Influence of coronary bifurcation angle on atherosclerosis

Liu, Zhaomiao; Zhao, Shengwei; Li, Yunjie; Shen, Feng; Qi, Yipeng; Wang, Qi

doi:10.1007/s10409-019-00878-7

Cited by 10 publications

(22 citation statements)

References 30 publications

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Section: Resultsmentioning

confidence: 99%

“…Seven of the thirteen studies were causal-comparative by design [ 4 , 6 , 7 , 8 , 15 , 16 , 17 ], five were descriptive [ 9 , 10 , 11 , 12 , 18 ], and one study had both causal-comparative and correlational components [ 19 ] ( Table 2 ). Five of the thirteen studies (38%) were conducted in Australia [ 4 , 6 , 10 , 11 , 16 ], three (22%) in China [ 8 , 9 , 12 ], one (8%) in Taiwan [ 7 ], one (8%) in Turkey [ 19 ], one (8%) in South Korea [ 15 ], one (8%) in Argentina [ 17 ], and one (8%) was a collaborative study between authors from Saudi Arabia, India, and Oman [ 18 ]. Five studies (38%) involved the use of CFD analysis to observe and measure intraluminal forces at the LAD-LCx angle [ 9 , 10 , 11 , 12 , 18 ], and eight (62%) involved repeatedly measuring LAD-LCx angle on coronary angiography imaging to assess its relationship with CAD and/or associated risk factors [ 4 , 6 , 7 , 8 , 15 , 16 , 17 , 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five of the thirteen studies (38%) were conducted in Australia [ 4 , 6 , 10 , 11 , 16 ], three (22%) in China [ 8 , 9 , 12 ], one (8%) in Taiwan [ 7 ], one (8%) in Turkey [ 19 ], one (8%) in South Korea [ 15 ], one (8%) in Argentina [ 17 ], and one (8%) was a collaborative study between authors from Saudi Arabia, India, and Oman [ 18 ]. Five studies (38%) involved the use of CFD analysis to observe and measure intraluminal forces at the LAD-LCx angle [ 9 , 10 , 11 , 12 , 18 ], and eight (62%) involved repeatedly measuring LAD-LCx angle on coronary angiography imaging to assess its relationship with CAD and/or associated risk factors [ 4 , 6 , 7 , 8 , 15 , 16 , 17 , 19 ]. Of the studies analysing CFD, one used models derived from real patients’ CCTA datasets [ 10 ], two used simulated LAD-LCx models [ 12 , 18 ], and two used a combination of both [ 9 , 11 ], with sample sizes ranging from four to 30 models [ 9 , 10 , 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…The findings of several recent studies have suggested a direct correlation between LAD-LCx bifurcation angle and CAD [ 4 , 6 , 7 , 8 ]. This has been investigated further via computational fluid dynamics (CFD), with the correlation being primarily attributed to a change in wall shear stress (WSS) observed in bifurcation angles of variable size [ 9 , 10 , 11 , 12 ]. Consequently, it has been proposed that the LAD-LCx angle may be indicative of a patient’s likelihood of developing CAD, and it could be a useful tool for enhancing the routine diagnostic reporting of coronary computed tomography angiography (CCTA) studies [ 4 , 13 ], especially since the LAD-LCx measurement is of improved diagnostic value compared to standard coronary lumen assessment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Relationship between Left Coronary Artery Bifurcation Angle and Coronary Artery Disease: A Systematic Review

Geerlings-Batt

Sun

2022

JCM

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Recent studies have suggested a relationship between wide left coronary artery bifurcation (left anterior descending [LAD]-left circumflex [LCx]) angle and coronary artery disease (CAD). Current literature is multifaceted. Different studies have analysed this relationship using computational fluid dynamics, by considering CAD risk factors, and from simple causal-comparative and correlational perspectives. Hence, the purpose of this systematic review was to critically evaluate the current literature and determine whether there is sufficient evidence available to prove the relationship between LAD-LCx angle and CAD. Five electronic databases (ProQuest, Scopus, PubMed, CINAHL Plus with Full Text, and Emcare) were used to locate relevant texts, which were then screened according to predefined eligibility criteria. Thirteen eligible articles were selected for review. Current evidence suggests individuals with a wide LAD-LCx angle experience altered haemodynamics at the bifurcation site compared to those with narrower angles, which likely facilitates a predisposition to developing CAD. However, further research is required to determine causality regarding relationships between LAD-LCx angle and CAD risk factors. Insufficient valid evidence exists to support associations between LAD-LCx angle and degree of coronary stenosis, and future haemodynamic analyses should explore more accurate coronary artery modelling, as well as CAD progression in already stenosed bifurcations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the Relationship between Left Coronary Artery Bifurcation Angle and Coronary Artery Disease: A Systematic Review

Geerlings-Batt

Sun

2022

JCM

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“…Coronary artery models are reconstructed by setting segmentation threshold and region growth of the original DICOM file by Mimics 18.0 (Materialize, Leuven, Belgium), as shown in Figure 1(a). 25 The model includes the left main coronary artery (LMCA), left anterior descending (LAD) branch, intermediate branch (IB), and left circumflex branch (LCX). The diameter stenosis of the LAD is 65%, while the LCX is 56%, and both the lesion lengths are 12.4 mm.…”

Section: Establishment Of Modelsmentioning

confidence: 99%

The effect of anastomotic angle and diameter ratio on flow field in the distal end-to-side anastomosis

Liu

Yang

Nan

et al. 2019

Proc Inst Mech Eng H

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Flow fields in the distal end-to-side anastomosis of coronary artery bypass graft are associated with intimal hyperplasia and bypass failure. This work aims to demonstrate the effect of anastomotic angle and diameter ratio on flow field of coronary artery bypass graft. The flow fields inside polydimethylsiloxane models of coronary artery bypass graft with various anastomotic angles ( α = 30°, 45°, 60° and 75°) and different diameter ratios ( Φ = 0.78 and 1.11) are investigated using particle image velocimetry and computational fluid dynamics method under pulsatile flow condition. The results show that the anastomotic angle is positively correlated with the number and area of the recirculation zone, and the flow field disturbance at the anastomosis will develop in the same direction. Compared with that of Φ = 0.78, when Φ = 1.11, the flow fields at the anastomosis are relatively smoother with less turbulence.

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Spatiotemporally Mapped Endothelial Dysfunction at Bifurcations in a Coronary Artery‐on‐a‐Chip

Singh,

Gambhir,

Goh

et al. 2024

Adv Materials Technologies

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Atherosclerotic plaques are commonly observed at low shear regions, in particular, the left main coronary artery (LMCA) bifurcation. Low shear regions at bifurcations promote endothelial dysfunction, a key factor initiating atherogenesis, however, mechanisms underlying this process are poorly understood. Dynamic in vitro models are critical to investigate endothelial dysfunction, but current static and vessels‐on‐chip systems typically lack physiologically complex geometries and local shear changes. Here, a bifurcating coronary artery‐on‐a‐chip is developed, mimicking the human LMCA, displaying reduced shear near the bifurcation, verified using computational fluid dynamics simulations. Over 7 days of dynamic culture, human coronary artery endothelial cells aligned with the flow and expressed more Endothelial nitric oxide synthase (eNOS) and intercellular cell adheison molecule‐1 (ICAM‐1) at high shear regions (12.7 dyn cm−2) adjacent to, but not at the bifurcation (0–3 dyn cm−2). After tumor necrosis factor‐alpha (TNFα) stimulation to induce endothelial dysfunction, spatially mapping cellular changes and shear gradients revealed cell alignment is disrupted over a larger area surrounding the bifurcation at a higher shear, and ICAM‐1 expression is increased closer to the bifurcation at a lower shear. This coronary artery‐on‐a‐chip establishes a system to spatially map endothelial cell behavior in response to differential shear and vessel geometry, enabling future studies into plaque initiation events, treatment targets, and drug screening.

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Influence of coronary bifurcation angle on atherosclerosis

Cited by 10 publications

References 30 publications

Evaluation of the Relationship between Left Coronary Artery Bifurcation Angle and Coronary Artery Disease: A Systematic Review

Evaluation of the Relationship between Left Coronary Artery Bifurcation Angle and Coronary Artery Disease: A Systematic Review

The effect of anastomotic angle and diameter ratio on flow field in the distal end-to-side anastomosis

Spatiotemporally Mapped Endothelial Dysfunction at Bifurcations in a Coronary Artery‐on‐a‐Chip

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