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

BACKGROUND
Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH), and may be associated with extrinsic compression of left main coronary artery (LMCA-Co) and/or compression of 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 right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a pulmonary artery (PA) aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography (MDCT). The LMCA-Co is defined as diameter stenosis ≥ 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 cut-off for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, negative predictive value 98%), and PA diameter > 35 mm was cut-off for LMCA-Co > 50% (AUC: 0.794; sensitivity 89%, specificity 58 %, negative predictive value 99%). Odds ratio of hoarseness for LMCA-Co was 83.3 (95 % CI; 36.5 -190, p< 0.001) with 3.2 % sensitivity, 98.7 % specificity, and 59 % positive and 98 % negative predictive values.

CONCLUSIONS
In this study, a close relationship was found between the presence of hoarseness and probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.