Abstract
Background: Atherosclerosis generally occurs in the blood vessels with angulation or curvature, however, association between coronary bifurcation angle and coronary artery disease needs to be further clarified when compared to normal patients. Objectives: The aim of this study is to determine the relationship between left coronary bifurcation angle and development of coronary artery disease when compared to patients with normal coronary arteries. Methods: Fifty patients (40 men, mean age, 55.2 years) who underwent coronary computed tomography (CT) angiography for clinical diagnosis of coronary artery disease were included in the study. Of these patients, coronary plaques were present at one or more coronary arteries in 25 patients, while in the remaining 25 cases, no plaque was detected at the coronary arteries, thus serving as the control group. Left coronary bifurcation angle between left anterior descending and left circumflex was measured on 3D volume rendering images by two assessors with >80o as the cut-off value to determine significant stenosis. Results: The mean bifurcation angle was 72.9o±19.4o (range, 36o, 112o) among 50 patients. The mean bifurcation angle was significantly wider in patients with coronary plaques than that measured in patients with normal coronary artery (p 80o, while only 12% of the patients had a bifurcation angle >80o in the control group. Conclusion: This study further confirms the direct relationship between left coronary bifurcation angle and development of coronary artery disease with diseased coronary arteries associated with wider angulation.
Highlights
The temporal resolution of current multislice computed tomography (CT) scanners is between 83 and 175 ms, use of beta-blockers is necessary to control heart rate in most of the patients with heart rate >70 beats per minute, high diagnostic value of Coronary computed tomography angiography (CCTA) in patients with high heart rates has been reported in some recent studies using latest CT scanners.[6,7,8,9,10]
Recent studies have shown that diagnostic accuracy of CCTA has been significantly augmented with use of bifurcation angle as a criterion to determine coronary stenosis when compared to assessment of the degree of lumen stenosis.[19,20,21]
Fifty-one patients met our selection criteria and were included in the analysis with good image quality allowing analysis of normal coronary anatomy and coronary plaques.The bifurcation angle could not be detected in one patient due to anomaly of the left circumflex which arose from the ascending aorta posterior to the right coronary artery
Summary
The temporal resolution of current multislice CT scanners is between 83 and 175 ms, use of beta-blockers is necessary to control heart rate in most of the patients with heart rate >70 beats per minute, high diagnostic value of CCTA in patients with high heart rates has been reported in some recent studies using latest CT scanners.[6,7,8,9,10] It is well known that high calcification or high calcium score in the coronary arteries results in false positive results, leading to low specificity and positive predictive value (PPV).[11,12,13,14,15] This limitation has been addressed to some extent with use of image processing methods as reported in some studies.[16,17,18] Another approach to improve diagnostic value of CCTA in the diagnosis of calcified plaques is to use left coronary bifurcation angle as opposed to the conventional method of measuring coronary lumen stenosis. Conclusion: This study further confirms the direct relationship between left coronary bifurcation angle and development of coronary artery disease with diseased coronary arteries associated with wider angulation
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