Comparative coronary anatomy in six twin pairs with coronary artery disease

Abstract

Objective-To compare the coronary anatomy and the location of coronary lesions in monozygotic and dizygotic twin pairs aVected with coronary artery disease. Design-Coronary angiographic findings were compared with respect to the distribution of coronary blood supply and the location of coronary lesions. Main outcome measures-Distribution of coronary blood supply, diameters and length of proximal coronary arteries. Results-The lumen diameters of the left main coronary artery, the left anterior descending coronary artery, the circumflex artery, and the right coronary artery, as well as the lengths of the left main coronary artery, showed similar variability within monozygotic and dizygotic twin pairs. With respect to the dominance pattern of coronary blood supply, two of three monozygotic twin pairs diVered, while all dizygotic twin pairs were concordant. Concordant and discordant locations of stenoses were found with similar frequency in monozygotic and dizygotic twin pairs. Conclusions-The dominance pattern of coronary blood supply and the location of coronary lesions are not strictly hereditary. The high concordance of premature coronary artery disease found in monozygotic twin pairs may largely be related to factors that are independent of the macroanatomic distribution of the coronary blood supply. The chance of dying from coronary heart disease within 10 years is almost 50% for a 55 year old man if his monozygotic twin had a fatal myocardial infarction.1 This risk is about 20 times higher than for a representative individual in the overall population and 3.2-to sixfold higher than for the dizygotic twin of a patient with myocardial infarction.1 The question arises as to what mechanisms account for such a high concordance for myocardial infarction in the second monozygotic twin. We speculated that as well as having inherited risk factors aVected monozygotic twins may share the anatomy of their coronary arteries. In this respect it has been well documented that certain anatomical features may precipitate coronary atherosclerosis and occlusion.2 However, it is unknown whether the coronary anatomy in monozygotic twins is identical, as few case reports have evaluated this. [3][4][5][6][7] In order to study the heredity of coronary anatomy in more detail we compared the coronary arteries in three monozygotic and three dizygotic twin pairs by measuring key anatomical features and the location of coronary lesions. MethodsThree monozygotic and three dizygotic twin pairs were identified retrospectively by screening of 93 500 patient records in seven cardiac rehabilitation centres. All individuals had symptomatic premature coronary heart disease and were thus studied by cardiac catheterisation. All participants gave written informed consent for study of genetic risk factors for myocardial infarction.Anthropometric data, risk factors, and clinical events were taken from the patients' records. Obesity, hypertension, and dyslipidaemia were defined as previously suggested. 8 To document monozygosity and dizygosity...

Anatomical Risk Factors Of Coronary Heart Disease

“…[1][2][3][4][5][6] Although several cardiovascular risk factors, such as hypercholesterolemia, diabetes, hypertension and smoking have been associated with coronary heart disease (CHD), it is a conventional knowledge that these factors can explain only the half of the variability in the occurrence of atherosclerosis or CHD. [3,[6][7][8][9] This means that there are additional risk factors that predispose atherosclerosis and CHD. During the past few decades, it has been shown that the vascular flow pattern has an effect on the development and progression of atherosclerosis.…”

“…During the past few decades, it has been shown that the vascular flow pattern has an effect on the development and progression of atherosclerosis. [8,[10][11][12][13] Friedman and Ding [3] proposed that variations in arterial geometry may have a role in some of the unexplained variations in cardiovascular risk. Considering the fact that the most of the atherosclerotic plaques localize particularly at bifurcation sites, most commonly on the ostium of the LAD [2,7,14] it can be suggested that the angulations of the coronary bifurcations might have an effect on the incidence of atherosclerosis.…”

Characterization of cryoinjury-induced infarction with manganese-and gadolinium-enhanced MRI and optical spectroscopy in pig hearts

“…However, occlusion of coronary artery branches results in variable lesion size/volume due to variation in arterial branching patterns in respective pigs. Even in twins, there still exists inconsistency with respect to the dominance pattern of the coronary blood supply [36]. Secondly, coronary artery occlusion usually cannot produce a myocardial lesion with a clearly defined epicardial border.…”

Distinct Heritable Patterns of Angiographic Coronary Artery Disease in Families With Myocardial Infarction

“…Until now, only a few case reports on monozygotic or dizygotic twins have investigated the hereditary aspects of coronary morphology, but even these have produced inconsistent results. [5][6][7][8][9][10][11][12][13] Therefore, a large angiographic database for patients with familial MI was established to investigate the hypothesis that specific coronary morphologies have a genetic component. Detailed heritable disease patterns could enhance clinical risk characterization and offer new opportunities for clinical follow-up investigations in relatives of affected patients.…”