Coronary artery abnormalities: Current clinical issues

The value of CCTA combined with machine learning for predicting angina pectoris in the anomalous origin of the right coronary artery

BACKGROUND

Anomalous origin of coronary artery is a common coronary artery anatomy anomaly. The anomalous origin of the coronary artery may lead to problems such as narrowing of the coronary arteries at the beginning of the coronary arteries and abnormal alignment, which may lead to myocardial ischemia due to the compression of the coronary arteries. Clinical symptoms include chest tightness and dyspnea, with angina pectoris as a common symptom that can be life-threatening. Timely and accurate diagnosis of anomalous coronary artery origin is of great importance. Coronary computed tomography angiography (CCTA) can provide detailed information on the characteristics of coronary arteries. Therefore, we combined CCTA and artificial intelligence (AI) technology to analyze the CCTA image features and clinical features of patients with anomalous origin of the right coronary artery to predict angina pectoris and the relevance of different features to angina pectoris.

METHODS

In this retrospective analysis, we compiled data on 15 characteristics from 126 patients diagnosed with anomalous right coronary artery origins. The dataset encompassed both CCTA imaging attributes, such as the positioning of the right coronary artery orifices and the alignment of coronary arteries, and clinical parameters including gender and age. To identify the most salient features, we employed the Chi-square feature selection method, which filters features based on their statistical significance. We then focused on features yielding a Chi-square score exceeding a threshold of 1, thereby narrowing down the selection to seven key variables, including cardiac function and gender. Subsequently, we evaluated seven classifiers known for their efficacy in classification tasks. Through rigorous training and testing, we conducted a comparative analysis to identify the top three classifiers with the highest accuracy rates.

RESULTS

The top three classifiers in this study are Support Vector Machine (SVM), Ensemble Learning (EL), and Kernel Approximation Classifier. Among the SVM, EL and Kernel Approximation Classifier-based classifiers, the best performance is achieved for linear SVM, optimizable Ensembles Learning and SVM kernel, respectively. And the corresponding accuracy is 75.7%, 75.7%, and 73.0%, respectively. The AUC values are 0.77, 0.80, and 0.75, respectively.

CONCLUSIONS

Machine learning (ML) models can predict angina pectoris caused by the origin anomalous of the right coronary artery, providing valuable auxiliary diagnostic information for clinicians and serving as a warning to clinicians. It is hoped that timely intervention and treatment can be realized to avoid serious consequences such as myocardial infarction.

Takotsubo syndrome unmasking malignant coronary artery anomaly in a patient presenting with acute coronary syndrome: Expanding definitions of Takotsubo cardiomyopathy?

The simultaneous occurrence of Takotsubo syndrome, congenital coronary artery anomaly and severe coronary artery disease is a rare clinical triad. This case report highlights the intricacies of management of this 'triple jeopardy' scenario.

Percutaneous Pulmonary Valve Implantation Based on Minimally Invasive Direct Coronary Bypass Surgery

Approximately 5% of percutaneous pulmonary valve implantations (PPVIs) are at risk for coronary compression. Therefore, PPVI is contraindicated if coronary anomalies and tested coronary flow impairment are observed. Simultaneous right ventricular outflow tract ballooning and coronary angiography are mandatory elucidating contraindications for PPVI. We present the case of a 22-year-old woman who had Rastelli repair with chronic right heart failure. Weighing the risk of several offered surgical options, she underwent successful PPVI after minimally invasive direct coronary artery bypass procedure.

Cardiac arrest due to an anomalous aortic origin of a coronary artery: are older patients really safe?

The authors report a rare case of successful Advanced Life Support in the context of cardiac arrest due to the presence of an anomalous aortic origin of the right coronary artery in a 49-year-old patient. The patient was admitted due to chest pain and dyspnea, with rapid evolution of pulseless ventricular tachycardia and cardiopulmonary arrest. Acute myocardial infarction was considered, and in the absence of a hemodynamic laboratory in the hospital, thrombolysis was performed. Subsequently, coronary angiography revealed no angiographic lesions in the coronary arteries and an anomalous right coronary artery originating from the opposite sinus of Valsalva. Coronary computed tomography angiography confirmed this finding and determined the course between the pulmonary artery and the aorta. The patient underwent cardiac surgery with a bypass graft to the right coronary artery, with no recurrent episodes of arrythmia.

Anomalous left anterior descending artery diagnosed on pulmonary artery computed tomography

Typically, the left anterior descending artery (LAD) and left circumflex artery (LCX) arise from the left main coronary artery. However, uncommon coronary anomalies may be found in clinical practice. This case presents with a rare finding where the LAD originates from the right coronary artery (RCA) separately from the LCX and takes an interarterial pathway to reach its perfusion territory. A 49-year-old Hispanic female with hypertension and diabetes mellitus presented to the emergency department with a 7-day history of chest pain. She denied nausea, diaphoresis, syncope, or other symptoms. A grade 3 out of 6 systolic murmur was noted on physical examination. Computed tomography of the pulmonary arteries (CTPA) revealed that the patient had no left main coronary artery. The patient's LAD arose from the proximal RCA and took an inter-arterial course. Subsequent coronary catheterization showed no stenosis of the coronary arterial system. The patient's chest pain subsided during the course of her admission and she was deemed stable for discharge with close cardiology follow up. In general, coronary artery anomalies are an uncommon finding in clinical practice. However, it is important to realize the different pathways of coronary artery anomalies because those with the inter-arterial subtype, such as our patient, may result in sudden cardiac death. All cases of clinically suspected inter-arterial coronary artery anomalies are recommended to undergo imaging studies to help visualize anatomic features as a guide for further management. This case represents the first reported diagnosis of this type of anomalous coronary artery on CTPA.