Dominant Left Coronary Artery Research Articles

Variants of arterial supply to the inferior (diaphragmatic) surface of the ventricles of the heart and the influence on age at death.

Coronary artery systems of the inferior wall of the ventricles vary considerably. Schlesinger's concept distinguishes dominance of the right or left coronary artery (LCA) or balanced type. LCA dominance has been reported to be associated with increased mortality. Early angiography studies have shown that the anterior interventricular artery (AIVA), a branch of the LCA, often continues on the inferior surface of the heart and may replace the inferior interventricular artery. Others considered an AIVA on the inferior surface of the heart a rare variant. A long AIVA is a strong predictor of death in acute anterior wall myocardial infarction. We determined coronary artery variance at the inferior surface of the ventricles in 134 dissected human hearts and analyzed a possible association between coronary artery variance and age at death. The AIVA extended to the inferior side in 64.9% of the hearts, but rarely reached the basal half of the inferior interventricular groove. Most frequently (53%), it extended into the apical two-fifths of the length of the inferior ventricular walls. An AIVA extending to the apical 40% of the length of the inferior ventricular walls may therefore be considered a common variant. In 20.1% of the hearts, a right inferior diagonal artery was also found. Statistical analysis neither revealed an association between mean AIVA length at the inferior ventricular surface and type of coronary artery dominance nor an association between AIVA length at the inferior ventricular surface or coronary artery dominance type and age at death.

Coronary Artery Dominance and Cardiovascular Pathologies in Patients with Bicuspid Aortic Valve

BackgroundBicuspid aortic valve (BAV) is the most common congenital heart defect and is associated with a number of cardiac pathologies including coarctation of the aorta (CoA), aortic dilation, aortic stenosis, and premature coronary artery disease (CAD). Furthermore, BAV has been associated with left dominant coronary artery anatomy but there is still much debate regarding this association. To date, no study has investigated the association between coronary artery dominance and cardiac pathologies in patients with BAV. MethodsA total of 45 patients with BAV who underwent coronary computed tomography angiography (CTA) and/or cardiac catheterization at a single center were included. Coronary artery dominance, presence of CAD, CoA, and aortic dilation was determined from coronary CTA and/or cardiac catheterization reports. Incidence of aortic valve stenosis and aortic valve regurgitation was determined from echo reports. ResultsOf the 45 patients with BAV, 80% (36) had right dominant coronary artery circulations. Patients with BAV with left dominant circulations had a significantly (p = 0.04) higher incidence of CoA compared to patients with right dominant circulations (44% vs. 14%). There was no significant difference when comparing the incidences of aortic dilation, aortic valve stenosis, aortic valve regurgitation and CAD in right and left dominant patients. ConclusionsOur study found a predominance of right dominant coronary artery circulation in patients with BAV, similar to the general population. Interestingly, left dominance was significantly associated with CoA in patients with BAV. This observation highlights the importance of further studies regarding how coronary artery dominance can be associated with other cardiovascular pathologies in patients with BAV.

Abstract 13174: Coronary Origin Patterns: Utility in Echocardiographic Diagnosis of Forme Fruste Right-left Bicuspid Aortic Valve

Introduction: Bicuspid aortic valve (BAV) is a common congenital heart defect associated with coronary artery (CA) variants, including higher incidence of left CA dominance and shorter left main CA length. In patients with right-left fusion (R/L) BAV, we observed that the origins of left and right coronaries are in closer proximity than in normal patients. ‘Forme fruste’ types of R/L BAV are subtle and difficult to diagnose, hence this coronary pattern can aid in diagnosis. We defined intercoronary distance as the angle separating the left and right coronary ostia relative to the aortic valve center. Hypothesis: The coronary angle is more acute in R/L BAV than in normal aortic valves. Methods: A retrospective review of pediatric echocardiograms with R/L BAV at a single institution (12/2010-11/2018) was performed; coronary angles were measured and compared to age-matched controls. Those with inadequate images or anomalous coronary origins were excluded. Results: We identified 193 patients with R/L BAV (64% male) and 136 patients with normal aortic valves (57% male). Coronary angle was significantly more acute in R/L BAV than in controls (117.7°±16.8° vs 139.0°±10.1°, p<0.0001). This was independent of age, gender, or other cardiac defects. This relationship remained when BAV patients with abnormal aortic Z-scores were removed from analysis (119.2°±15.3° vs 139.0°±10.1°, p<0.0001), ruling out an effect of abnormal aortic annulus or root. Conclusions: Coronary origins are in closer proximity in R/L BAV independent of annulus/root geometry, associated cardiac defects, age, or gender. This new finding may assist in echocardiographic diagnosis of subtle subtypes of BAV.

Anatomical indicators of the heart and coronary arteries: An anthropometric study

Introduction: Previous studies confirm that there is no anthropometric index of normal Iranian hearts, including diameter of cardiac valve, thickness of myocardial septum and coronary artery variation. The purpose of this study was to assess the anatomical indexes of the human heart and coronary artery in the Iranian population.
 Methods: The study was performed with 207 adult human hearts in both sexes (182 male and 25 female), fixed in 10% formaldehyde. Myocardial thickness and diameter of heart valves were measured using a Vernier caliper. Assessments of the coronary artery were carried out after removal of the pericardium.
 Results: Analysis of 207 cadaver coronary arteries showed left coronary artery (LCA) dominance type was present in 6.3% of corpus, and balance was present in 4.3% of corpus, while the largest number (89.4%) had right coronary artery (RCA) dominance. The mean values of the morphometric data are as follows: right atrial wall thickness (2.08 +/- 0.04 mm), left atrial wall thickness (2.08 +/- 0.04 mm), interatrial wall thickness (4.92 +/- 0.08 mm), right ventricular wall thickness (3.35 +/- 0.05 mm), left ventricular wall thickness (8.36 +/- 0.13 mm), interventricular wall thickness (12.01 +/- 0.2 mm), diameter of the aorta (23.6 +/- 0.4 mm), diameter of the pulmonary artery (24.94 +/- 0.4 mm), large diameter of the mitral valve (34.16 +/- 0.27 mm), and large diameter of the tricuspid valve (38.8 +/- 0.24 mm).
 Conclusion: The anatomical knowledge of cardiac indicators and coronary artery data will be helpful and clinically relevant, especially for cardiac surgeons for coronary artery bypass grafting and coronary arteriography.

Left Circumflex Artery Injury After Mitral Valve Surgery: An Algorithm Management Proposal

Left circumflex coronary (LCx) artery injury during mitral valve surgery is a life-threatening complication. This report describes a series of patients with this complication in a high-volume mitral surgery center. Between January 2004 and December 2017, a total of 6501 mitral valve procedures were performed at the San Raffaele Scientific Institute in Milan, Italy. An LCx injury occurred in 10 patients (10 of 6501; 0.15%) after either mitral valve repair (n= 5) or replacement (n= 5). Coronary angiography was performed in 9 patients and showed 5 cases of left coronary artery dominance, 2 cases of right dominance, and 2 cases of codominance. All data were prospectively collected in the hospital database and were retrospectively reviewed. Suspicion of LCx injury was raised in the operating room in 5 patients and in the intensive care unit in the other 5 patients. Postoperative coronary angiography confirmed the LCx lesion. In the presence of total LCx occlusion, coronary artery bypass grafting (n= 3) or partial removal of the annuloplasty ring(n= 1) was performed. In cases of partial kinking (n= 4), percutaneous coronary intervention (PCI) was preferred. In the 2 patients with extrinsic subocclusion of the LCx, rescue PCI was initially attempted, but both procedures were complicated by artery disruption and stent underexpansion. In our series, LCx occlusion occurred more commonly in patients with left-dominant coronary artery circulation. Clinical presentation may be variable. Rescue PCI is a valid option in cases of kinking of the artery, but in other cases emergency coronary bypass grafting should be the first choice. Repositioning of the prosthesis may be an option in specific circumstances.

Association of coronary artery dominance and mortality rate and complications in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Background:Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI.Materials and Methods:In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups.Results:Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different (P > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 (P = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, P = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate (P > 0.05).Conclusion:Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.

Association Between Left Anterior Descending Artery Length with Coronary Artery Dominance: An Angiographic Study

Introduction: Although left anterior descending (LAD) artery supplies a large portion of the myocardium, the amount of blood supply provided by LAD is depended on the length of the LAD. The aim of the current study was to evaluate the association between coronary artery dominance and LAD anatomic types in patients with normal epicardial coronary arteries. Methods: This retrospective study was conducted at a tertiary teaching hospital on a total of 252 patients with normal coronary artery angiographic findings between April 2018 to March 2019. Patient’s medical records were utilized to collect demographic and catheterization data, as well as their clinical characteristics. Qualitative and quantitative catheterization data, including the anatomical type of LAD, dominance, LAD slow flow phenomenon, LAD ectasia, and Muscle Bridge were obtained from the angiographic examination. The three anatomical LAD types, including type I (LAD terminating before the apex), type II (LAD reached the apex), and type III (LAD wrapping around the apex) were compared in the left and right dominant coronary artery patients. Results: The mean age of patients was 58.06±10.89 years (age range: 27-79 years). The slow flow phenomenon was more significantly observed in patients with type C LAD (P=0.015); however, there was no significant difference between LAD types regarding LAD Muscle Bridge (P=0.099) and ectasia (P=0.810). In total, 54.8% and 45.2% of the patients had right and left dominant coronary artery systems, respectively. Moreover, there was a statistically significant association between wrap-around LAD and left coronary artery dominance (P<0.001). Conclusion: The type C LAD is more prevalent in patients with left dominant coronary artery.

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study

BackgroundPrevious studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI).MethodsBetween January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi’an Jiaotong University in Xi’an, China. All participants underwent coronary angiography. The exclusion criteria included history of coronary artery bypass graft surgery, chronic or systemic diseases (including hepatic failure, kidney failure, hypothyroidism and Grave’s disease), ventricular fibrillation, and known allergy to iodinated contrast agent. Patients with left- or co-dominant anatomies were placed into the LD group and those with right-dominant anatomy were included in the RD group. The association of acute inferior MI and coronary dominant anatomy were assessed using multivariable conditional logistic regression, and to estimate the odds ratio (OR) and 95% confidence interval (95%CI).ResultsDistributions of right dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, P = 0.018). Univariable conditional logistic regression revealed that right dominance may be a risk factor for the incident acute inferior MI (OR: 2.137; 95% CI: 1.210–3.776; P = 0.009). After adjusting for baseline systolic blood pressure, heart rate, smoking status, diabetes mellitus, hypertension, hyperlipidaemia, and family history of coronary artery disease, results of multivariate conditional logistic regression showed that right dominance was associated with the incidence of acute inferior MI (OR: 2.396; 95% CI: 1.328–4.321; P = 0.004).ConclusionsRight coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. However, further studies are needed to verify our findings, especially with regard to the underlying mechanisms.

Value of three-dimensional echocardiography study of left ventricle function correlated to coronary arterial dominance in predicting the outcome of primary percutaneous coronary intervention

BackgroundLimited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI). ObjectivesThe study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3 months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke. Patients and methodsThe study population consisted of 300 consecutive patients (mean age, 57.35 ± 13.41 years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3 months follow-up after STEMI. ResultsRight dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3 months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system. ConclusionIn patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3 months follow-up compared to right and balanced coronary artery dominance.

GW28-e0566 Impact of coronary artery dominance on myocardial infarction in Northern Chinese population

Previous studies have reported a relationship between left coronary artery dominance and worse prognoses in patients with acute coronary syndrome. However, the effect of right dominance on coronary artery disease has not been well understood. The aim of this study was to investigate whether coronary

Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance.

Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCX-NSTEACS do not have higher mortality compared with patients with LCX-STEMI or NSTEACS with lesions in other coronary territories.

Coronary anatomy as related to bicuspid aortic valve morphology

ObjectiveVariable coronary anatomy has been described in patients with bicuspid aortic valves (BAVs). This was never specified to BAV morphology, and prognostic relevance of coronary vessel dominance in this patient...

Chronically Occluded Coronary Artery in Patients Undergoing Acute Coronary Syndromes Worsens their Long-Term Prognosis

Background: Comparison of patients with and without chronic total occlusion in a non-infarct related artery (non-IRA) and the coronary artery dominance type in terms of clinical characteristics and impact on the degree of left ventricular dysfunction and long term survival. Material and findings: There were 402 consecutive patients with multi-vessel disease, who had undergone percutaneous coronary intervention because of acute coronary syndrome, enrolled in this study. As many as 33.8% of patients had at least one chronic total occlusion in non-IRA. Left coronary artery dominance was present in 10.95% of patients only, and 83.58% of them showed right coronary artery dominance. Patients with chronic total occlusion were at higher risk because of age and comorbidity. An ST-segment elevation myocardial infarction occurred more often in all patients without chronic total occlusion, while patients with non-IRA chronic total occlusion more frequently presented with an-ST-segment elevation myocardial infarction. No fewer than 48.5% of patients with chronic total occlusion had at least moderate left ventricular dysfunction while in patients without chronic total occlusion the number reached 25.56% only (p = 0.02). No significant differences were observed between patients with right dominance vs left dominance (p = 0.9). The average 466-day mortality in 402 patients with multivessel disease was 13.18%. Among patients with chronic total occlusion, all cause and cardiovascular mortality were 17% and 12.5%, while in patients without chronic total occlusion 11% and 9%, respectively (p = 0.2 and p = 0.4). In patients with left dominance vs right dominance it was 20.5% and 16% vs 13.1% and 9.8%, respectively (p = 0.36 and p = 0.4). Conclusions: The main factor that influences prognosis is the presence of chronic total occlusion in a non-infarct related artery rather than the coronary artery dominance type. However, the presence of left dominance may be an additional adverse cardiovascular risk factor.

Morphological characterisation of the coronary arteries in African sheep (Ovis orientalis). Differential analysis with those of humans and other animal species.

Despite the importance of the coronary system in the African sheep as a possible experimental model, there is little information about this particular vascular system. The objective of this investigation was to characterise morpho- logically the coronary arteries and their branches in African sheep. This descriptive cross-sectional study evaluated the coronary arteries and their branches of 62 hearts of short hair sheep. The right and left coronary ostia were perfused with a semi-synthetic resin (Palatal GP40L 85%; styrene 15%) dyed with mineral red. The morphological characteristics were evaluated using a digital calibrator and the biometrics of the coronary arteries and their branches were registered. The right coronary artery had a proximal calibre of 2.11 ± 0.46 mm. The subsinusal interventricular branch ended at the middle third of the homonym sulcus in 19 (30.6%) specimens. The left coronary artery had a diameter of 5.38 ± ± 1.59 mm and a length of 4.67 ± 3.32 mm. This artery bifurcated itself in the paraconal interventricular branch and the left circumflex branch in 57 (91.9%) hearts and trifurcated with an additional left diagonal branch in 5 (8.1%) spec- imens. Left coronary artery dominance was observed in 51 (82.3%) specimens, whereas in 11 (17.7%) cases the coronary circulation dominance was balanced. Due to the similitude in the features of the coronary arteries between African sheep and humans, this animal model can be proposed for procedural and haemodynamic activities.

Coronary Artery Dominance and Long-term Prognosis in Patients With ST-segment Elevation Myocardial Infarction Treated With Primary Angioplasty

Introduction and objectivesThe long-term prognostic significance of coronary artery dominance pattern in patients with ST-segment elevation myocardial infarction is poorly characterized. We investigated the prognosis of such patients according to whether they had right dominance, left dominance, or codominance. MethodsThis was a retrospective study of 767 patients, who were admitted to hospital between 2007 and 2012 with ST-segment elevation myocardial infarction and treated with primary percutaneous coronary intervention. We determined the effect of the coronary dominance pattern on all-cause mortality and readmission for infarction, adjusting for mortality as a competing event. ResultsA total of 80.9% of patients had right coronary dominance, and 8.6% had left coronary dominance. Over 40.8 months’ [interquartile range, 21.9-58.3 months] follow-up, 118 (15.4%) deaths were recorded, of which 39 (5.1%) were in hospital. Mortality for right dominance, left dominance, and codominance was 7.1%, 36.4%, and 13.8% (P ˂ .001), respectively. Cause of death was cardiovascular in 7.1%, 21.2%, and 2.4%. On Cox multivariate analysis, left dominance was significantly associated with mortality (hazard ratio = 1.76; P = .02). Taking “coronary dominance” into account in prediction of risk of death improved the discrimination and calibration capacity of GRACE (Global Registry of Acute Coronary Events) scoring. At follow-up, 9.3% (71 patients) had reinfarction. On multivariate analysis, left dominance was an independent predictor of reinfarction (subhazard ratio = 2.06; P = .01). ConclusionsIn ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, left coronary artery dominance confers a higher risk of death and reinfarction than right coronary artery dominance, and should be included in prognostic stratification.

Dominancia coronaria y pronóstico a largo plazo de los pacientes con infarto de miocardio con elevación del segmento ST tratado con angioplastia primaria

Introduction and objectivesThe long-term prognostic significance of coronary artery dominance pattern in patients with ST-segment elevation myocardial infarction is poorly characterized. We investigated the prognosis of such patients according to whether they had right dominance, left dominance, or codominance. MethodsThis was a retrospective study of 767 patients, who were admitted to hospital between 2007 and 2012 with ST-segment elevation myocardial infarction and treated with primary percutaneous coronary intervention. We determined the effect of the coronary dominance pattern on all-cause mortality and readmission for infarction, adjusting for mortality as a competing event. ResultsA total of 80.9% of patients had right coronary dominance, and 8.6% had left coronary dominance. Over 40.8 months’ [interquartile range, 21.9-58.3 months] follow-up, 118 (15.4%) deaths were recorded, of which 39 (5.1%) were in hospital. Mortality for right dominance, left dominance, and codominance was 7.1%, 36.4%, and 13.8% (P ˂ .001), respectively. Cause of death was cardiovascular in 7.1%, 21.2%, and 2.4%. On Cox multivariate analysis, left dominance was significantly associated with mortality (hazard ratio = 1.76; P = .02). Taking “coronary dominance” into account in prediction of risk of death improved the discrimination and calibration capacity of GRACE (Global Registry of Acute Coronary Events) scoring. At follow-up, 9.3% (71 patients) had reinfarction. On multivariate analysis, left dominance was an independent predictor of reinfarction (subhazard ratio = 2.06; P = .01). ConclusionsIn ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, left coronary artery dominance confers a higher risk of death and reinfarction than right coronary artery dominance, and should be included in prognostic stratification.Full English text available from:www.revespcardiol.org/en

Prognostic value of anatomical dominance of coronary circulation in patients with surgical myocardial revascularization.

Introduction:This study evaluated the frequency of domination of the coronary arteries types in patients treated by surgical myocardial revascularization. The aim of the study was to determine whether the left coronary circulation dominance is a prognostic factor for poorer outcome in patients undergoing coronary artery bypass surgery.Material and methods:A total sample consisted of 100 patients with coronary artery disease that were treated with coronary artery bypass grafting at the Clinic for Cardiac Surgery, Clinical Center of the University of Sarajevo. To all patients on the basis of preoperative coronary angiography was determined the dominance of the coronary arteries. Patients included in the study were divided into two groups, with the left and right with coronary dominance.Results:Left coronary dominance in a sample of patients was present in 21/100 (21%), right in 69/100 (69%) and balanced in 10/100 (10%) cases. Female gender was significantly more frequent in patients with left coronary dominance and proved to be a stronger predictor of poorer outcome, especially in combination with left main stenosis of the left coronary artery and left coronary dominance. Inability of revascularization of the r. interventricularis posterior (RIVP) was statistically significantly higher in case of left dominance 9/21 (42.9%), compared to the right 16/79 (20.3%), p=0.033. Lethal outcome was more common in case of left dominance in relation to the right (9.4% vs 0.9%). The incidence of surgical complications, respiratory, neurological and renal complications was not significantly different between groups, while the length of hospital stay was significantly higher in the group of patients with left dominance, p = 0.003.Conclusion:Left coronary dominance is an important risk factor for patients undergoing surgical myocardial revascularization.

Sex-dependent association between coronary vessel dominance and cardiac syndrome X: a case-control study.

BackgroundPrevious studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD). However, no studies have investigated the influence of coronary vessel dominance on non obstructive CAD. The aim of this study was to establish the association of left and mixed dominance of the major epicardial arteries with the development of non obstructive CAD and evaluate potential sex-dependent differences in the coronary artery supply.MethodsA total of 484 patients underwent the same diagnostic procedures. The patients were divided into two groups based on their coronary angiogram results: the control group (242 patients with obstructive CAD; coronary artery stenosis of ≥50%) and the experimental group (242 patients with non obstructive CAD; coronary artery stenosis of <50%).ResultsSignificantly more women than men were affected by non obstructive CAD (P = 0.005). Left dominance was more frequent in the non obstructive CAD group than in the control group (P = 0.018) and was more pronounced in women than in men (P = 0.013). Among men with non obstructive CAD, a left supply was more frequent than a mixed supply (P = 0.012). Women with non obstructive CAD had a higher frequency of a left supply, whereas a mixed supply was less frequent in men than in patients with obstructive CAD (P = 0.013 and 0.018, respectively).ConclusionThese results suggest that left dominance (particularly in women) and the absence of a mixed supply in men could cause regional ischemia, thus affecting the development of non obstructive CAD. Furthermore, sex may determine the incidence of specific coronary artery supply types, therefore influencing disease development and prognosis.

Relation Between Coronary Arterial Dominance and Left Ventricular Ejection Fraction After ST-Segment Elevation Acute Myocardial Infarction in Patients Having Percutaneous Coronary Intervention

The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.

Angiographic profile of coronary arteries in Keralite population

Abstract Background and aims: The incidence of Coronary Artery Disease (CAD) has reached alanning proportions in India. The pathological hall mark of CAD is myocardial ischemia resulting from the atherosclerotic narrowing of coronary arteries. In this era of advanced interventions and cardiac surgery, a thorough knowledge of normal and variant anatomy of coronary arteries is of prime significance and of great use both to the clinicians and anatomists. Materials and methods: One hundred coronary angiograms of patients free of disease were studied in detail in different profiles. The data obtained was quantified according to their frequencies. The relation between the length of left main coronary artery and coronary artery dominance was statistically analyzed using the 'Chi Square test for Trend'. Results: This study highlighted some interesting findings such as the origin of Sino- atrial nodal artery from the second segment of right coronary artery in 3% of cases, double right marginal artery in 4% cases. Other variations such as Mouchet's posterior recurrent interventricular artery, origin of circumflex artery from the right coronary artery and abnormal communication between the terminal parts of right coronary artery and circumflex artery were each noticed in 1 % of cases. Conclusions: Coronary arteries and their branches are prone to variations in their course and morphology. Prior knowledge about this is important for the interpretation of coronary angiograms and surgical myocardial revascularization. The present work on normal and variant pattern of coronary arteries will help in gathering momentum to the already advancing research work in this field.