, Tanboga IH et al (2018) Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: Its correlates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging 19(11):1302–1308. https://doi.org/10.1093/ehjci/jex303

    Article  PubMed  Google Scholar 

  11. McLaughlin VV, Archer SL, Badesch DB et al (2009) A report of the american college of cardiology foundation task force on expert consensus documents and the american heart association. Circulation 119(16):2250–2294. https://doi.org/10.1161/CIRCULATIONAHA.109.192230

    Article  PubMed  Google Scholar 

  12. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  13. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2021) Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane. Available from www.training.cochrane.org/handbook

    Google Scholar 

  14. Veroniki AA, Jackson D, Viechtbauer W et al (2016) Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods 7(1):55–79. https://doi.org/10.1002/jrsm.1164

    Article  PubMed  Google Scholar 

  15. Vaseghi M, Lee MS, Currier J, Tobis J, Shapiro S, Aboulhosn J (2010) Percutaneous intervention of left main coronary artery compression by pulmonary artery aneurysm. Catheter Cardiovasc Interv 76(3):352–356. https://doi.org/10.1002/ccd.22555

    Article  PubMed  Google Scholar 

  16. Lee SE, An HY, Im JH et al (2016) Screening of mechanical complications of dilated pulmonary artery related to the risk for sudden cardiac death in patients with pulmonary arterial hypertension by transthoracic echocardiography. J Am Soc Echocardiogr 29(6):561–566. https://doi.org/10.1016/j.echo.2016.02.002

    Article  PubMed  Google Scholar 

  17. Labin JE, Saggar R, Yang EH et al (2021) Left main coronary artery compression in pulmonary hypertension. Catheter Cardiovasc Interv 97(7):E956–E966. https://doi.org/10.1002/ccd.29401

    Article  PubMed  Google Scholar 

  18. Dakkak W, Tonelli AR (2016) Compression of adjacent anatomical structures by pulmonary artery dilation. Postgrad Med 128(5):451–459. https://doi.org/10.1080/00325481.2016.1157442

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jacques F, Kotani Y, Deva DP et al (2012) Left main coronary artery compression long term after repair of conotruncal lesions: the bow string conduit. Ann Thorac Surg 94(1):283–285. https://doi.org/10.1016/j.athoracsur.2011.12.048

    Article  PubMed  Google Scholar 

  20. Piña Y, Exaire JESJ (2006) Left main coronary artery extrinsic compression syndrome: a combined intravascular ultrasound and pressure wire—PubMed. J Invasive Cardiol 18:E102–E104

    PubMed  Google Scholar 

  21. Velázquez Martín M, Montero Cabezas JM, Huertas S et al (2020) Clinical relevance of adding intravascular ultrasound to coronary angiography for the diagnosis of extrinsic left main coronary artery compression by a pulmonary artery aneurysm in pulmonary hypertension. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. https://doi.org/10.1002/ccd.29194

    Article  Google Scholar 

  22. Demerouti E, Manginas A, Petrou E et al (2016) Cardiac dual-source computed tomography for the detection of left main compression syndrome in patients with pulmonary hyper-tension. Open Cardiovasc Med J 10(1):130–137. https://doi.org/10.2174/1874192401610010130

    Article  PubMed  PubMed Central  Google Scholar 

  23. NucheBerenguer J, Lareo A, Montero Cabezas JM et al (2019) Prognostic implications of early detection and treatment of left main coronary artery compression by a pulmonary artery among pulmonary arterial hypertension patients. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz745.0530

    Article  Google Scholar 

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Funding

The authors have not received funding related to this work. Dan M. Dorobantu is supported by a doctoral scholarship (grant MR/N0137941/1) for the GW4 BIOMED DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI).

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Author notes

  1. Ruxandra Badea and Dan M. Dorobantu authors contributed equally to this work.

Authors and Affiliations

  1. Cardiology Department, Carol Davila University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest, Romania

    Ruxandra Badea, Lucian M. Predescu, Ioan M. Coman & Carmen Ginghina

  2. Children’s Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK

    Dan M. Dorobantu

  3. School of Population Health Sciences, University of Bristol, Bristol, UK

    Dan M. Dorobantu

  4. Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, UK

    Mansour T. A. Sharabiani

  5. Cardiology Department, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Lucian M. Predescu, Ioan M. Coman & Carmen Ginghina

Authors
  1. Ruxandra Badea
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  2. Dan M. Dorobantu
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  3. Mansour T. A. Sharabiani
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  4. Lucian M. Predescu
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Contributions

RB: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data Curation, Writing–Original Draft, Writing–Review and Editing, Visualization; DMD: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data Curation, Writing–Original Draft, Writing–Review and Editing, Visualization; MTAS: Methodology, Formal analysis, Writing–Review and Editing, Visualization; LMP: Conceptualization, Methodology, Writing–Original Draft, Writing–Review and Editing, Supervision; IMC: Conceptualization, Methodology, Writing–Review and Editing, Supervision; CG: Conceptualization, Methodology, Writing–Review and Editing, Supervision.

Corresponding author

Correspondence to Ruxandra Badea.

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Badea, R., Dorobantu, D.M., Sharabiani, M.T.A. et al. Left main coronary artery compression by dilated pulmonary artery in pulmonary arterial hypertension: a systematic review and meta-analysis. Clin Res Cardiol 111, 816–826 (2022). https://doi.org/10.1007/s00392-022-01999-z

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  • DOI: https://doi.org/10.1007/s00392-022-01999-z

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