Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease

Abstract

To explore the association between the left main coronary artery bifurcation angle and common atherosclerotic risk factors with regard to the development of coronary artery disease (CAD) using coronary computed tomography angiography (CCTA). A retrospective review of 196 CCTA cases (129 males, 67 females, mean age 58 ± 10.5 years) was conducted. The bifurcation angle between the left anterior descending (LAD) and left circumflex (LCx) was measured on two-dimensional (2D) and three-dimensional (3D) reconstructed images and the type of plaque and degree of lumen stenosis was assessed to determine the disease severity. An association between bifurcation angle and patient risk factors [gender, body mass index (BMI), hypertension, cholesterol, diabetes, smoking and family history] of CAD was also assessed to demonstrate the relationship between these variables. The mean bifurcation angle between the LAD and LCx was 79.40° ± 22.97°, ranging from 35.5° to 178°. Gender and BMI were found to have significant associations with bifurcation angle. Males were at 2.07-fold greater risk of having a >80° bifurcation angle and developing CAD than females (P = 0.003), and patients with high BMI (>25 kg/m(2)) were 2.54-fold more likely to have a >80° bifurcation angle than patients with a normal BMI (P = 0.001) and thus were at greater risk of developing CAD. There is a direct relationship between the left main coronary artery bifurcation angle and patient gender and BMI. Measurement of the bifurcation angle should be incorporated into clinical practice to identify patients at high risk of developing CAD.

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

“…A wider LCBA has been shown to produce a region of low wall shear stress in the left main bifurcating regions, which has drawn much research interest regarding the effect of LCBA on the development of CAD 4, 5, 8, 10, 12, 13, 17, 18 . A prior study using intravascular ultrasonography confirmed the higher prevalence of atherosclerotic plaques in the left main bifurcation area rather than in the left main coronary artery 4, 21, 22 , which also established the basis for the concept of using the LCBA to assess the left coronary bifurcation.…”

“…Prior literatures emphasized the association of a wider LCBA with the development of CAD and a cut-off value of 80 degrees for predicting the presence of CAD 4, 5, 11, 15, 17 . The results of our study corresponded with a cut-off value of greater than 80 degrees for detecting CAD (mean LCBA 87.34° for group I).…”

“…During the past decade, coronary computed tomography angiography (coronary CTA) has been accepted as a highly reliable and less invasive modality for CAD diagnosis owing to its high spatial and temporal resolution and excellent diagnostic accuracy 1–5 . Coronary CTA allows the visualization of coronary artery anatomy and the associated atherosclerotic plaques 6–8 .…”

Diagnostic Value of Coronary CT Angiography With Use of Left Coronary Bifurcation Angle in Coronary Artery Disease

“…30 This has been confirmed by a recent study investigating the association between bifurcation angle and risk factors of developing coronary artery disease. 31 Based on analysis of 196 patients with suspected coronary artery disease, Temov and Sun concluded that male patients and patients with large body mass index were more than 2-fold likely to have wider angulation (>80º) with associated higher risk of coronary artery disease. This study further highlights the additional value of using bifurcation angle for diagnosis of coronary artery disease through a direct comparison between diseased patients and the normal ones.…”

“…However, the association between common risk factors and coronary artery disease has been well studied in a recently published study. 31 Finally, although plaque distribution and type of plaque were analyzed, due to limited number of cases, there is no analysis of plaque features, in particular, analysis of plaque composition such as low-attenuating plaque, plaque volume and length which are commonly used to indicate the plaque vulnerability.…”