Coronary artery stenosis associated with right ventricular dysfunction in acute pulmonary embolism: A case-control study

Abstract

Background: The potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE.

Methods: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction.

Results: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively.

Conclusions: Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.

Keywords: Coronary artery stenosis; Pulmonary embolism; Right ventricular dysfunction; Systolic pulmonary artery pressure.

Figure 1

The flow chart of the study investigating the association between pre-existing CAS and RV dysfunction in patients with acute PE. The case group included patients with acute PE with CAS, and the control group included those with acute PE without CAS. CAS: Coronary artery stenosis; hs-cTnI: High-sensitivity cardiac troponin I; PE: Pulmonary embolism; RV: Right ventricular.

Figure 2

Representative CCTA imaging of patients with acute PE. (A, B) Illustrative cases of acute PE demonstrate the absence of CAS in the left anterior descending artery in the control group. (C, D) CCTA showed 70% stenosis in the proximal to the middle segment of the left anterior descending branch in the case group (yellow arrow). The case group included patients with acute PE with CAS, and the control group included those with acute PE without CAS. “Roll” refers to the rotation compensation Angle. The parameters of LAO, CRA, and ROLL are the technical specifications for the X-ray gantry angles. AS: Acute marginal branch; CAS: Coronary artery stenosis; CCTA: Coronary computed tomographic angiography; CRA: Cranial; LAO: Left anterior oblique; LIA: Left inferior artery; PE: Pulmonary embolism; PI: Posterior interventricular artery; RSP: Right posterior segment artery.

Figure 3

Comparison of RV dysfunction prevalence and vital signs in patients with PE with different CAS. Patients with acute PE were grouped by no stenosis (n = 176), single-vessel stenosis (n = 36), and multivessel stenosis (n = 53) groups. In the comparison of prevalence of RV dysfunction (A) and elevated sPAP (B) between patients with no stenosis, single-vessel stenosis, and multivessel stenosis, chi-squared test or Fisher’s exact tests for categorical variables were used. In the comparison of differences of heart rate (C) and NT-proBNP (D) between patients with no stenosis, single-vessel stenosis, and multivessel stenosis, unpaired two-tailed Student’s t-test was used. The data are presented as the mean ± standard deviation. CAS: Coronary artery stenosis; HR: Heart rate; ns: Not significant; NT-proBNP: N-terminal pro-B type natriuretic peptide; RV: Right ventricular; sPAP: Systolic pulmonary arterial pressure.