Uygur Begum, Memiç Sancar Kadriye, Bulut Ümit, Kahraman Serkan, Ateşli Yazıcı Alkım, Demir Ali Rıza, Zencirkıran Ağuş Hicaz, Coşkun Gizemnur, Erturk Mehmet, Yıldız Mustafa
Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Kirikhan State Hospital, Hatay, Turkey.
Herz. 2025 Sep 22. doi: 10.1007/s00059-025-05341-x.
The coronary sinus (CS) can reflect the pressure and volume load of the right heart chambers. Idiopathic pulmonary arterial hypertension (IPAH) is a progressive, life-threatening disease in which risk assessment plays a critical role. We aimed to evaluate (a) the correlation between CS diameter and risk assessment parameters in IPAH patients and (b) the utility of CS diameter in predicting mortality and hospitalization.
This retrospective study included 25 IPAH patients. All patients underwent echocardiographic and laboratory examinations, 6‑minute walk test, and cardiopulmonary exercise test on the same day. The follow-up was 16.8 ± 10.1 months. The primary endpoint was mortality or hospitalization. The relationship between CS diameter, established risk parameters, and prognosis was analyzed.
Six patients (24%) were hospitalized, and three patients (12%) died during the follow-up . The mean CS diameter was 9.9 ± 3.7 mm and showed a moderate positive correlation with age (r = 0.560, p = 0.004) and NT-proBNP levels (r = 0.625, p = 0.001); a weak positive correlation with functional class (r = 0.483, p = 0.017); and moderate negative correlations with 6‑min walking distance (r = -0.553, p = 0.005) and peak oxygen uptake (r = -0.506, p = 0.038). Greater CS diameter was associated with older age, higher NT-proBNP levels, and worse functional class, while reduced exercise capacity and peak VO were accompanied by increased CS diameter. A CS diameter > 9 mm predicted mortality and hospitalization with a sensitivity of 77.8% and specificity of 75.0% (area under the curve [AUC]: 0.788; 95% CI: 0.580-0.996; p = 0.019). The Kaplan-Meier curve showed that as CS diameter increased, mortality and hospitalization rates increased significantly.
The CS diameter is a simple, readily available, noninvasive echocardiographic parameter that may be a valuable adjunct to current risk assessment models in IPAH.
冠状窦（CS）可反映右心腔的压力和容量负荷。特发性肺动脉高压（IPAH）是一种进行性、危及生命的疾病，风险评估在其中起着关键作用。我们旨在评估（a）IPAH患者CS直径与风险评估参数之间的相关性，以及（b）CS直径在预测死亡率和住院率方面的效用。
这项回顾性研究纳入了25例IPAH患者。所有患者在同一天接受了超声心动图和实验室检查、6分钟步行试验以及心肺运动试验。随访时间为16.8±10.1个月。主要终点是死亡率或住院率。分析了CS直径、既定风险参数与预后之间的关系。
6例患者（24%）在随访期间住院，3例患者（12%）死亡。CS平均直径为9.9±3.7mm，与年龄呈中度正相关（r = 0.560，p = 0.004），与NT-proBNP水平呈中度正相关（r = 0.625，p = 0.001）；与功能分级呈弱正相关（r = 0.483，p = 0.017）；与6分钟步行距离呈中度负相关（r = -0.553，p = 0.005），与峰值摄氧量呈中度负相关（r = -0.506，p = 0.038）。CS直径越大与年龄越大、NT-proBNP水平越高以及功能分级越差相关，而运动能力和峰值VO降低则伴随着CS直径增加。CS直径>9mm预测死亡率和住院率的敏感性为77.8%，特异性为75.0%（曲线下面积[AUC]：0.788；95%可信区间：0.580 - 0.996；p = 0.019）。Kaplan-Meier曲线显示，随着CS直径增加，死亡率和住院率显著增加。
CS直径是一个简单、易于获取的无创超声心动图参数，可能是目前IPAH风险评估模型的一个有价值的辅助指标。
