Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?

Turgut, Okan Onur; Yılmaz, Ahmet; Yalta, Kenan; Yilmaz, Birhan; Ozyol, Ali; Kendirlioğlu, Ömer; Karadaş, Filiz; Tandoğan, İzzet

doi:10.1007/s10554-006-9186-4

Cited by 62 publications

(57 citation statements)

References 24 publications

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“…They compose a poorly defined systemic syndrome with prolongation of the arteries, tortuosity and thinning of the arterial wall. [24][25][26] A case described in 1969 shows a patient who died at 17 months of age due to coronary insufficiency and multiple peripheral pulmonary stenosis. Postmortem exams showed that pathological alterations were restricted to elastic arteries and to the first part of muscular arteries.…”

Section: Arterial Tortuosity Syndromementioning

confidence: 99%

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Estrada

Lopes

Villacorta

2017

International Journal of Cardiovascular Sciences

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The objective of this study is to make a review of the narrative of coronary artery tortuosity (CAT) approaching several situations in clinical practice where tortuosity can have a relevant role, and also evaluate if tortuosity can be related to the presence of myocardial ischemia in patients without coronary obstruction using scientific evidences in medical literature. Textbook of applied Physiology in Cardiology with study of coronary circulation, theoretical articles with studies of Hemodynamics, Fluid and Mechanical Dynamic, and experimental articles with simulation in computers were used as support to answer this last question. Introduction Coronary circulationThere are two basic types of coronary vessels: conductance and resistance vessels. The epicardial arteries, right and left, and its main and major branches that emerge in acute angle of relative large caliber work as vessels of conductance offering in the diastole minimum resistance to the blood flow. The deep perforators that originate in a right angle of the epicardial arteries penetrate deeply in the myocardial walls and nurture sub endocardial layers offering great resistance to the flow mainly in the ventricular systole. They are responsible for the coronary flow autoregulation maintaining it adequately in broad spectrum of the pressure variation and increasing the flow in exercising situations mainly through the local metabolic regulation. Microcirculation is part of the coronary circulation constituted by arterioles and capillaries responsible for regulating the oxygen supply to the myocardium.The heart is a highly aerobic organ, but it depends almost exclusively on the oxidation of the substrates to generate energy which will move it and has almost no oxygen reserve. It receives about 5% of cardiac output and it is a little perfused organ, but it is the organ that has the highest oxygen extraction of the organism.Taking into consideration Fick's equation (oxygen consumption = coronary flow X arteriovenous difference of oxygen), we verified that the physiological determinants of the coronary flow are the same that command the demand and consumption of oxygen: blood pressure, heart rate, ventricular wall tension, dP/dt maximum.According to Poiseuille's law, the flow in any vessel system is directly proportional to the difference of pressure in its extremities, and inversely proportional to the resistance of the system, which is in turn proportional to the length of the tube, viscosity of the fluid and inversely proportional to the fourth power of the radius (most important factor). Influences of vasomotility of the autonomous nervous system, of drugs, mainly of local autoregulation, determine variations in the flow. Due to cyclical pressure and variations and myocardium tension, the coronary flow, in the systole represents from 25% to 30% of the total, and from 70% to 75% in the diastole.Factors that can affect myocardial consumption of oxygen and consequently the coronary flow can be divided into 3 groups: a) Factors that affect consump...

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Section: Arterial Tortuosity Syndromementioning

confidence: 99%

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Estrada

Lopes

Villacorta

2017

International Journal of Cardiovascular Sciences

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“…CT is associated with increased acute occlusion of coronary arteries, diabetes, and coronary artery fistula [4,15]. CT hampers ventricular function and has been proposed as an indicator of ventricular dysfunction [16]. Of the three coronary arteries, the circumflex artery is most often affected, especially when associated with hypertension [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D insufficiency is associated with coronary artery tortuosity

et al. 2017

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A b s t r a c tBackground: Increasing evidence suggests a relationship between vitamin D (VD) insufficiency and cardiovascular disease. Aim:We aimed to investigate the association between serum 25-hydroxyvitamin D (25-OH VD) with coronary tortuosity (CT) in patients with normal or near-normal (< 40% stenosis) coronary arteries. Methods:The present study was cross-sectional and observational. We enrolled 356 consecutive patients who had undergone coronary angiography for suspected ischaemic heart disease and were found to have normal or near-normal coronary arteries. Patients were categorised as VD insufficient (< 30 ng/mL) or VD sufficient (≥ 30 ng/dL). CT was defined as the presence of ≥ three bends (defined as ≥ 45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole. Results:The study populations were divided into two groups according to the presence of CT: patients with CT (n = 103, 29%) and patients without CT (NCT; n = 253, 71%). CT is more frequently seen in elderly women and is positively correlated with hypertension. The incidence of VD insufficiency was significantly higher in the CT group (n = 46, 45%) than in the NCT group (n = 90, 36%; p = 0.005). In further multivariate logistic regression analyses, adjustment for major clinical parameters affecting CT showed statistically significant correlations between 25-OH VD and CT (odds ratio = 0.77, 95% confidence interval 0.66-0.98, p = 0.006). Conclusions: Vitamin D insufficiency was independently associated with coronary tortuosity.Key words: vitamin D insufficiency, coronary tortuosity, coronary artery disease, biomarkers, coronary angiography Kardiol Pol 2017; 75, 2: 174-180 INTRODUCTIONCoronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Coronary angiography is still the gold standard for the diagnosis of CAD, and coronary artery tortuosity (CT) is a common coronary angiography (CAG) finding [1][2][3]. The aetiology and clinical importance of CT are still unclear. CT is generally attributed to age-dependent, pathologic changes of elastic material in the vessel, and hypertension due to elongation and dilatation of the arteries with left ventricular hypertrophy [3,4]. A recent clinical trial showed that CT was associated with subclinical atherosclerosis and increased coronary artery calcification, even in the absence of significant obstructive lesion [5].

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“…Coronary tortuosity (CorT) is a common coronary angiography finding. CorT is defined as a fixed 3 bends during both systole and diastole, in at least a single epicardial artery, with each bend 45 change in the vessel direction [6]. The etiology, clinical implication and long term prognosis are still not well clarified.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Vitamin B12 in Patients with Coronary Tortuosity

Cerit

Kemal

Günsel

et al. 2016

Preprint

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Background: Vitamin B 12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinemia. Coronary tortuosity (CorT) is a common coronary angiography finding. The etiology, clinical implication and long term prognosis are still not well clarified. This study was conducted with the aim to evaluate the relationship between CorT and vitamin B12. Subjects and Method: The medical records of consecutive patients, who underwent coronary angiography, were retrospectively reviewed. The study group consisted of 1624 patients. Taking into consideration the inclusion criteria, 212 patients with CorT and 210 patients with normal coronary angiographies (control group) were included in the study. Vitamin B12, other biochemical parameters, clinical and echocardiographic parameters, and CorT score were evaluated in all patients. CorT is defined as fixed 3 bends during both systole and diastole, with each bend ≥45 °. Results: Patients with CorT had higher prevalence of older, female gender, hypertension, current smoking. Vitamin B12 was significantly decreased in patient with CorT (134.7±47.8 vs 239.6±53.8 p<0.001). On multivariate analysis age, female gender, hypertension, diabetes mellitus and vitamin B12 were independent predictors for CorT (OR 1.56; 95% CI: 1.247-1.962; p < 0.001, OR 1.628; 95% CI: 1.376-2.048; p<0.001, OR 1.865; 95% CI: 1.387-2.695; p<0.001, OR 1.362; 95% CI: 1.184-1.726; p<0.001, OR 1.862; 95% CI: 1.486-2.674; p<0.001, respectively). Conclusion: In our study, we have founded a significant relationship between vitamin B12 deficiency and CorT.

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Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?

Abstract: This study depicts that coronary tortuosity is associated with impaired left ventricular relaxation.Thus, coronary tortuosity might be an indicator of impaired left ventricular relaxation.

Cited by 62 publications

References 24 publications

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Vitamin D insufficiency is associated with coronary artery tortuosity

Assessment of Vitamin B12 in Patients with Coronary Tortuosity

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