Coronary Artery Dimensions Research Articles

Coronary Artery Dimensions on Computed Tomography Following the Neonatal Arterial Switch Operation for the Complete Transposition of the Great Arteries.

Coronary events are life-threatening long-term complications of the arterial switch operation for complete transposition of the great arteries. The aim of our study was to assess the dimensions of the reimplanted coronary arteries and their relationship with the various geometric characteristics to gain a better understanding of the involved mechanisms. Coronary computed tomography angiography (CCTA) scans of 78 asymptomatic pediatric patients were performed at the age of 10.7 (6.3-17.8) years. The position of the ostia, the branching angles, and the diameters of the coronary arteries were determined in a subgroup of 51 patients presenting the usual preoperative coronary anatomy. Mean Z-score of the left main coronary artery (LMCA), left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) diameters were 0.7 ± 1.2, - 0.4 ± 1.1, - 0.3 ± 1.1, and - 0.3 ± 1.1, respectively. The Z-score of the ostial LMCA diameter had a positive correlation with the remoteness from the main pulmonary artery (p < 0.001) and the branching angle (p = 0.001). The ostial diameter Z-score of the LMCA had a negative correlation with the interval between the arterial switch operation and the CCTA (p = 0.004). Even though most of the coronary diameters fell within the accepted range, which suggests normal overall development, acute branching angle and more anterior origin were associated with smaller ostial coronary artery diameter Z-scores. To prove the clinical relevance of the smaller ostial diameter of high-risk left coronary arteries and the decrease of ostial coronary artery Z-scores over time needs further follow-up studies.

Coronary artery size based on intravascular ultrasound in Southeast Asia population

BackgroundOne of the downsides of percutaneous coronary intervention (PCI) is stent failure which could be related to stent underexpansion. Hence, PCI based on an accurate coronary artery size obtained from intracoronary imaging is tremendously important. Until now, there is no data about all coronary artery dimensions in the Southeast Asian population performed by intravascular ultrasound (IVUS). The coronary artery size of 153 patients with chronic coronary syndrome (CCS) in acute or chronic settings who underwent percutaneous coronary intervention (PCI) with IVUS was examined. The mean artery size and its predictors were analyzed.ResultsThere were 153 patients with 633 coronary artery segments: the mean left main (LM) external elastic membrane (EEM) diameter and cross-sectional area (CSA) were 5.02 ± 0.43 mm and 19.93 ± 3.48 mm2, proximal left anterior descending artery (LAD) 4.25 ± 0.42 mm and 14.34 ± 2.85 mm2, the mid-LAD 3.86 ± 0.39 mm and 11.70 ± 2.24 mm2, the distal LAD 3.32 (2.83–4.30) mm and 8.77(6.23–14.99) mm2, the proximal left circumflex artery (LCX) 3.91 ± 0.42 mm and 12.07 ± 2.53 mm2, the distal LCX 3.51 ± 0.47 mm and 9.90 (5.09–14.20) mm2, the proximal right coronary artery (RCA) 4.50 ± 0.48 mm and 16.14 ± 3.43 mm2, the mid-RCA 4.16 ± 0.420 mm and 13.74 ± 2.72 mm2, the distal RCA 3.81 ± 0.41 mm and 11.59 ± 2.46 mm2, respectively. Body surface area (BSA) is an independent predictor for the majority of epicardial coronary arteries with a positive linear relationship.ConclusionsThe mean artery size of the Indonesian population was comparable with previous studies. The knowledge of coronary artery size will help the clinician to have a reference for intervention, especially when no intravascular imaging is available.

Analysis of gender influence on left main coronary artery dimensions in patient with coronary artery disease single center observational study

Analysis of gender influence on left main coronary artery dimensions in patient with coronary artery disease single center observational study

Single Center Retrospective Evaluation of Coronary Artery Fistula Outcomes.

There is a paucity of literature describing long-term outcomes of patients with coronary artery fistula with most manuscripts focusing on those requiring interventions. We describe single-center outcomes of coronary artery fistulas including those not requiring intervention. We performed a retrospective review of the electronic medical record and identified all patients with a diagnosis of coronary artery fistula over the last 10years. 158 patients were identified with a coronary artery fistula. The mean age at diagnosis was 5.8years (SD ± 5.9). There was a male (55%, n = 87) predominance. Concomitant congenital heart lesion was present in 49% (n = 77) and a genetic anomaly was found in 18% (n = 29). No ischemic changes on electrocardiogram or ECG-stress test were observed. The mean follow-up was 5.0 (SD ± 3.8) years. Most patients (94%, n = 149) did not undergo an intervention. Of those 63% (n = 94) had at least one follow-up echocardiogram. There was spontaneous coronary artery fistula closure in 44% (n = 41), 8% (n = 8) decreased in size, and 48% (n = 45) were unchanged. No patient had enlargement of the coronary artery fistula over time. Additionally, tiny and small coronary artery fistulas showed no significant clinical changes in coronary artery dimensions, left ventricle dimensions and function over time. Seven patients required intervention; two patients underwent surgical ligation and five underwent catheter-based intervention. Most patients with coronary artery fistula in our cohort did not require intervention and over half either closed spontaneously or decreased in size with routine follow-up.

Coronary artery morphometrics in Indians – An optical coherence tomography perspective

Abstract BACKGROUND: The diameter of the coronary artery is an important predictor of prognosis and long-term outcome after percutaneous coronary interventions. There are very limited data available about coronary artery dimensions in an Indian population. AIMS: The aim is to study the normal dimensions of the coronary artery segments in Indians without coronary artery disease using optical coherence tomography and to compare the dimensions in Indians with Western. METHODS: Two hundred patients who have undergone coronary angiography with an entirely normal coronary angiogram were included in our study. RESULTS: This study showed the diameter of vessels in males and females when taken together, the left main was larger in size, followed by the proximal left anterior descending, proximal right coronary artery, and proximal left circumflex, respectively. When the vessel diameter was indexed to body surface area (BSA), there was no statistical difference between males and females (P &gt; 0.05). The computed value of proximal coronary artery diameter unadjusted for individual BSA, when compared to Caucasians, showed that Caucasians have larger coronary artery dimensions than Indians. However, when the proximal vessel diameter was indexed to BSA, there was no statistically significant difference between Indians and Caucasians (P &gt; 0.05). CONCLUSIONS: We found that coronary artery size when indexed to BSA is not statistically different in Indian males and females and compared to Caucasians. However, with a smaller body habitus, Indians have smaller coronary arteries.

Dimensions of Normal Coronary Arteries in a Tertiary Cardiac Center Kathmandu

Introduction: Coronary artery disease is the major cause of morbidity and mortality worldwide. The knowledge of normal coronary artery dimensions is fundamental during the percutaneous coronary intervention for appropriate sizing of the coronary balloons and stents. The dimensions of the coronary arteries differs among individuals of various countries, even among the different ethnicities. So, this study wass done to find out the normal coronary artery dimensions. Methods: This study was done in randomly selected 100 normal coronary angiograms. The diameter and the length of different segments of coronary artery were measured with the use of software as quantitative coronary angiography. Results: Diameter of left main (LM) coronary artery was 4.06±0.68 mm. Similarly, diameters of prox-left anterior descending (LAD) artery, mid-LAD, dist-LAD, prox-left circumflex (LCx) artery and dist-LCx were 3.26±0.48 mm, 2.67±0.49 mm, 2.01±0.44 mm, 2.91±0.48 mm and 2.38±0.44 mm respectively. The diameters of prox-right coronary artery (RCA), mid-RCA and dist-RCA were 3.2±0.51 mm, 2.89±0.5 mm and 2.43±0.51 mm respectively. The lengths of LM, proximal/mid and distal LAD were 10.06±3.12 mm, 17.91±6.09 mm, 18.28±6.81 mm, 67.94±15.57 mm respectively. The lengths of proximal and distal LCX were 18.95±10.13 mm, and 52.1±17.78 mm respectively. Similarly, the lengths of proximal, mid, and distal RCA were 17.2±4.74 mm, 33.82±9.4 mm, 33.43±12.01 mm respectively. The diameter and length of ramus intermedius (RI) was 2.32±0.56 mm and 70.77±19.75 mm. Conclusion: LM artery and p-RI had the largest and the smallest diameters respectively. LAD and RI had the longest and the shortest courses respectively.

Study on Coronary Artery Dimensions in Normal Adult Bangladeshis

Background: The heart is supplied by the two coronary arteries and their branches. Coronary computed tomography angiography is a cardiac imaging test that helps to determine coronary artery disease. The detailed anatomical knowledge of coronary arteries is essential for proper diagnosis and management of heart diseases. There is no published article available on morphometric analysis of normal coronary arteries by computed tomography angiogram in adult Bangladeshi people. Morphometry of the coronary arteries will provide useful baseline data to almost all the sectors of the medical science. Methods: A Cross-sectional, analytical study was conducted on 35 adult male and 35 adult female Bangladeshi people in Department of Anatomy, Dhaka Medical College, Dhaka, from January, 2017 to December, 2017. After obtaining the images of coronary CT angiogram, different dimensions of coronary arteries were measured by using a computer software program followed by statistical analysis. Results: The mean diameter of the left main coronary artery (LMCA) and left anterior descending artery (LAD), and the mean length of the right coronary artery (RCA), LMCA, and LAD were significantly higher in men than women (p &lt; 0.05). However, there was no significant difference (p &gt; 0.05) between men and women in the mean diameter of the RCA, or the mean diameter and mean length of the left circumflex artery (LCX). Conclusion: The study findings suggest that morphometric measurements of coronary arteries show variations among adult Bangladeshi male and female.

Assessment of the Dimensions of Coronary Arteries for the Manifestation of Coronary Artery Disease.

The size of the coronary artery influences the effective outcome of therapeutic measures like coronary artery bypass graft (CABG) surgery, percutaneous coronary interventions (PCI), and diagnosis of coronary artery disease. Patients' age, gender, BMI, anatomical variations, and increased left ventricular size all have an effect on coronary artery parameters. This study aims to compare the average size of the coronary arteries of the Pakistani population in both sexes for manifestation of coronary artery disease. For the analysis of the coronary arteries, 100 patients of both sexes, male and female, were taken. X-ray angiography was performed for two-dimensional images of coronary arteries. For diameter measurement, images were visualized on quantitative coronary angiography (QCA) in different views (caudal and cranial views). The diameters of the left main coronary artery (left main stem/LMS), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) were measured on angiograms. Data about the dimensions of the coronary artery was gathered through quantitative angiography. Data analysis was done throughSPSS version 26 (IBM Corp., Armonk, NY). There is a notable distinction in the average diameters among the proximal LAD (3.12), mid-LAD (2.40), and distal LAD (1.29). A statistically significant difference is evident among mid-LCx, distal LCx, and proximal LCx (p-value < 0.001). Likewise, the average diameter of the distal RCA (1.89) was smaller when compared to the mid-RCA (3.19) and proximal RCA (3.78). However, there was no significant difference in the average diameter among mid-LMS, distal LMS, and proximal LMS (p-value = 0.09). The average diameter of distal RCA was smaller when compared to mid-RCA and proximal RCA. The average size of proximal LAD and proximal LCx was comparatively larger than mid- and distal LAD and LCx. The findings of current research will be beneficial for the diagnosis and management of coronary artery disease patients.

Rationale and design of the INVICTUS Registry: (Multicenter Registry of Invasive and Non-Invasive imaging modalities to compare Coronary Computed Tomography Angiography, Intravascular Ultrasound and Optical Coherence Tomography for the determination of Severity, Volume and Type of coronary atherosclerosiS)

BackgroundCoronary CT angiography (CCTA) is a first-line noninvasive imaging modality for evaluating coronary artery disease (CAD). Recent advances in CCTA technology enabled semi-automated detection of coronary arteries and atherosclerosis. However, there have been to date no large-scale validation studies of automated assessment of coronary atherosclerosis phenotype and coronary artery dimensions by artificial intelligence (AI) compared to current standard invasive imaging. MethodsINVICTUS registry is a multicenter, retrospective, and prospective study designed to evaluate the dimensions of coronary arteries, as well as the characteristic, volume, and phenotype of coronary atherosclerosis by CCTA, compared with the invasive imaging modalities including intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS)-IVUS and optical coherence tomography (OCT). All patients clinically underwent both CCTA and invasive imaging modalities within three months. ResultsPatients data are sent to the core-laboratories to analyze for stenosis severity, plaque characteristics and volume. The variables for CCTA are measured using an AI-based automated software and assessed independently with the variables measured at the imaging core laboratories for IVUS, NIRS-IVUS, and OCT in a blind fashion. ConclusionThe INVICTUS registry will provide new insights into the diagnostic value of CCTA for determining coronary atherosclerosis phenotype and coronary artery dimensions compared to IVUS, NIRS-IVUS, and OCT. Our findings will potentially shed new light on precision medicine informed by an AI-based coronary CTA assessment of coronary atherosclerosis burden, composition, and severity. (ClinicalTrials.gov: NCT04066062).

Accuracy of IVUS-Based Machine Learning Segmentation Assessment of Coronary Artery Dimensions and Balloon Sizing

BackgroundAccurate intravascular ultrasound (IVUS) measurements are important in IVUS-guided percutaneous coronary intervention optimization by choosing the appropriate device size and confirming stent expansion. ObjectivesThe purpose of this study was to assess the accuracy of machine learning (ML) automatic segmentation of coronary artery vessel and lumen dimensions and balloon sizing. MethodsUsing expert analysis as the gold standard, ML segmentation of 60 MHz IVUS images was developed using 8,076 IVUS cross-sectional images from 234 patients, which were randomly split into training (83%) and validation (17%) data sets. The performance of ML segmentation was then evaluated using an independent test data set (437 images from 92 patients). The endpoints were the agreement rate between ML vs experts’ measurements for appropriate balloon size selection, and lumen and acute stent areas. Appropriate balloon size was determined by rounding down from the mean vessel diameter or rounding up from the mean lumen diameter to the next balloon size. The difference of lumen area ≥0.5 mm2 was considered as clinically significant. ResultsML model segmentation correlated well with experts’ segmentation for training data set with a correlation coefficient of 0.992 and 0.993 for lumen and vessel areas, respectively. The agreement rate in lumen and acute stent areas was 85.5% and 97.0%, respectively. The agreement rate for appropriate balloon size selection was 70.6% by vessel diameter only and 92.4% by adding lumen diameter. ConclusionsML model IVUS segmentation measurements were well-correlated with those of experts and selected an appropriate balloon size in more than 90% of images.

A Quantitative Investigation of Gender-Related Variations in Coronary Artery Diameters

Objective: To evaluate the association between gender and coronary artery diameter at the cardiac ward of a tertiary care hospital. Background: Understanding the normal structure of the coronary arteries is essential for accurately describing the amount of coronary atherosclerosis. However, studies on the true normal coronary arteries' luminal diameters are scarce. Although numerous studies have assessed the post-mortem coronary artery dimensions. A few studies have been conducted in living patients with presumed normal arteries utilizing quantitative coronary arteriography techniques Study Design: A cross-sectional study Place and Duration: This study was conducted at Peoples University of Medical and Health Sciences for women Nawabshah from December 2021 to December 2022. Methodology: The study has 121 participants. The statistical analysis was performed using SPSS version 23. We used the t-test to analyse the connection between numerical and categorical variables. A P value of 0.05 or less was considered statistically significant in every case. The patient identification number was substituted for the patient's name, angiography film number, and medical record number in the proforma, and each patient's identity was kept private. Films from coronary angiography that were deemed to be normal were gathered and examined. Results: In the present study, males were in higher proportion compared to the females with 53.72 % against 46.28%. The mean age of females was 54.9 ± 8.3 and the mean age of males was 58.7 ±9.1 Years. The mean body surface area (BSA) for males was 1.79 ±0.07 and the mean BSA for females was 1.73 ±0.02. Conclusion: Although multiple alternative explanations for the difference in coronary dimensions with gender and age have been discussed, however, in our results, coronary dimensions didn’t show a significant association with gender. There is still huge space for large-scale studies on the subject. Keywords: Coronary artery diameters, Gender Association, comparison

Clinical profile and outcomes of multisystem inflammatory syndrome in children associated with COVID-19 virus after surgery for congenital heart defects.

To study the clinical presentation, laboratory profile, echocardiographic details, management, and outcomes of children who were diagnosed to have multisystem inflammatory syndrome in children (MIS-C) in the immediate postoperative period after surgery for congenital heart defects (CHDs). This is a prospective case-control study that included children diagnosed to have MIS-C in the postoperative period based on clinical signs, rise in inflammatory markers, and echocardiographic features of ventricular dysfunction or coronary involvement. Management included intravenous immunoglobulin (IVIG), steroids, and antiplatelet medications in addition to routine postoperative care. Out of the 461 children who underwent surgery for CHD between April 1st, 2021, and November 30th, 2021, 18 children were diagnosed with MIS-C. After the initial routine postoperative course, all 18 children had sudden worsening in clinical and laboratory parameters. Other causes such as bacterial infection were ruled out. All of these children had features of MIS-C with ventricular dilatation and dysfunction, coronary artery involvement, and reactive COVID-19 immunoglobulin G antibody. There was a significant improvement in coronary artery dimensions after IVIG administration (P = 0.001). The involvement of the left main coronary artery was associated with significantly increased length of intensive care unit (ICU) and hospital stay (P = 0.019). Mean ICU and hospital stay was prolonged in the MIS-C group. There were two deaths in this group due to severe left ventricular dysfunction. During the pandemic, a proportion of patients undergoing elective cardiac surgery may develop unexpected worsening in clinical status due to MIS-C. A high index of suspicion and prompt treatment with IVIG and steroids may be helpful in improving outcomes.

Disparity in coronary artery dimensions in diabetic and non-diabetic population undergoing quantitative coronary angiography in South India: a 2-year prospective analysis

Diabetic subjects have higher prevalence as well as increased risk for coronary artery disease than non-diabetic counterparts. The study was aimed to seek the disparity of vessel diameters among diabetic and non-diabetic patients undergoing quantitative coronary angiography (QCA). The objectives were to compare coronary artery measurements (CAM) between diabetic and non-diabetic patients and also to find the respective segment of coronary artery affected greatest among diabetics by QCA. A cross sectional study was conducted in four cities of India after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study. Among total sample population, non-flow limiting coronaries were seen in 1100(27.5%) cases [167 in NFL diabetic and 933 in NFL non-diabetic group]. We had 2890 (72.2%) patients with diseased coronaries. Ten segments of the coronary arteries were taken for diameter measurements namely, LMCA, LAD (O, P), DIAG, LCx (O, P), OM, RCA (O, P), RAM. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m2BSA). For all arterial segments both indexed and non-indexed measurements of diabetic patients with NFL coronaries had significantly (p&lt;0.01) smaller arterial segments except for RCA-o. Reduced dimensions after post balloon dilatations of PCI, diffused lesions can result in increased chances for in-stent restenosis among diabetics leading to poor outcome following PCI.

Geographic and population variation in coronary artery dimensions across Southern India: A multicentre cross sectional study

Ischemic Heart Diseases (IHD) among Asian Indian migrants in the western world are documented with high prevalence. We aimed to assess population specific variation in artery dimensions among normal and Single Vessel Disease (SVD) patients among four states of Southern India: Telangana, Karnataka, Kerala and Tamil Nadu using Quantitative Coronary Angiography (QCA) in the disease presentations. QCA of four thousand patients of Indian origin were studied prospectively after procuring the ethical clearance. Informed consents were obtained. Post Percutaneous Coronary Angioplasty (PCI) as well as Post Coronary Bypass Operations (CABG) and patient being diabetic for ≥5 years were excluded. Principal Component Analysis (PCA) was performed with samples to identify region-specific clustering.

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study.

BackgroundThis study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago.MethodsPatients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables.ResultsOne hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051).ConclusionsSignificantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease.Trial registration numberNCT04774861.

Left main coronary artery dimension and variation in Thai population

Abstract Funding Acknowledgements Type of funding sources: None. Objectives The aim of our study was to determine the length, proximal and distal dimension of the left main coronary artery (LMCA) in Thai population with normal LMCA, from coronary computed tomography angiography (CCTA). Background The dimensions and length of the coronary artery are important to treatment planning and outcome prediction after revascularization. The previous studies showed that coronary artery dimensions are influenced by age, sex and BSA which may be effected by race. Recently, very limited data about coronary artery dimensions in general Thai population are available. Methods 560 patients who have undergone CCTA at a Thai hospital with normal coronary angiogram of LMCA and no history of previous percutaneous coronary interventions and coronary artery bypass graft surgery were included in the study. The LMCA cross-sectional dimensions were obtained at two points of each vessel: ostium and distal. The length of LMCA was studied. The baseline characteristics data of participants such as age, body weight, height body surface area (BMI) and body surface area (BSA) and the other findings of CCTA on the LMCA dimensions and length were evaluated. Results This study showed that the mean cross-sectional dimensions of the proximal and distal of LMCA were 3.89 ± 0.76 mm. and 3.4 ± 0.67 mm. respectively. The mean length of LMCA was 8.66 ± 3.69 mm. The dimension of vessels in males were significantly larger in size than females. The proximal and distal LMCA dimensions in males were 3.98 ± 0.81 mm. and 3.8 ± 0.69 mm. respectively. And the proximal and distal LMCA dimensions in females were 3.51 ± 0.72 mm. and 3.27 ± 0.59 mm. respectively. The factors of significant correlations were found with sex, height, weight, BMI, BSA, left dominant vessel and coronary artery calcium scores (CACs) on the proximal and distal dimensions of LMCA. In multivariate analysis, BSA and dominant system were showed significant correlation to the proximal dimension of LMCA, and BSA was showed significant correlation to the distal dimension of LMCA. The influences on length of LMCA were height, weight, BMI, BSA, right dominant vessel and CACs but no factors were significant correlation by multivariate analysis. Conclusions The length, proximal and distal dimensions of LMCA in general Thai population were differences from the previous studies which were studied in other nations. The influences on the dimensions of LMCA were sex, height, weight, BMI, BSA, left dominant vessel, and CACs. And the influences on the length of LMCA were height, weight, BMI, BSA, right dominant vessel and CACs.

Detection of myocardial bridge by optical coherence tomography.

Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, "fine" layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5° vs. 268.4 ± 92.1°, P = 0.008) and length was significantly longer (22.6 ± 11.7 mm vs. 14.5 ± 8.1 mm, P = 0.014) in angio-detectable MB than OCT-detectable but angio-undetectable MB. Both vessel (6.8 ± 1.5 to 5.3 ± 1.0 mm2, P = 0.035) and lumen area (4.4 ± 1.5 to 3.1 ± 0.7 mm2, P = 0.040) decreased significantly from diastole to systole. Adventitial (0.08 ± 0.03 to 0.08 ± 0.02 mm, P = 0.828) and intima+plaque thickness (0.12 ± 0.05 to 0.10 ± 0.03 mm, P = 0.398) did not change significantly during cardiac cycle. On the other hand, medial thickness increased significantly from diastole to systole (0.08 ± 0.03 to 0.12 ± 0.03 mm, P = 0.022). In conclusion, MB is frequently detected as intermediate intensity, fine layer by OCT. During systole, vessel and lumen size decrease with increased medial thickness. Therefore, we should be careful for OCT interpretation of the coronary arteries with MB.

Coronary artery dimensions in normal adult Indian population by computed tomography coronary angiography

Coronary artery dimensions in normal adult Indian population by computed tomography coronary angiography

Identifying children with Kawasaki disease at high risk for coronary aneurysms

Kawasaki disease, a childhood vasculitis manifested by symptoms of high fever, mucocutaneous inflammation, and unilateral cervical adenopathy, can cause lasting damage to the coronary arteries, and more rarely, other medium-sized muscular arteries. Most children respond well to prompt treatment with high-dose intravenous immunoglobulin (IVIG). However, coronary artery aneurysms, defined by internal lumen diameter at least 2.5 SDs above the population mean for body surface area (Z≥2.5), occur in ∼25% of affected children and are the principal cause of long-term morbidity and mortality in Kawasaki disease. Several risk scores have attempted to predict which children are likely to develop coronary aneurysms. In previous studies in North America, baseline risk factors for coronary artery aneurysms on echocardiography performed 2-8 weeks after Kawasaki disease onset have included higher coronary artery dimensions on baseline echocardiography, IVIG resistance (the persistence or recrudescence of fever after a single dose of IVIG), young age (<12 months or <6 months depending upon the risk score), Asian race, and late diagnosis and treatment with IVIG. Japanese risk scores based upon clinical and laboratory variables have been highly accurate in predicting IVIG resistance, one of the strongest risk factors for coronary artery aneurysms. In Japanese children predicted to have high risk of IVIG resistance, primary adjunctive therapy with corticosteroids or cyclosporine has been shown in randomized clinical trials to reduce the incidence of coronary artery aneurysms. However, Japanese children predicted to be at low risk for aneurysms on the basis of laboratory measures may still develop coronary abnormalities. Understanding the risk factors for aneurysm development thus requires further refinement. In this volume of The Journal, Iio et al analyze independent risk factors for development of coronary artery aneurysms in 1632 Japanese children with Kawasaki disease who were predicted to be at low risk for resistance to primary IVIG treatment. In this low-risk group, 5.5% of patients developed any coronary artery aneurysms and 1%, medium or large coronary aneurysms. In multivariable analysis, baseline coronary artery Z score >2.5, age <12 months at fever onset, and IVIG resistance were independent risk factors for diagnosis of coronary artery aneurysms on echocardiography one month after disease onset. Among these risk factors, coronary artery Z score ≥2.5 was most strongly associated with aneurysm development. Taken together with previous literature, these data suggest that enlarged coronary Z scores measured on baseline echocardiography can be used to select children at high risk for subsequent coronary artery aneurysms and thus who may benefit from adjunctive therapy. The study of Iio et al adds weight to the concept that a high-risk cohort for randomized clinical trials of primary adjunctive therapy in Kawasaki disease may be most simply selected through findings on baseline echocardiography. The ability to select such a high-risk cohort is critical to the design of trials to answer remaining questions in Kawasaki disease therapy: In children of all races and ethnicities, who should receive treatment with adjunctive therapies? How do antiinflammatory therapies compare with each other, and what is the cost/benefit ratio for these therapies? Article page 158 Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISEThe Journal of PediatricsVol. 240PreviewTo detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score. Full-Text PDF

Coronary Artery Dimensions in Endurance Athletes by Computed Tomography Angiography: A Quantitative Analysis.

(1) Background: The athlete’s heart may develop permanent vessel enlargement. The purpose of our study was to define normal values for coronary artery dimensions of endurance athletes by coronary computed tomography angiography (CTA). (2) Methods: Ninety-eight individuals (56.2 ± 11 years) were included into this retrospective matched case-controlled-study. Endurance athletes had regular training volumes of ≥1 h per unit, ≥3–7 times per week (either cycling, running or mountain-endurance). Athletes were matched for age and gender with sedentary controls using propensity score. Quantitative CTA analysis included coronary vessel dimensions (two diameters and area) of the LM, LAD, CX and RCA for all AHA-16-segments. (3) Results: Proximal LAD area and diameter (p = 0.019); proximal/mid CX (diameter and area; p = 0.026 and p = 0.018/p = 0.008 and p = 0.009); mid RCA diameter and area; and proximal RCA diameter were significantly larger in endurance athletes (p < 0.05). The left main area (p = 0.708) and diameter (p = 0.809) as well as the mid LAD and distal segments were not different. We present the histograms and data for normal values ±1 and ± 2 SD. (4) Conclusions: Endurance athletes have larger proximal LAD, proximal/mid CX and RCA vessel dimensions, while LM and distal segments are similar. Hence, dilated coronary arteries in endurance athletes (“Athlete’s arteries”) have to be distinguished from diffuse ectatic segments developing during Kawasaki disease or multisystemic inflammation syndrome after COVID-19.