Left Anterior Descending Coronary Artery-left Circumflex Coronary Artery Bifurcation Angle and Severity of Coronary Artery Disease; is There Any Correlation? A Cross-sectional Study

Overview

Journal Health Sci Rep

Specialty General Medicine

Date 2024 Jun 13

PMID 38868537

Authors

Pejman Mansouri

Ebrahim Nematipour

Nadia Rajablou

Seyyed Mojtaba Ghorashi

Samad Azari

Negar Omidi

Affiliations

Soon will be listed here.

Abstract

Background And Aims: The aim of this study is to evaluate the association of coronary computed tomography angiography derived (CCTA) plaque characteristics and the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) bifurcation angle with severity of coronary artery disease (CAD).

Methods: All the stable patients with suspected CAD who underwent CCTA between January to December 2021 were included. Correlation between CCTA-derived aggregated plaque volume (APV), LAD-LCX angle, remodeling index (RI), coronary calcium score with Gensini score in conventional angiography were assessed. One hundred and twenty-two patients who underwent both CCTA and coronary angiography were analyzed.

Results: Our analysis showed that the median (percentile 25% to percentile 75%) of the APV, LAD-LCx angle, and calcium score were 31% (17%-47%), 58° (39°-89°), and 31 (0-186), respectively. Also, the mean ± SD of the RI was 1.05 ± 0.20. Significant correlation between LAD-LCx bifurcation angle (0.0001-0.684), APV (0.002-0.281), RI (0.0001-0.438), and calcium score (0.016-0.217) with Gensini score were detected. There was a linear correlation between the mean LAD-LCx bifurcation angle and the Gensini score. The sensitivity and specificity for the cut-off value of 47.5° for the LAD-LCX angle were 86.7% and 82.1%, respectively.

Conclusion: There is a direct correlation between the LAD-LCx angle and the Gensini score. In addition to plaque characteristics, anatomic-based CCTA-derived indices can be used to identify patients at higher risk for CAD.

References

Moon S, Byun J, Kim J, Kim S, Kim K, Jung J . Clinical usefulness of the angle between left main coronary artery and left anterior descending coronary artery for the evaluation of obstructive coronary artery disease. PLoS One. 2018; 13(9):e0202249. PMC: 6136703. DOI: 10.1371/journal.pone.0202249. View

Cui Y, Zeng W, Yu J, Lu J, Hu Y, Diao N . Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT. PLoS One. 2017; 12(3):e0174352. PMC: 5367806. DOI: 10.1371/journal.pone.0174352. View

Kawasaki T, Koga H, Serikawa T, Orita Y, Ikeda S, Mito T . The bifurcation study using 64 multislice computed tomography. Catheter Cardiovasc Interv. 2009; 73(5):653-8. DOI: 10.1002/ccd.21916. View

Temov K, Sun Z . Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease. Int J Cardiovasc Imaging. 2016; 32 Suppl 1:129-37. DOI: 10.1007/s10554-016-0884-2. View

Ferencik M, Schlett C, Ghoshhajra B, Kriegel M, Joshi S, Maurovich-Horvat P . A computed tomography-based coronary lesion score to predict acute coronary syndrome among patients with acute chest pain and significant coronary stenosis on coronary computed tomographic angiogram. Am J Cardiol. 2012; 110(2):183-9. PMC: 3383897. DOI: 10.1016/j.amjcard.2012.02.066. View

Agatston A, Janowitz W, HILDNER F, Zusmer N, VIAMONTE Jr M, Detrano R . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15(4):827-32. DOI: 10.1016/0735-1097(90)90282-t. View

Gensini G . A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983; 51(3):606. DOI: 10.1016/s0002-9149(83)80105-2. View

Pflederer T, Marwan M, Schepis T, Ropers D, Seltmann M, Muschiol G . Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis. 2010; 211(2):437-44. DOI: 10.1016/j.atherosclerosis.2010.02.001. View

Kitagawa T, Yamamoto H, Horiguchi J, Ohhashi N, Tadehara F, Shokawa T . Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging. 2009; 2(2):153-60. DOI: 10.1016/j.jcmg.2008.09.015. View

10.

Stone P, Saito S, Takahashi S, Makita Y, Nakamura S, Kawasaki T . Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation. 2012; 126(2):172-81. DOI: 10.1161/CIRCULATIONAHA.112.096438. View

11.

Sara L, Rochitte C, Lemos P, Niinuma H, Dewey M, Shapiro E . Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy. Int J Cardiol. 2014; 177(2):385-91. DOI: 10.1016/j.ijcard.2014.08.130. View

12.

Cademartiri F, La Grutta L, Malago R, Alberghina F, Palumbo A, Belgrano M . Assessment of left main coronary artery atherosclerotic burden using 64-slice CT coronary angiography: correlation between dimensions and presence of plaques. Radiol Med. 2009; 114(3):358-69. DOI: 10.1007/s11547-008-0293-2. View

13.

Mandrekar J . Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010; 5(9):1315-6. DOI: 10.1097/JTO.0b013e3181ec173d. View

14.

Osborne-Grinter M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson P . Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial. Eur Heart J Cardiovasc Imaging. 2021; 23(9):1210-1221. PMC: 9612790. DOI: 10.1093/ehjci/jeab135. View

15.

Sun Z . Coronary CT angiography in coronary artery disease: correlation between virtual intravascular endoscopic appearances and left bifurcation angulation and coronary plaques. Biomed Res Int. 2014; 2013:732059. PMC: 3888717. DOI: 10.1155/2013/732059. View

16.

Hecht H, Cronin P, Blaha M, Budoff M, Kazerooni E, Narula J . 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2016; 11(1):74-84. DOI: 10.1016/j.jcct.2016.11.003. View

17.

Nakazato R, Shalev A, Doh J, Koo B, Gransar H, Gomez M . Aggregate plaque volume by coronary computed tomography angiography is superior and incremental to luminal narrowing for diagnosis of ischemic lesions of intermediate stenosis severity. J Am Coll Cardiol. 2013; 62(5):460-7. DOI: 10.1016/j.jacc.2013.04.062. View

18.

Juan Y, Tsay P, Shen W, Yeh C, Wen M, Wan Y . Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries. Sci Rep. 2017; 7(1):1515. PMC: 5431433. DOI: 10.1038/s41598-017-01679-3. View

19.

Cecchi E, Giglioli C, Valente S, Lazzeri C, Gensini G, Abbate R . Role of hemodynamic shear stress in cardiovascular disease. Atherosclerosis. 2010; 214(2):249-56. DOI: 10.1016/j.atherosclerosis.2010.09.008. View

20.

Goldstein J, Chinnaiyan K, Abidov A, Achenbach S, Berman D, Hayes S . The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 2011; 58(14):1414-22. DOI: 10.1016/j.jacc.2011.03.068. View