Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye.
Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye.
Turk Kardiyol Dern Ars. 2023 Oct;51(7):447-453. doi: 10.5543/tkda.2023.63828.
Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH.
Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes.
The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values.
In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.
肺动脉（PA）扩张是严重肺动脉高压（PH）患者的常见表现，可能与左主干冠状动脉（LMCA-Co）的外部压迫和/或左喉返神经的压迫有关，导致声音嘶哑，称为 Ortner 综合征（OS）。本研究旨在评估 OS 对预测 PH 患者 PA 瘤和 LMCA-Co 显著狭窄的诊断价值。
本研究回顾性分析了 2006 年至 2022 年期间接受右心导管检查确诊为 PH 的 865 例患者。患者因多种原因接受冠状动脉造影检查，包括超声心动图发现 PA 瘤、心绞痛症状或多排螺旋 CT 发现 LMCA-Co 意外。LMCA-Co 定义为在两个连续的血管造影平面上参考远端 LMCA 节段直径狭窄³50%。
PH 患者中 LMCA-Co 和声音嘶哑的发生率分别为 3.8%和 4.3%。PA 直径的增加与更差的临床、血流动力学、实验室和超声心动图参数显著相关。ROC 曲线显示，PA 直径>41mm 是声音嘶哑的截断值（AUC：0.834；敏感性 69%，特异性 84%，阴性预测值 98%），PA 直径>35mm 是 LMCA-Co>50%的截断值（AUC：0.794；敏感性 89%，特异性 58%，阴性预测值 99%）。声音嘶哑与 LMCA-Co 的比值比为 83.3（95%置信区间：36.5-190，P<0.001），敏感性为 3.2%，特异性为 98.7%，阳性预测值为 59%，阴性预测值为 98%。
本研究发现，在严重 PH 患者中，PA 增大与 LMCA-Co 外部压迫之间存在密切关系。因此，在出现声音嘶哑的 PH 患者中，应考虑存在 LMCA-Co 的可能性。
