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Taskin U, Mammadov G, Topaloglu C, Koyuncu I, Dogdus M. Evaluation of left atrial and left ventricular functions with 3D speckle-tracking echocardiography in patients with coronary artery tortuosity. Echocardiography 2023; 40:1237-1242. [PMID: 37817486 DOI: 10.1111/echo.15702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Tortuosity in the coronary arteries is a very common entity encountered during angiography. The effect of coronary artery tortuosity (CAT) on the myocardium has not been completely investigated. The aim of the current study was to assess the effects of CAT on left atrial (LA) and left ventricular (LV) myocardial functions by 3D speckle-tracking echocardiography (3D-STE). METHODS Seventy-five patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms (CAG) were enrolled into the study. Following CAG, the 2D images were obtained first, and then 3D images were obtained for strain analysis. RESULTS The LAS-r, LAS-active, and LV-GLS were significantly depressed in the CAT (+) group (p < .001, p < .001, p = .012, respectively). The multivariate regression models demonstrated that LAS-r (p < .001), LAS-active (p = .009), and LV-GLS (p = .024) were found to be independent factors predicting CAT. CONCLUSION The current study is the first to focus on the assessing both LA and LV myocardial dynamics in CAT (+) patients by strain echocardiography. The results of our study support the patients with CAT may have subclinical LA and LV myocardial involvements.
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Affiliation(s)
- Ugur Taskin
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Ganbar Mammadov
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Caner Topaloglu
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Ilhan Koyuncu
- Bakircay University, Cigli Training and Research Hospital, Department of Cardiology, Izmir, Turkey
| | - Mustafa Dogdus
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
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2
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Zebic Mihic P, Saric S, Bilic Curcic I, Mihaljevic I, Juric I. The Association of Severe Coronary Tortuosity and Non-Obstructive Coronary Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1619. [PMID: 37763738 PMCID: PMC10534717 DOI: 10.3390/medicina59091619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: There is an increasing interest in the coronary tortuosity as a novel pathophysiological mechanism of ischemia in coronary artery disease without significant obstruction, but there are a lack of studies to confirm this relationship in the clinical setting. The aim of our study was to evaluate the association of severe coronary tortuosity and the potential role of coronary blood supply dominance in the appearance of myocardial ischemia in patients with non-obstructive coronary artery disease (non-CAD), compared to patients with obstructive coronary artery disease (CAD). Materials and Methods: The study enrolled 131 participants (71 male and 60 female), recruited among patients referred to cardiologists due to angina symptoms with ischemic alterations established by cardiac stress tests, as well as those admitted to the hospital for acute coronary syndrome. Results: Mean age of recruited patients was 61.6 (±10.1) years. According to the coronary angiography, they were divided into two groups: non-obstructive and obstructive CAD (77 and 54, respectively). There were significantly more women (61% vs. 24%, p < 0.001) in the non-CAD group. Both tortuous coronary arteries (50.6% vs. 14.8%, p < 0.001) and left coronary dominance (37.7% vs. 16.7%, p = 0.006) were more frequent in the non-CAD group compared to the CAD group. Female sex (OR = 17.516, p = 0.001), tortuous coronary arteries (OR = 7.962, p = 0.006) and left dominance of blood supply were significant predictors for non-CAD. Conclusions: Non-obstructive CAD is common among patients, especially women, who are referred for coronary angiography. Severe coronary artery tortuosity is the strongest independent predictor of non-obstructive CAD, followed by female gender and left coronary dominance.
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Affiliation(s)
- Petra Zebic Mihic
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Sandra Saric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ines Bilic Curcic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Endocrinology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Ivan Mihaljevic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nuclear Medicine, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Iva Juric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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3
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Estrada A, Sousa AS, Mesquita CT, Villacorta H. Coronary Tortuosity as a New Phenotype for Ischemia without Coronary Artery Disease. Arq Bras Cardiol 2022; 119:883-890. [PMID: 36169451 DOI: 10.36660/abc.20210787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/15/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Coronary arteries tend to be more tortuous than other arteries and follow the repeated flexion and relaxation movements that occur during the cardiac cycle. Coronary tortuosity (CorT) leads to changes in coronary flow with a reduction in distal perfusion pressure, which could cause myocardial ischemia. OBJECTIVE To assess the association between CorT and myocardial ischemia. METHODS Between January 2015 and December 2017, 57 patients with angina and nonobstructive coronary artery disease detected by invasive coronary angiography (ICA) were retrospectively enrolled. Angiographic variables were analyzed to assess the presence and degree of tortuosity and correlated with their respective vascular territories on stress myocardial perfusion imaging (MPI). CorT was defined as coronary arteries with three or more bend angles ≤90°, measured during diastole. Statistical significance was determined at the 5% level. RESULTS A total of 17 men and 40 women were enrolled (mean age 58.3 years). CorT was observed in 16 patients (28%) and in 24 of 171 arteries. There was a significant association between CorT and ischemia when analyzed per artery (p<0.0001). The angiographic factor most associated with ischemia was the number of bend angles in an epicardial artery measured at systole (p=0.021). CONCLUSION This study showed an association of CorT and myocardial ischemia in patients with unobstructed coronary arteries and angina. An increased number of coronary bend angles measured by angiography during systole was related to ischemia.
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Affiliation(s)
- André Estrada
- Universidade Federal Fluminense Hospital Universitário Antônio Pedro , Niterói , RJ - Brasil
| | - André Silveira Sousa
- Universidade Federal Fluminense Hospital Universitário Antônio Pedro , Niterói , RJ - Brasil.,Hospital Pró-Cardíaco , Rio de Janeiro , RJ - Brasil
| | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense Faculdade de Medicina - Departamento de Radiologia , Niterói , RJ - Brasil
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4
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Hou J, Yuan Y, Chen P, Lu K, Tang Z, Liu Q, Xu W, Zheng D, Xiong S, Pei H. Pathological Roles of Oxidative Stress in Cardiac Microvascular Injury. Curr Probl Cardiol 2022; 48:101399. [PMID: 36103941 DOI: 10.1016/j.cpcardiol.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/06/2023]
Abstract
Cardiac microvascular injury can be a fundamental pathological process that causes high incidence cardiovascular diseases such heart failure, diabetic cardiomyopathy, and hypertension. It is also an independent risk factor for cardiovascular disease. Oxidative stress is a significant pathological process in which the body interferes with the balance of the endogenous antioxidant defense system by producing reactive oxygen species, leading to property changes and dysfunction. It has been demonstrated that oxidative stress is one of the major causes of cardiac microvascular disease. Therefore, additional investigation into the relationship between oxidative stress and cardiac microvascular injury will direct clinical management in the future. In order to give suggestions and support for future in-depth studies, we give a basic overview of the cardiac microvasculature in relation to physiopathology in this review. We also summarize the role of oxidative stress of mitochondrial and non-mitochondrial origin in cardiac microvascular injury and related drug studies.
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Affiliation(s)
- Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital/Affiliated Hospital of Southwest Jiao Tong University, Chengdu 610031, China
| | - Yuan Yuan
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Peiwen Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu 611130, China
| | - Keji Lu
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu 611130, China
| | - Zhaobing Tang
- Department of Rehabilitation Medicine, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Qing Liu
- Department of medical engineering, The 950th Hospital of PLA, Yecheng 844900, China
| | - Wu Xu
- Department of Urology, The Fifth Afliated Hospital of Southern Medical University, Guangzhou 510900, China
| | - Dezhi Zheng
- Department of Cardiovascular Surgery, the 960th Hospital of the PLA Joint Logistic Support Force, Jinan 250031, China
| | - Shiqiang Xiong
- Department of Cardiology, Chengdu Third People's Hospital/Affiliated Hospital of Southwest Jiao Tong University, Chengdu 610031, China
| | - Haifeng Pei
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu 610083, China.
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5
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Maznyczka A, Rajkumar C, Hobson A, Haworth PA. Effect of coronary tortuosity on invasive physiology. BMJ Case Rep 2022; 15:e249095. [PMID: 35688575 PMCID: PMC9189850 DOI: 10.1136/bcr-2022-249095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of angina, where extreme coronary tortuosity affected invasive physiology interpretation. Extreme coronary tortuosity may lower fractional flow reserve and instantaneous wave-free ratio. Therefore, invasive physiology can be misleading in this setting, when used to evaluate stenosis significance, or when used post-percutaneous coronary (PCI) intervention for physiology guided stent optimisation.
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Affiliation(s)
- Annette Maznyczka
- Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Christopher Rajkumar
- Department of Cardiology, Imperial College London National Heart and Lung Institute, London, UK
| | - Alex Hobson
- Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Peter Aj Haworth
- Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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6
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Sun Z, Jiang D, Liu P, Muccio M, Li C, Cao Y, Wisniewski TM, Lu H, Ge Y. Age-Related Tortuosity of Carotid and Vertebral Arteries: Quantitative Evaluation With MR Angiography. Front Neurol 2022; 13:858805. [PMID: 35572919 PMCID: PMC9099009 DOI: 10.3389/fneur.2022.858805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background and Purpose The vascular tortuosity (VT) of the internal carotid artery (ICA), and vertebral artery (VA) can impact blood flow and neuronal function. However, few studies involved quantitative investigation of VT based on magnetic resonance imaging (MRI). The main purpose of our study was to evaluate the age and gender effects on ICA and VA regarding the tortuosity and flow changes by applying automatic vessel segmentation, centerline tracking, and phase mapping on MR angiography. Methods A total of 247 subjects (86 males and 161 females) without neurological diseases participated in this study. All subjects obtained T1-weighted MRI, 3D time-of-flight MR angiography, and 2D phase-contrast (PC) MRI scans. To generate quantitative tortuosity metrics from TOF images, the vessel segmentation and centerline tracking were implemented based on Otsu thresholding and fast marching algorithms, respectively. Blood flow and velocity were measured using PC MRI. Among the 247 subjects, 144 subjects (≤ 60 years, 49 males/95 females) were categorized as the young group; 103 subjects (>60 years, 37 males/66 females) were categorized as the old group. Results Independent t-test showed that older subjects had higher tortuosity metrics, whereas lower blood flow and velocity than young subjects (p < 0.0025, Bonferroni-corrected). Cerebral blood flow calculated using the sum flux of four target arteries normalized by the brain mass also showed significantly lower values in older subjects (p < 0.001). The age was observed to be positively correlated with the VT metrics. Compared to the males, the females demonstrated higher geometric indices within VAs as well as faster age-related vascular profile changes. After adjusting age and gender as covariates, maximum blood velocity is negatively correlated with geometric measurements. No association was observed between blood flux and geometric measures. Conclusions Vascular auto-segmentation, centerline tracking, and phase mapping provide promising quantitative assessments of tortuosity and its effects on blood flow. The neck arteries demonstrate quantifiable and significant age-related morphological and hemodynamic alterations. Moreover, females showed more distinct vascular changes with age. Our work is built upon a comprehensive quantitative investigation of a large cohort of populations covering adult lifespan using MRI, the results can serve as reference ranges of each decade in the general population.
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Affiliation(s)
- Zhe Sun
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,Vilcek Institute of Biomedical Science, NYU Grossman School of Medicine, New York, NY, United States
| | - Dengrong Jiang
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peiying Liu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Marco Muccio
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Chenyang Li
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,Vilcek Institute of Biomedical Science, NYU Grossman School of Medicine, New York, NY, United States
| | - Yan Cao
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Thomas M. Wisniewski
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States,Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States,Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Hanzhang Lu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yulin Ge
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,*Correspondence: Yulin Ge
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7
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Li M, Wang ZW, Fang LJ, Cheng SQ, Wang X, Liu NF. Correlation analysis of coronary artery tortuosity and calcification score. BMC Surg 2022; 22:66. [PMID: 35197040 PMCID: PMC8867736 DOI: 10.1186/s12893-022-01470-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background Coronary artery tortuosity (CAT) is regarded as a variation of vascular anatomy, and its relationship with coronary artery calcification (CAC) score is still not well clarified. Studying the correlation between coronary artery calcification scores and CAT to determine specific prevention and intervention populations seems to have more meaningful. Methods The study is a cross-sectional retrospective study, including 1280 patients. CAT is defined as the presence of at least three consecutive curvatures of more than 45°measured during systole or diastole of a major epicardial coronary artery. Multivariable regression analysis was used to adjust the clinical parameters directly affecting CAT. Results Of these individuals, 445 (35%) were evaluated having CAT, of which females are higher than males (59.1% vs. 40.9%). Moderate CAC score (101–400) (odds ratio (OR) 1.49, 95% confidence interval [95%CI] 1.05–2.10, P = 0.025) revealed significantly associated with CAT on univariable analysis. However, multivariable analysis after adjusting for confounding factors only indicated that CAT was positively correlated with female (OR 1.68, 95%CI 1.30–2.17, P < 0.001), hypertension (OR 1.35, 95% CI 1.04–1.75, P = 0.024), and age (OR 1.02, 95% CI 1.01–1.03, P = 0.001), while was negatively associated with body mass index (BMI) 24–27.9(OR 0.76, 95% CI 0.58–1.00, P = 0.044), and BMI > 28 (OR 0.46, 95% CI 0.31–0.68, P < 0.001). Further analysis stratified by gender showed that compared with non-CAT, CAT was significantly linked with moderate CAC score (OR 1.79, 95% CI 1.00–3.20, P = 0.048), hypertension (OR 1.54, 95% CI 1.07–2.22, P = 0.021), and high-density lipoprotein (HDL) (OR 1.86, 95% CI 1.07–3.24, P = 0.028), while was negatively related to BMI > 28 (OR 0.51, 95% CI 0.31–0.84, P = 0.008) in female patients. Conclusions CAT is more likely to be found in females, connected with hypertension, age, and BMI. No significant correlation is found between the presence of tortuosity and calcium score or diameter stenosis on multivariable analysis. Whereas the CAT is associated with moderate CAC score in correlation analysis when women are selected as the main group. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01470-w.
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Affiliation(s)
- Min Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Zhen-Wei Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Li-Juan Fang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Shou-Quan Cheng
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Xin Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Nai-Feng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
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8
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Peper J, Becker LM, van Kuijk JP, Leiner T, Swaans MJ. Fractional Flow Reserve: Patient Selection and Perspectives. Vasc Health Risk Manag 2021; 17:817-831. [PMID: 34934324 PMCID: PMC8684425 DOI: 10.2147/vhrm.s286916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023] Open
Abstract
The aim of this review was to discuss the current practice and patient selection for invasive FFR, new techniques to estimate invasive FFR and future of coronary physiology tests. We elaborate on the indication and application of FFR and on the contraindications and concerns in certain patient populations.
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Affiliation(s)
- Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonie M Becker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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9
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Persu A, Dobrowolski P, Gornik HL, Olin JW, Adlam D, Azizi M, Boutouyrie P, Bruno RM, Boulanger M, Demoulin JB, Ganesh SK, Guzik T, Januszewicz M, Kovacic JC, Kruk M, Leeuw DP, Loeys B, Pappaccogli M, Perik M, Touzé E, Van der Niepen P, Van Twist DJL, Warchoł-Celińska E, Prejbisz A, Januszewicz A. Current progress in clinical, molecular, and genetic aspects of adult fibromuscular dysplasia. Cardiovasc Res 2021; 118:65-83. [PMID: 33739371 DOI: 10.1093/cvr/cvab086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease that may involve medium-sized muscular arteries throughout the body. The majority of FMD patients are women. Although a variety of genetic, mechanical, and hormonal factors play a role in the pathogenesis of FMD, overall, its cause remains poorly understood. It is probable that the pathogenesis of FMD is linked to a combination of genetic and environmental factors. Extensive studies have correlated the arterial lesions of FMD to histopathological findings of arterial fibrosis, cellular hyperplasia, and distortion of the abnormal architecture of the arterial wall. More recently, the vascular phenotype of lesions associated with FMD has been expanded to include arterial aneurysms, dissections, and tortuosity. However, in the absence of a string of beads or focal stenosis, these lesions do not suffice to establish the diagnosis. While FMD most commonly involves renal and cerebrovascular arteries, involvement of most arteries throughout the body has been reported. Increasing evidence highlights that FMD is a systemic arterial disease and that subclinical alterations can be found in non-affected arterial segments. Recent significant progress in FMD-related research which has led to improved understandings of the disease's clinical manifestations, natural history, epidemiology, and genetics. Ongoing work continues to focus on FMD genetics and proteomics, physiological effects of FMD on cardiovascular structure and function, and novel imaging modalities and blood-based biomarkers that can be used to identify subclinical FMD. It is also hoped that the next decade will bring the development of multi-centred and potentially international clinical trials to provide comparative effectiveness data to inform the optimal management of patients with FMD.
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Affiliation(s)
- Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Heather L Gornik
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester University, Leicester, UK
| | - Michel Azizi
- Université de Paris, INSERM CIC1418, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM U970 Team 7, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Pharmacology Department and DMU CARTE, Paris, France
| | - Rosa Maria Bruno
- Université de Paris, INSERM U970 Team 7, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Pharmacology Department and DMU CARTE, Paris, France
| | - Marion Boulanger
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | | | - Santhi K Ganesh
- Division of Cardiovascular Medicine, Department of Internal Medicine, and Department of Human Genetics University of Michigan, Ann Arbor, Michigan, USA
| | - Tomasz Guzik
- Jagiellonian University, Collegium Medicum, Krakow, Poland.,Institute of Cardiovascular & Medical Sciences BHF Glasgow Cardiovascular Research Centre; Glasgow, UK
| | | | - Jason C Kovacic
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia, and St. Vincent's Clinical School, University of NSW, Australia
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - de Peter Leeuw
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Bart Loeys
- Center for Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Marco Pappaccogli
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Melanie Perik
- Center for Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | | | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB) Brussels, Belgium
| | | | | | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
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10
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Li Y, Zhang X, Dai Q, Ma G. Coronary flow reserve and microcirculatory resistance in patients with coronary tortuosity and without atherosclerosis. J Int Med Res 2020; 48:300060520955060. [PMID: 32954929 PMCID: PMC7509742 DOI: 10.1177/0300060520955060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective Coronary tortuosity may affect epicardial coronary arterial blood flow. This study aimed to investigate the effect of coronary tortuosity on coronary flow reserve and the coronary microcirculation in patients without apparent coronary atherosclerosis. Methods Prospective patients (n = 8, 3 men, mean age: 58 ± 6.0 years) with coronary tortuosity and without apparent coronary atherosclerosis were enrolled. Coronary tortuosity was defined by the finding of ≥three bends (defined as a ≥45° change in vessel direction) along the main trunk of the left anterior descending artery or left circumflex artery. Coronary flow reserve and the index of microcirculatory resistance were measured by the thermodilution technique. Results A total of eight coronary arteries with coronary tortuosity were analyzed. The mean fractional flow reserve was 0.98 ± 0.007. The mean coronary flow reserve was 1.5 ± 0.3, which is much lower than that in the normal coronary artery as reported in the literature. The mean index of microcirculatory resistance was 26.7 ± 2.3, which is much higher than that in the normal coronary artery. Conclusions Coronary tortuosity is associated with decreased coronary flow reserve and an increased index of microcirculatory resistance. Trial registration: This study is registered at the Chinese Clinical Trial Registry, NCT No: ChiCTR2000033671
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Affiliation(s)
- Yang Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiming Dai
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Esenboga K, Baskovski E, Sahin E, Ozyuncu N, Tan TS, Candemir B, Turhan S, Tutar E. Assessment of Myocardial Perfusion by Angiographic Methods in Tortuous Coronary Arteries. Angiology 2020; 71:616-620. [PMID: 32314591 DOI: 10.1177/0003319720919325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.
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Affiliation(s)
- Kerim Esenboga
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Emir Baskovski
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Ebru Sahin
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Nil Ozyuncu
- Ankara University, Cardiology Department, Ankara, Turkey
| | | | - Basar Candemir
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Sibel Turhan
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Eralp Tutar
- Ankara University, Cardiology Department, Ankara, Turkey
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13
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Coronary tortuosity affects left ventricular myocardial functions: a 3D-speckle tracking echocardiography study. Int J Cardiovasc Imaging 2020; 36:627-632. [PMID: 31916067 DOI: 10.1007/s10554-019-01760-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Coronary artery tortuosity (CAT) is a common finding in coronary angiography, and is defined as three fixed bends during both systole and diastole in at least one epicardial coronary artery, with each bend showing a 45° change in vessel direction. The impact of CAT on the myocardial deformation has not been completely evaluated using 3D-STE. As a result of this, we aimed to assess the effects of CAT on LV functions using 3D-STE in the present study. Eighty-two patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms were enrolled into the study. 3D-STE was performed and LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient after coronary angiography. The LV-GLS was significantly depressed in the CAT ( +) group than in the control group (p = 0.001). ROC analysis was performed to find out ideal LV-GLS cut off value to predict the presence of CAT. A LV-GLS value of > - 17 has 81.3% sensitivity, 56.7% specificity to detect the presence of CAT. The present study is the first to focus on the assessing LV myocardial functions in patients with CAT by 3D-STE. CAT has a considerable negative effect on LV myocardial longitudinal deformation as evaluated by 3D strain parameters. Our results support that patients with CAT may have subclinical LV longitudinal deformation abnormalities even though they are apparently healthy.
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Khosravani-Rudpishi M, Joharimoghadam A, Rayzan E. The significant coronary tortuosity and atherosclerotic coronary artery disease; What is the relation? J Cardiovasc Thorac Res 2019; 10:209-213. [PMID: 30680079 PMCID: PMC6335987 DOI: 10.15171/jcvtr.2018.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Although coronary tortuosity is relatively common in coronary angiograms, there
is much debate over the significance of this anatomical variation. So in this study the relation
between significant coronary tortuosity (SCT) and coronary artery disease (CAD) was examined.
Methods: The cross-sectional study included 737 patients (57% male) who were admitted to the
hospital for a coronary angiography, based on their symptoms or non-invasive imaging. Coronary
arteries defined as SCT are in the presence of either ≥3 consecutive curvatures of 90◦ to 180◦ or
≥2 consecutive curvatures of ≥180◦ measured at the end-diastole, in a major epicardial coronary
artery ≥2 mm in diameter.
Results: 29.17% of the patients had SCT of which females (64.7% vs. 34.1%, P < 0.001) and higher aged persons (62.9±8.4 vs. 57.8±10.7 years ± SD; P < 0.001) were significantly associated with SCT compared to non-SCT. Left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) with SCT in comparison to non-SCT, had lesser probability of CAD with stenosis severity of ≥50% (34.5% vs. 46.1%; P = 0.019 and 17.7% vs. 31.1%; P = 0.001 and 27.9% vs. 43.5%; P = 0.013 respectively) and also had significant lower Gensini scores (4.1±5.3 vs. 8.4±11.9; P = 0.011; 2.1±3.4 vs. 5.2±9.5; P = 0.01 and 1.2±1.9 vs. 5.03±8.9; P < 0.001 respectively) but higher TIMI frame count (15.7±5.3 vs. 11.9±4.6; P < 0.001 and 17.1±4.4 vs. 12.7±4.4; P < 0.001 and 15.2±3.9 vs. 11.6±4.8; P < 0.001 respectively).
Conclusion: SCT is negatively correlated with CAD and there is a significant association between SCT and reduced coronary flow rate.
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Affiliation(s)
| | - Adel Joharimoghadam
- Department of Cardiology, Science and Research branch, AJA University of Medical Sciences, Tehran, Iran
| | - Elham Rayzan
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Li Y, Feng Y, Ma G, Shen C, Liu N. Coronary tortuosity is negatively correlated with coronary atherosclerosis. J Int Med Res 2018; 46:5205-5209. [PMID: 30304979 PMCID: PMC6300977 DOI: 10.1177/0300060518804723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective The impact of coronary tortuosity on coronary atherosclerosis remains unclear. This study was performed to determine to the relationship between coronary tortuosity and the presence of coronary atherosclerosis. Methods Tortuosity and the presence of coronary atherosclerosis in the main coronary arteries were evaluated. The coronary artery was divided into non-tortuous and tortuous segments. The incidence of coronary atherosclerosis between the two segments was compared. Results The prevalence of coronary atherosclerotic stenosis was significantly lower in the tortuous than non-tortuous segment. Conclusion The prevalence of coronary atherosclerotic stenosis is lower in the coronary tortuous than non-tortuous segment, indicating that coronary tortuosity might be considered a protective factor for atherosclerosis.
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Affiliation(s)
- Yang Li
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yi Feng
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Genshan Ma
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chengxing Shen
- 2 Department of Cardiology, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naifeng Liu
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Khosravani-Rudpishi M, Akhavan-Khaleghi N, Hosseinsabet A. Two-dimensional speckle-tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:467-474. [PMID: 29683198 DOI: 10.1002/jcu.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Coronary artery tortuosity (CAT) is an anatomical condition in which epicardial coronary arteries have abnormal curves or spiral courses. Although correlated with higher rates of positive stress test, its effects on the myocardial function remain to be clearly defined. METHODS We included in this cross-sectional study and evaluated with 2D speckle-tracking echocardiography 40 consecutive patients admitted to our hospital for selective coronary angiography which showed severe CAT without significant epicardial coronary artery stenosis, and 40 consecutive subjects matched for age, hypertension, and diabetes in whom selective coronary angiography showed neither CAT nor significant epicardial coronary artery stenosis. RESULTS Systolic strain, strain rate, and early and late diastolic strain rates were not significantly different between the 2 groups, even after adjustment for potential confounding variables. CONCLUSION The 2D speckle-tracking echocardiography-derived indices of longitudinal deformation of the left ventricular myocardium were not significantly different between the patients with severe CAT and controls.
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Affiliation(s)
| | | | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
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Li Y, Qadir Nawabi A, Feng Y, Ma G, Tong J, Shen C, Liu N. Coronary tortuosity is associated with an elevated high-sensitivity C-reactive protein concentration and increased risk of ischemic stroke in hypertensive patients. J Int Med Res 2018; 46:1579-1584. [PMID: 29436255 PMCID: PMC6091816 DOI: 10.1177/0300060517748527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective The clinical implication of coronary tortuosity is unclear. The present study was conducted to determine the relationships between coronary tortuosity and the high-sensitivity C-reactive protein (hs-CRP) concentration and between coronary tortuosity and cerebrovascular accident in hypertensive patients without coronary artery disease. Methods In total, 236 patients with normal coronary angiography findings were categorized into 3 different groups: control participants (n = 58), who had neither hypertension nor coronary tortuosity; patients with hypertension but no coronary tortuosity (H-NCT group, n = 93); and patients with both hypertension and coronary tortuosity (H-CT group, n = 85). The hs-CRP concentration was measured in every patient, and 168 hypertensive patients were followed up for at least 2 years to check for the development of cerebrovascular accident. Results The hs-CRP concentration was significantly higher in the H-CT group than in the control and H-NCT groups (4.33 ± 3.15 vs. 1.52 ± 1.31 and 2.31 ± 2.09 mg/L, respectively). The incidence of lacunar infarction was higher in the H-CT than H-NCT group during the follow-up. Conclusions Hypertensive patients with coronary tortuosity have a higher serum hs-CRP level concentration and have a higher incidence of lacunar infarction than hypertensive patients without coronary tortuosity.
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Affiliation(s)
- Yang Li
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Abdul Qadir Nawabi
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yi Feng
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Genshan Ma
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jiayi Tong
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chengxing Shen
- 2 Department of Cardiology, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naifeng Liu
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Kagan HJ, Belekdanian VD, Chen J, Backeris P, Hammoudi N, Turnbull IC, Costa KD, Hajjar RJ. Coronary capillary blood flow in a rat model of congestive heart failure. J Appl Physiol (1985) 2017; 124:632-640. [PMID: 29051335 DOI: 10.1152/japplphysiol.00741.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to explore the role of abnormal coronary microvasculature morphology and hemodynamics in the development of congestive heart failure (CHF). CHF was induced in rats by aortic banding, followed by ischemia-reperfusion and later aortic debanding. Polymerized casts of coronary vasculature were imaged under a scanning electron microscope (SEM). Matrix Laboratory (MATLAB) software was used to calculate capillary structure index (CSI), a measure of structural alignment also called mean vector length (MVL), for 93 SEM images of coronary capillaries (CSI→1 perfect linearity; CSI→0 circular disarray). CSI was incorporated as a constant to represent tortuosity and nonlaminar flow in Poiseuille's equation to estimate the differences in capillary blood flow rate, velocity, and resistance for CHF vs. CONTROL The morphology of CHF capillaries is significantly disordered and tortuous compared with control (CSI: 0.35 ± 0.02 for 61 images from 7 CHF rats; 0.58 ± 0.02 for 32 images from 7 control rats; P < 0.01). Estimated capillary resistance in CHF is elevated by 173% relative to control, while blood flow rate and blood velocity are 56 and 43% slower than control. Capillary resistance increased 67% due to the significantly narrower capillary diameter in CHF, while it increased an additional 105% due to tortuosity. The significant structural abnormalities of CHF coronary capillaries may drastically stagnate hemodynamics in myocardium and increase resistance to blood flow. This could play a role in the development of CHF. NEW & NOTEWORTHY In the present study, coronary capillary tortuosity was measured by applying Matrix Laboratory software to scanning electron microscope images of capillaries in a rat model of congestive heart failure. Stagnant blood flow in coronary capillaries may play a role in the development of congestive heart failure. The application of computer modeling to histological and physiological data to characterize the hemodynamics of coronary microcirculation is a new area of study.
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Affiliation(s)
- Heather J Kagan
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Varujan D Belekdanian
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Peter Backeris
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Irene C Turnbull
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Kevin D Costa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
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Oehler AC, Minnier J, Lindner JR. Increased Coronary Tortuosity Is Associated with Increased Left Ventricular Longitudinal Myocardial Shortening. J Am Soc Echocardiogr 2017; 30:1028-1034.e2. [PMID: 28781117 DOI: 10.1016/j.echo.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanistic basis for tortuosity of the coronary arteries (TCA) is unclear. The aim of this study was to test the hypothesis that the relative degree of systolic longitudinal shortening of the left ventricle that deforms coaxially oriented coronary arteries is associated with TCA. METHODS Adult subjects undergoing coronary angiography and comprehensive echocardiography within 3 months were classified dichotomously as with (n = 32) or without (n = 42) TCA defined on the basis of number and severity of coronary angles. Systolic left ventricular (LV) longitudinal deformation was determined by mitral annular plane systolic excursion (MAPSE) from both B-mode displacement and tissue Doppler time-velocity integral; data were indexed to LV diastolic long-axis length. RESULTS There were no differences between groups with respect to age, gender, hypertension, or coronary artery disease. Patients with TCA had significantly (P < .01) lower LV mass index and a shorter total LV diastolic long-axis length (mean, 8.3 ± 1.9 vs 9.1 ± 2.2 cm; P < .01). Despite having a shorter length, those with TCA had greater MAPSE by both methods. MAPSE normalized to diastolic length was significantly greater (P < .01) in those with TCA, which remained the case after excluding subjects with reduced LV ejection fraction. Multiple linear regression found that lateral annular MAPSE had the largest effect size, with a 13-fold increase in likelihood for TCA for every 0.1 of normalized MAPSE. CONCLUSIONS TCA is not associated with increased LV mass but rather with smaller hearts that have greater relative longitudinal shortening of the left ventricle. This finding suggests that TCA could represent an adaptive response to longitudinal systolic distortion of coaxially oriented coronary arteries that dynamically produce shear stresses associated with expansive coronary remodeling.
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Affiliation(s)
- Andrew C Oehler
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jessica Minnier
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Chiha J, Mitchell P, Gopinath B, Burlutsky G, Kovoor P, Thiagalingam A. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease. IJC HEART & VASCULATURE 2017; 14:23-27. [PMID: 28616559 PMCID: PMC5454180 DOI: 10.1016/j.ijcha.2016.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/19/2016] [Indexed: 12/04/2022]
Abstract
Background Little is known about the significance of severe coronary tortuosity (SCT) despite it being a relatively common finding on coronary angiography. We examined whether the presence of tortuosity was influenced by gender or cardiac risk factors. Methods and results We examined 870 patients (Men = 589, Women = 281) who presented to Westmead Hospital, Sydney, Australia for invasive coronary angiography for the assessment of chest pain due to suspected CAD. Female gender and age were significantly associated with SCT (p < 0.001 for age) with 45.2% of women having SCT as opposed to 19.7% of men (p < 0.001). Men with SCT had lower Extent scores only compared than those without tortuosity (22.4 vs. 32.4, p = 0.003). However, women with SCT had less severe coronary artery disease than those with no SCT as measured by both the Extent score (12.4 vs. 19.1, p = 0.03) and Gensini score (10.4 vs. 15.5, p = 0.02). Conclusion There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.
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Affiliation(s)
- Joseph Chiha
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Pramesh Kovoor
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
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Cerit L, Cerit Z. Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit. Cardiovasc J Afr 2017; 28:385-388. [PMID: 28470327 PMCID: PMC5885048 DOI: 10.5830/cvja-2017-023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
Background Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina. Methods The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°. Results The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT. Conclusion CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
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Arcari L, Limite LR, Cacciotti L, Alonzo A, Musumeci MB, Passaseo I, Marazzi G, Berni A, Ansalone G, Volpe M, Autore C. Tortuosity, Recurrent Segments, and Bridging of the Epicardial Coronary Arteries in Patients With the Takotsubo Syndrome. Am J Cardiol 2017; 119:243-248. [PMID: 27866652 DOI: 10.1016/j.amjcard.2016.09.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022]
Abstract
Myocardial bridging (MB) and a long recurrent wraparound left anterior descending artery (wrap-LAD) are coronary anatomic variants that have been recently suggested to be associated with takotsubo syndrome (TS). Until now, coronary artery tortuosity (CAT) has never been investigated in this setting. Our study sought to evaluate the prevalence of the aforementioned anatomic variants in a large population with TS. In this retrospective angiographic study, 109 patients with TS were compared with 109 age- and gender-matched subjects without coronary artery disease, valve heart disease, or cardiomyopathy. CAT was identified by ≥3 consecutive curvatures ≥90° (criteria 1) or by ≥2 consecutive curvatures ≥180° (criteria 2). Wrap-LAD was defined if any part of the vessel outreached the apex of the left ventricle and MB as the presence of a milking effect or a step-up and step-down phenomenon. An anatomic variant was found in 79 patients with TS (72%) and in 48 controls (44%) (p <0.001). CAT in at least 1 vessel (criteria 1: 49% vs 20%, p <0.001; criteria 2: 38% vs 13%, p <0.001), ≥2 vessels (criteria 2: 14% vs 3%, p = 0.005), and wrap-LAD (41% vs 27%, p = 0.02) were significantly more frequent in patients with TS than in controls. The prevalence of MB (9% vs 5%, p = 0.18) did not differ between groups. In conclusion, CAT and wrap-LAD have higher prevalence in patients with TS than in matched controls. These findings could support the hypothesis that anatomic variants might act as potential pathogenic substrates in TS.
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El Tahlawi M, Sakrana A, Elmurr A, Gouda M, Tharwat M. The relation between coronary tortuosity and calcium score in patients with chronic stable angina and normal coronaries by CT angiography. Atherosclerosis 2016; 246:334-7. [DOI: 10.1016/j.atherosclerosis.2016.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 12/17/2022]
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Effects of Vessel Tortuosity on Coronary Hemodynamics: An Idealized and Patient-Specific Computational Study. Ann Biomed Eng 2015; 44:2228-39. [PMID: 26498931 DOI: 10.1007/s10439-015-1492-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
Abstract
Although coronary tortuosity can influence the hemodynamics of coronary arteries, the relationship between tortuosity and flow has not been thoroughly investigated partly due to the absence of a widely accepted definition of tortuosity and the lack of patient-specific studies that analyze complete coronary trees. Using a computational approach we investigated the effects of tortuosity on coronary flow parameters including pressure drop, wall shear stress, and helical flow strength as measured by helicity intensity. Our analysis considered idealized and patient-specific geometries. Overall results indicate that perfusion pressure decreases with increased tortuosity, but the patient-specific results show that more tortuous vessels have higher physiological wall shear stress values. Differences between the idealized and patient-specific results reveal that an accurate representation of coronary tortuosity must account for all relevant geometric aspects, including curvature imposed by the heart shape. The patient-specific results exhibit a strong correlation between tortuosity and helicity intensity, and the corresponding helical flow contributes directly to the observed increase in wall shear stress. Therefore, helicity intensity may prove helpful in developing a universal parameter to describe tortuosity and assess its impact on patient health. Our data suggest that increased tortuosity could have a deleterious impact via a reduction in coronary perfusion pressure, but the attendant increase in wall shear stress could afford protection against atherosclerosis.
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Eskerud I, Gerdts E, Nordrehaug JE, Lønnebakken MT. Global Coronary Artery Plaque Area is Associated with Myocardial Hypoperfusion in Women with Non-ST Elevation Myocardial Infarction. J Womens Health (Larchmt) 2015; 24:367-73. [PMID: 25692527 PMCID: PMC4440999 DOI: 10.1089/jwh.2014.4920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Women with non-ST elevation myocardial infarction (NSTEMI) have similar extent of myocardial ischemia but less obstructive coronary artery disease (CAD) than their male counterparts. We tested the impact of global coronary artery plaque area and artery tortuosity on myocardial perfusion in NSTEMI patients. METHODS Coronary artery plaque area was determined by quantitative angiography in 108 patients (32% women) with NSTEMI. Myocardial perfusion was assessed by contrast echocardiography in the 17 individual left ventricular segments. Artery tortuosity was defined as ≥3 curves >45° in a main coronary artery. RESULTS Age, prevalence of hypertension, and diabetes did not differ between sexes (all nonsignificant). Women had lower prevalence of ≥50% coronary artery stenosis (74% vs. 91%, p<0.05), while global coronary plaque area (35±22 vs. 43±21mm(2)) and the number of segments with hypoperfusion (6.9±3.7 vs. 7.2±3.4) did not differ between sexes (both p>0.07). In multivariate analysis, larger coronary artery plaque area was associated with a 35% higher risk for having severe myocardial hypoperfusion (odds ratio 1.35 [95% confidence interval 1.01-1.80], p<0.05) in the total study population, while no association between artery tortuosity and myocardial ischemia was found. Similar results were obtained in separate analysis among women and men. CONCLUSION In women and men with NSTEMI, the global coronary artery plaque area was an important determinant of the severity of myocardial hypoperfusion at rest independent of presence of significant coronary stenoses. These findings may expand current understanding of NSTEMI in patients with nonobstructive CAD.
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Affiliation(s)
- Ingeborg Eskerud
- Department of Clinical Science, University of Bergen , Bergen, Norway
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Xie X, Wang Y, Zhou H. Impact of coronary tortuosity on the coronary blood flow: a 3D computational study. J Biomech 2013; 46:1833-41. [PMID: 23777815 DOI: 10.1016/j.jbiomech.2013.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/22/2013] [Accepted: 05/07/2013] [Indexed: 01/11/2023]
Abstract
Tortuous coronary arteries are commonly observed but the etiology and clinical importance are still unclear. Hemodynamic factors are vital modulators of the vascular structure and a full understanding of hemodynamic changes caused by the coronary tortuosity (CT) is meaningful for clinical researches. A three-dimensional computational fluid dynamic study was conducted to evaluate hemodynamic changes caused by the CT. Six idealized small sections of the left anterior descending coronary artery (LAD) with different levels of tortuosity were employed. The dynamic vessel motion was added to the three-dimensional tortuous coronary models to make the computational results more realistic. The rest and exercise conditions were modeled by specifying proper boundary conditions. Results showed that a low and oscillated wall shear stress (WSS) region was formed at the inner wall downstream of the bend section when the bend angle was larger than 120°. The resistance of the coronary arteries increased up to 92% due to the CT during exercise. A maximum increase of 96% was observed in the mean diastole driving pressure for the CT model as compared to the non-tortuous model during exercise. This study indicated that the severe CT may be a risk factor for atherosclerosis and may make the regulation of the blood flow ineffective during exercise.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Engineering, Fudan University, No. 220 Handan Road, Shanghai, China
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28
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Xie X, Wang Y, Zhu H, Zhou H, Zhou J. Impact of coronary tortuosity on coronary blood supply: a patient-specific study. PLoS One 2013; 8:e64564. [PMID: 23691249 PMCID: PMC3656900 DOI: 10.1371/journal.pone.0064564] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tortuous coronary arteries are commonly observed in clinical screenings and it may cause a reduction of the coronary pressure. However, whether this reduction leads to significant decreasing in the coronary blood supply is still unknown. The purpose of this study was to investigate the effect of the coronary tortuosity (CT) on the coronary blood supply. METHOD A computational fluid dynamics (CFD) study was conducted to evaluate the impact of tortuosity on the coronary blood supply. Two patient-specific left anterior descending coronary artery (LAD) models and the corresponding non-tortuous models were reconstructed to perform three-dimensional CFD analysis. The lumped parameter model was coupled to the outlet of the simulated branches to represent the absent downstream vasculatures. The rest and exercise conditions were modeled by specifying proper boundary conditions. RESULT Under resting condition, the mean flow rate could be maintained by decreasing less than 8% of the downstream vascular bed's resistance for tortuous models. While during exercise (maximal dilatation condition), the maximal coronary blood supply would reduce up to 14.9% due to tortuosity. Assuming that the flow rate can be maintained by the auto-regulation effect under the maximal dilatation condition, the distal resistances for CT models still have to reduce more than 23% to maintain blood perfusion. CONCLUSIONS Coronary tortuosity has minor influence on coronary blood supply at rest; while during exercise, patients with CT may lack the ability to adjust distal resistance sufficiently to compensate for the extra resistances generated by tortuosity and this may further lead to an ineffective regulation of the blood supply.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Engineering, Fudan University, Shanghai, China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, China
- * E-mail:
| | - Hongmin Zhu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Hu Zhou
- Department of Electronic Engineering, Fudan University, Shanghai, China
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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