Clinical studyLikelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension
Section snippets
Patients
All patients with pulmonary hypertension treated at the Heart Institute of the University of São Paulo in 2002 were eligible for the study. The entry criteria were a mean pulmonary artery pressure >25 mm Hg and a pulmonary wedge pressure <15 mm Hg. All subjects were initially evaluated as outpatients. The study protocol was approved by the Scientific Committee of the Heart Institute, and informed consent was obtained from all patients or their parents (in the case of adolescents).
Clinical assessment
Information on
Results
Thirty-six patients (26 women [72%]) were enrolled in the study (Table 1). The mean (± SD) age was 49 ± 18 years (median, 47 years; range, 15 to 86 years). Patients had a mean pulmonary artery pressure of 49 ± 14 mm Hg (median, 49 mm Hg; range, 30 to 90 mm Hg), a mean pulmonary trunk diameter of 41 ± 12 mm (median, 40 mm; range, 25 to 73 mm), and a mean pulmonary trunk to aortic diameter ratio of 1.56 ± 0.50 (median, 1.39; range, 1.0 to 2.83).
At presentation, 13 patients were in New York Heart
Discussion
This study shows that, in patients with pulmonary arterial hypertension, left coronary artery compression may cause angina and left ventricular ischemia more frequently than previously recognized. Compression was found in 19% of patients and was closely related to the diameter of the pulmonary trunk but not to pulmonary artery pressure or chest pain.
The clinical and angiographic presentation defined two distinct groups. The first consisted of 10 patients without a history of chest pain. All
Acknowledgements
We thank Mrs. Roseli Polo for technical assistance in the preparation of this manuscript.
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