ISSN 1016-5169 | E-ISSN 1308-4488
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Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2023; 51(7): 447-453 | DOI: 10.5543/tkda.2023.63828

Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension

Hacer Ceren Tokgöz1, Seda Tanyeri2, Ahmet Sekban1, Aykun Hakgör3, Barkın Kültürsay1, Berhan Keskin2, Ali Karagöz1, Ayhan Tosun1, Çağdaş Buluş1, Şeyhmus Külahçıoğlu1, İbrahim Halil Tanboğa4, Nihal Özdemir1, Cihangir Kaymaz1
1Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
2Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye
3Division of Cardiology, Medipol University, İstanbul, Türkiye
4Division of Cardiology, Nişantaşı University, İstanbul, Türkiye


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSION
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.

Keywords: Euphrates, hoarseness, left main coronary artery, pulmonary hypertension

How to cite this article
Hacer Ceren Tokgöz, Seda Tanyeri, Ahmet Sekban, Aykun Hakgör, Barkın Kültürsay, Berhan Keskin, Ali Karagöz, Ayhan Tosun, Çağdaş Buluş, Şeyhmus Külahçıoğlu, İbrahim Halil Tanboğa, Nihal Özdemir, Cihangir Kaymaz. Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension. Turk Kardiyol Dern Ars. 2023; 51(7): 447-453

Corresponding Author: Hacer Ceren Tokgöz, Türkiye
Manuscript Language: English


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