systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.26442/2075082X.2018.4.180105systhiper-572Research ArticleСТАТЬИARTICLESХроническое миокардиальное повреждение при идиопатической легочной артериальной гипертензии. Клиническое наблюдениеChronic myocardial damage in idiopathic pulmonary arterial hypertension: a clinical caseБыковА. Н.BykovA. N.sashacor83@yandex.ruАрхиповМ. В.ArkhipovM. V.markhipov55@mail.ruКлимушеваН. Ф.KlimushevaN. F.klimusheva@okb1.ruИофинА. И.IofinA. I.iofin@okb1.ruКрохалевВ. Я.KrokhalevV. Ya.vkrokhalev@yandex.ruГБУЗ СО «Свердловская областная клиническая больница №1»РоссияSverdlovsk Regional Clinical Hospital №1Russian FederationФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РоссииРоссияUral State Medical University of the Ministry of Health of the Russian FederationRussian Federation2018231220221548390Copyright © Быков А.Н., Архипов М.В., Климушева Н.Ф., Иофин А.И., Крохалев В.Я., 20222022Быков А.Н., Архипов М.В., Климушева Н.Ф., Иофин А.И., Крохалев В.Я.Bykov A.N., Arkhipov M.V., Klimusheva N.F., Iofin A.I., Krokhalev V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/572

Хроническое миокардиальное повреждение, определяемое постоянно повышенным уровнем сердечного тропонина (cTn), может наблюдаться у пациентов с легочной гипертензией (ЛГ), что указывает на тяжесть заболевания и связано с неблагоприятным прогнозом. Увеличение cTn среди пациентов с ЛГ регистрировалось и ранее 2018 г., но лишь с принятием Четвертого пересмотра определения инфаркта миокарда (2018 г.) пришло понимание этого феномена. Одной из причин хронического миокардиального повреждения у пациентов с ЛГ является компрессия коронарных артерий. Синдром сдавления ствола левой коронарной артерии (ЛКА) является редкой, вероятно, недооцененной причиной стенокардитической боли в груди и желудочковой недостаточности у пациентов с тяжелой формой легочной артериальной гипертензии (ЛАГ). Компрессия ствола ЛКА расширенным стволом легочной артерии была ассоциирована со стенокардией, однако правильные подходы к диагностике и лечению остаются до настоящего момента малоизученными. Приводится клинический случай пациентки с идиопатической ЛАГ и компрессией ствола ЛКА расширенной легочной артерией. Диагноз стеноза ЛКА был подтвержден мультиспиральной компьютерной томографией и коронарной ангиографией. Биомаркеры, такие как cTn и мозговой натрийуретический пептид, были определены как критерии оптимального лечения. Чрескожное коронарное вмешательство в сочетании с ЛАГ-специфической терапией - возможный, безопасный и эффективный вариант лечения пациентов с наружной компрессией ствола ЛКА расширенной легочной артерии

Chronic myocardial injury, determined by a constantly elevated cardiac troponin (cTn) value, may occur in patients with pulmonary arterial hypertension (PAH), indicating the severity of the disease and associated with an adverse prognosis. Increasing of cTn among patients with PAH was registered prior to 2018, but after the Fourth universal definition of myocardial infarction (2018) was released the understanding of this phenomenon has been changed. One of the causes of chronic myocardial injury in patients with PAH is the compression of coronary arteries. Left main coronary artery (LMCA) compression is an uncommon and probably underestimated cause for angina-like chest pain and ventricular dysfunction in patients with severe pulmonary artery hypertension. LMCA compression by an enlarged pulmonary artery trunk has been associated with angina, but appropriate diagnostic and treatment approaches remain poorly defined. This is a case report on a woman with idiopathic PAH and compression of the LMCA by an enlarged pulmonary artery. The diagnosis of LMCA stenosis was confirmed by multi-slice computed tomography and coronary angiography. Biomarkers such as cTn and brain natriuretic peptide have also been identified as criteria of optimal treatment. Percutaneous coronary intervention in conjunction with PAH-specific therapy appears to be a feasible, safe, and effective treatment option for patients with extrinsic compression of the LMCA from pulmonary artery enlargement

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The authors declare that there are no conflicts of interest present.