Decreased size of the left anterior descending coronary artery is an independent predictor of deterioration in non-high-risk patients with acute pulmonary embolism

Abstract

To evaluate the efficacy of measuring left coronary artery size to predict deterioration in non-high-risk acute pulmonary embolism (PE) patients. This retrospective study enrolled non-high-risk acute PE patients from January 2011 to December 2019. Patient deterioration was defined as the occurrence of adverse events within 30 days of hospital admission. Patients with adverse events were sex- and age-matched to patients without adverse events. Risk stratification was performed. Cross-sectional areas (CSAs) of the left main and left anterior descending (LAD) coronary artery inlets were measured. The main pulmonary artery (MPA) inlet and outlet and MPA LAD plane, which adjoined the LAD in the MPA, were reconstructed. CSAs, perimeters, and hydraulic diameters were measured to evaluate MPA size and deformation. Cardiac volume was also measured. Quantitative parameters were divided into tertiles. After adjustment by risk stratification, univariate and multivariate analyses were performed. Correlations between different parameters were analysed. Seventy-three patients with adverse events were matched to 73 patients without adverse events. The results of the univariate and multivariate analyses revealed that LAD inlet CSAs (middle and high) predicted adverse events (odds ratio: 0.28 and 0.07, 95% confidence interval: 0.10–0.77 and 0.02–0.22, p = 0.013 and < 0.0001). LAD inlet CSA was strongly and negatively correlated with MPA LAD hydraulic diameter and CSA (correlation coefficients: − 0.643 and − 0.604, p < 0.001). LAD inlet CSA measurement would facilitate adverse event prediction in non-high-risk acute PE patients on the basis of risk stratification. The dilated MPA may involve the decrease in LAD inlet CSA.

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References

  1. 1.

    Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jimenez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ainle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, The Task Force for the d, management of acute pulmonary embolism of the European Society of C (2019) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Res J. https://doi.org/10.1183/13993003.01647-2019

    Article  Google Scholar 

  2. 2.

    Beenen LFM, Bossuyt PMM, Stoker J, Middeldorp S (2018) Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Res J. https://doi.org/10.1183/13993003.02611-2017

    Article  Google Scholar 

  3. 3.

    Cok G, Tasbakan MS, Ceylan N, Bayraktaroglu S, Duman S (2013) Can we use CT pulmonary angiography as an alternative to echocardiography in determining right ventricular dysfunction and its severity in patients with acute pulmonary thromboembolism? Japanese journal of radiology 31(3):172–178. https://doi.org/10.1007/s11604-012-0164-6

    Article  PubMed  Google Scholar 

  4. 4.

    Santos AR, Freitas P, Ferreira J, Oliveira A, Goncalves M, Faria D, Bicho Augusto J, Simoes J, Santos A, Gago M, Oliveira J, Antunes RM, Correia D, Lynce A, Brito J, Morais C, Campos L, Mendes M (2019) Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup. European Heart Journal Acute Cardiovascular Care. https://doi.org/10.1177/2048872619846506

    Article  PubMed  Google Scholar 

  5. 5.

    Fernandez C, Bova C, Sanchez O, Prandoni P, Lankeit M, Konstantinides S, Vanni S, Fernandez-Golfin C, Yusen RD, Jimenez D (2015) Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism. Chest 148(1):211–218. https://doi.org/10.1378/chest.14-2551

    Article  PubMed  Google Scholar 

  6. 6.

    Mesquita SMF, Castro CRP, Ikari NM, Oliveira SA, Lopes AA (2004) Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. The American journal of medicine 116(6):369–374. https://doi.org/10.1016/j.amjmed.2003.11.015

    Article  PubMed  Google Scholar 

  7. 7.

    Alfonso F, Rivero F (2017) Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension. J Am Coll Cardiol 69(23):2818–2820. https://doi.org/10.1016/j.jacc.2017.04.047

    Article  PubMed  Google Scholar 

  8. 8.

    Saia F, Dall'Ara G, Marzocchi A, Dardi F, Palazzini M, Manes A, Taglieri N, Marrozzini C, Rinaldi A, Galie N (2019) Left Main Coronary Artery Extrinsic Compression in Patients With Pulmonary Arterial Hypertension: Technical Insights and Long-Term Clinical Outcomes After Stenting. JACC Cardiovascular interventions 12(3):319–321. https://doi.org/10.1016/j.jcin.2018.08.002

    Article  PubMed  Google Scholar 

  9. 9.

    Tezza M, Witsenburg M, Nieman K, van de Woestijne PC, Budde RPJ (2019) Cardiac CT to assess the risk of coronary compression in patients evaluated for percutaneous pulmonary valve implantation. Eur J Radiol 110:88–96. https://doi.org/10.1016/j.ejrad.2018.11.018

    Article  PubMed  Google Scholar 

  10. 10.

    Wang D, Sun JP, Lee AP, Ma GS, Yang XS, Yu CM, Ding JD, Liu NF (2015) Evaluation of left ventricular function by three-dimensional speckle-tracking echocardiography in patients with myocardial bridging of the left anterior descending coronary artery. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 28(6):674–682. https://doi.org/10.1016/j.echo.2015.02.012

    Article  Google Scholar 

  11. 11.

    Zuin M, Rigatelli G, Zonzin P, Casazza F, Roncon L (2017) Saddle pulmonary embolism in hemodynamically stable patients: To lyse or not to lyse? An issue in no guidelines land. European journal of internal medicine 46:e26–e28. https://doi.org/10.1016/j.ejim.2017.09.002

    Article  PubMed  Google Scholar 

  12. 12.

    Gong ZJ, Cheng JW, Gao PT, Huang A, Sun YF, Zhou KQ, Hu B, Qiu SJ, Zhou J, Fan J, Yang XR (2019) Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis. Oncologist 24(7):997–1007. https://doi.org/10.1634/theoncologist.2018-0268

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Kim J, Bergman T, Juergens AL (2019) Anomalous left anterior descending artery diagnosed on pulmonary artery computed tomography. The American journal of emergency medicine. https://doi.org/10.1016/j.ajem.2019.04.028

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Schievano S, Capelli C, Young C, Lurz P, Nordmeyer J, Owens C, Bonhoeffer P, Taylor AM (2011) Four-dimensional computed tomography: a method of assessing right ventricular outflow tract and pulmonary artery deformations throughout the cardiac cycle. Eur Radiol 21(1):36–45. https://doi.org/10.1007/s00330-010-1913-5

    Article  PubMed  Google Scholar 

  15. 15.

    Rembold CM, Suratt PM (2014) Airway turbulence and changes in upper airway hydraulic diameter can be estimated from the intensity of high frequency inspiratory sounds in sleeping adults. The Journal of physiology 592(17):3831–3839. https://doi.org/10.1113/jphysiol.2014.272302

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Galit Aviram ES, Bendet A, Shmueli H, Ziv-Baran T, Amitai Y, Friedensohn L, Berliner S, Meilik A, Topilsky Y (2016) Prediction of Mortality in Pulmonary Embolism Based on Left Atrial Volume Measured on CT Pulmonary Angiography. Chest 149(3):667–675. https://doi.org/10.1378/chest.15-0666

    Article  PubMed  Google Scholar 

  17. 17.

    Peng Z, Wei M, Chen S, Lin M, Jiang C, Mei J, Li B, Wang Y, Li J, Xie X, Kuang M (2018) Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol 28(8):3522–3531. https://doi.org/10.1007/s00330-017-5166-4

    Article  PubMed  Google Scholar 

  18. 18.

    Kobayashi N, Maehara A, Brener SJ, Genereux P, Witzenbichler B, Guagliumi G, Peruga JZ, Mehran R, Mintz GS, Stone GW (2015) Usefulness of the Left Anterior Descending Coronary Artery Wrapping Around the Left Ventricular Apex to Predict Adverse Clinical Outcomes in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). The American journal of cardiology 116(11):1658–1665. https://doi.org/10.1016/j.amjcard.2015.09.004

    Article  PubMed  Google Scholar 

  19. 19.

    Tian L, Kellihan HB, Henningsen J, Bellofiore A, Forouzan O, Roldan-Alzate A, Consigny DW, Gunderson M, Dailey SH, Francois CJ, Chesler NC (2014) Pulmonary artery relative area change is inversely related to ex vivo measured arterial elastic modulus in the canine model of acute pulmonary embolization. J Biomech 47(12):2904–2910. https://doi.org/10.1016/j.jbiomech.2014.07.013

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Cote B, Jimenez D, Planquette B, Roche A, Marey J, Pastre J, Meyer G, Sanchez O (2017) Prognostic value of right ventricular dilatation in patients with low-risk pulmonary embolism. Eur Res J. https://doi.org/10.1183/13993003.01611-2017

    Article  Google Scholar 

  21. 21.

    Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, Abro JA, Ravenel JG, Costello P, Goldhaber SZ (2011) CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovascular imaging 4(8):841–849. https://doi.org/10.1016/j.jcmg.2011.04.013

    Article  PubMed  Google Scholar 

  22. 22.

    Maier R, Krumnikl J, Knez I, Rainer PP (2016) Typical STEMI: or not? Embolic left anterior descending artery occlusion, fulminant pulmonary embolism, and in-transit thrombus in a patent foramen ovale. Eur Heart J 37(40):3114. https://doi.org/10.1093/eurheartj/ehw258

    Article  PubMed  Google Scholar 

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Funding

This study received funding from the 345 Talent Project of Shengjing Hospital of China Medical University.

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DJ designed and performed the research as well as wrote the manuscript; YG designed and performed the research.

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Correspondence to Yizhuo Gao.

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All authors have no relevant conflicts of interest to disclose.

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This research was approved by the Institutional Review Board of Shengjing Hospital of China Medical University.

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Informed consent was not required for use of medical recording and image data as a retrospective study.

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Baseline and risk stratification of all patients with pulmonary embolism beforepropensity score matching Supplementary file1 (DOCX 12 kb)

Comparison of the parameters between adverse event (+) and adverse event (-)patients after propensity score matching Supplementary file2 (DOCX 14 kb)

Cardiac reconstruction and measurement volumesLA, left atria; RA, right atria; LV, left ventricle; RV, right ventricle Supplementary file3 (TIF 5678 kb)

Univariate analysis after adjustment by risk stratification. The LAD inlet CSA wascorrelated with adverse events in the three risk groups (ORs: 0.83, 0.67, and 0.83, 95% CI: 0.70–0.99,0.50–0.91, and 0.75–0.93, p=0.034, 0.0093, and 0.0013, p<0.05, respectively).MPA, main pulmonary artery; CSA, cross-sectional area; LMA, left main coronary artery; LAD, leftanterior descending coronary artery; LA, left atrium; RA, right atrium; LV, left ventricle; RV, rightventricle Supplementary file4 (TIF 7887 kb)

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Jia, D., Gao, Y. Decreased size of the left anterior descending coronary artery is an independent predictor of deterioration in non-high-risk patients with acute pulmonary embolism. J Thromb Thrombolysis 51, 168–175 (2021). https://doi.org/10.1007/s11239-020-02136-1

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Keywords

  • Pulmonary embolism
  • Pulmonary artery
  • Coronary artery
  • Computed tomography