The role of coronary sinus in the risk stratification and the prognostic evaluation of idiopathic pulmonary arterial hypertension

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary sinus (CS) is a venous structure draining into the right atrium, therefore it can reflect the pressure and the volume load of the right heart chambers. Idiopathic pulmonary arterial hypertension (IPAH) is a progressive, life-threatening disease in which the risk assessment plays a critical role.

Purpose

We aimed to evaluate the correlation of CS diameter with the well-known risk assessment parameters in IPAH patients and to search the utility of CS diameter in the prediction of mortality and hospitalization.

Methods

A total of 25 IPAH patients were enrolled in our retrospective study.  All patients underwent detailed echocardiographic examination, laboratory examination, 6 minutes walking test and cardiopulmonary exercise test at the same day. The patients were followed-up for a mean 16.8 ± 10.1 months. Primary endpoint was mortality or hospitalization. The relationship between CS diameter and well-known risk parameters and the prognosis were analyzed.

Results

Mean CS diameter was 9.9 ± 3.7 mm. CS diameter had moderate positive correlation with age (r:0.560, p:0.004), NT-proBNP (r:0.625, p:0.001) and weak positive correlation with functional class (r:0.483, p:0.017) and moderate negative correlation with 6 minutes walking distance (r:-0.553, p:0.005) and peak oxygen uptake (r:-0.506 p:0.038). Six (24%) patients were hospitalized, and three patients (12%) died during mean 16.8 ± 10.1 months follow-up. The CS diameter > 9 mm predicted mortality and hospitalization with a sensitivity of 77.8%, specificity of 75.0% (Area under curve (AUC): 0.788; 95% CI: 0.580-0.996; P = 0.019).

Conclusion

CS which is a noninvasive, cheap and readily available echocardiographic parameter, might be used in the risk assessment and the evaluation of prognosis in IPAH patients. Abstract Figure. Coronary sinus measurement  Abstract Figure. Basal features