Variability of human coronary artery geometry: An angiographic study of the left anterior descending arteries of 30 autopsy hearts

Brinkman, Anne M.; Baker, Peter B.; Newman, William P.; Vigorito, Robert; Friedman, Morton H.

doi:10.1007/bf02368220

Cited by 52 publications

(35 citation statements)

References 27 publications

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“…[2][3][4][5][6][7][8][9][10][11][12][13] More specifically, coronary tortuosity has also been described. [1][2][3] A clear uniform definition of coronary tortuosity has not yet been established.…”

Section: Discussionmentioning

confidence: 99%

Coronary tortuosity: a long and winding road

Zegers

Meursing²,

Ophuis³

2007

NHJL

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Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise stress test has never been described in the literature.This article describes three cases of patients with anginal complaints, an abnormal exercise stress test and coronary angiography without the presence of a fixed atherosclerotic lesion.It is hypothesised that coronary tortuosity leads to flow alteration resulting in a reduction in coronary pressure distal to the tortuous segment of the coronary artery, subsequently leading to ischaemia. Future studies will be necessary to elucidate the actual mechanism of coronary tortuosity and its clinical significance. (Neth Heart J 2007;15:191-5.).

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Section: Discussionmentioning

confidence: 99%

Coronary tortuosity: a long and winding road

Zegers

Meursing²,

Ophuis³

2007

NHJL

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“…After that, simulations of rest and exercise of the models were carried out, in appropriate conditions, and it was verified that tortuosity has a smaller influence on coronary circulation at rest; however, during exercise, tortuosity may represent greater resistance to blood flow, in such a way that compensatory mechanisms of flow adjustment may not be enough to keep an adequate flow and lead to myocardial ischemia. 10 Xie et al 11,12 conducted a study with three-dimensional computational fluid dynamic, in which they selected six segments of the anterior descending artery with different tortuosity degrees, and evaluated the blood flow in situations of rest and exercise in appropriate conditions, and verified that tortuosity can increase coronary resistance in up to 92% during exercise, causing coronary autoregulation to fail. This study also suggests that tortuosity may constitute a risk factor for atherosclerosis, since it can lead to the appearance of a region with low, wavering shear stress in the internal wall of the curve's descent, when the angle of the curve is greater than 120 degrees.…”

Section: Studies With Computer Simulationsmentioning

confidence: 99%

“…This study also suggests that tortuosity may constitute a risk factor for atherosclerosis, since it can lead to the appearance of a region with low, wavering shear stress in the internal wall of the curve's descent, when the angle of the curve is greater than 120 degrees. 11,12 Outro estudo recente confirma que a tortuosidade leva a queda da pressão e pode levar a déficit de perfusão.…”

Section: Studies With Computer Simulationsmentioning

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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“…[11][12][13][14] This is in part because of a lack of relevant data for the in vivo situation. Biplane cineangiography and intravascular ultrasound (IVUS) are 2 powerful modalities for assessing this relationship in vivo.…”

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confidence: 99%

Relationship Between the Dynamic Geometry and Wall Thickness of a Human Coronary Artery

Zhu

Friedman

2003

ATVB

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Objective-It is widely recognized that hemodynamic and wall mechanical forces are involved in the initiation and development of atherosclerosis. In the coronary vasculature, these forces are likely mediated by arterial dynamics and geometry. This research examines the hypothesis that coronary artery motion and geometry affect the local predisposition to disease, presumably through their influence on the stresses at and in the artery wall. Methods and Results-The dynamics of a human right coronary artery and the variation of wall thickness along its length were characterized from biplane cineangiograms and intravascular ultrasound records, respectively. The dynamic geometry parameters were distance along the vessel, cyclic displacement, axial strain, curvature, and torsion. Multiple regression analyses using principal components show that (1) no single dynamic geometry parameter has a dominant influence on wall thickness, (2) Key Words: coronary arteries Ⅲ dynamic geometry Ⅲ wall thickness Ⅲ biplane angiography Ⅲ intravascular ultrasound A lthough several cardiovascular risk factors, including hypercholesterolemia, hypertension, smoking, and diabetes, have been associated with coronary heart disease (CHD), 1,2 it is conventional knowledge among investigators in atherosclerosis that these factors can explain no more than half of the variability in the occurrence of atherosclerotic lesions or CHD. [3][4][5] This situation suggests that there are additional risk factors that predispose to arterial disease. Friedman and colleagues 6 -8 have proposed that variations in arterial geometry, including the dynamic characteristics of the coronary arteries, can contribute to some of the unexplained variation in cardiovascular risk. This idea is based on the abundant and increasing evidence that hemodynamics and vascular wall stresses play an important role in the initiation and development of atherosclerosis. 9,10 The fluid dynamic environment at the arterial wall depends on the geometry and motion of the channel through which the flow is passing, and geometries that promote an adverse hemodynamic milieu could constitute additional risk factors for disease. Similarly, the motion of the coronary arteries during the cardiac cycle can lead to cyclic stresses in the wall that may prompt an atherosclerotic response.Most research seeking associations between coronary artery geometry and vessel pathology has been based on autopsy hearts. [11][12][13][14] This is in part because of a lack of relevant data for the in vivo situation. Biplane cineangiography and intravascular ultrasound (IVUS) are 2 powerful modalities for assessing this relationship in vivo. While the former modality makes it possible to accurately reconstruct the time-dependent 3D course of the coronary vessels on the beating heart, the latter provides the necessary in vivo vessel wall morphology. In this study, we demonstrate the use of these diagnostic techniques to evaluate the relationship between the dynamic geometry and morphometry of a human right coronary ar...

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Variability of human coronary artery geometry: An angiographic study of the left anterior descending arteries of 30 autopsy hearts

Cited by 52 publications

References 27 publications

Coronary tortuosity: a long and winding road

Coronary tortuosity: a long and winding road

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

Relationship Between the Dynamic Geometry and Wall Thickness of a Human Coronary Artery

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