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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Basic structure-function relations of the epicardial coronary vascular tree. Basis of quantitative coronary
C Seiler1, R L Kirkeeide, K L Gould
1University of Texas Medical School, Houston 77030.
Insights
Quantitative coronary arteriography can now quantify diffuse coronary artery disease by correlating coronary artery size with distal myocardial bed size. This method reveals significant underestimation of artery size in patients with diffuse disease.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Quantitative Anatomy
Background:
- Quantitative coronary arteriography (QCA) is established for localized stenotic lesions.
- QCA currently cannot assess diffuse coronary artery disease due to unknown normal artery dimensions relative to distal myocardial mass.
Purpose of the Study:
- To establish a method for quantifying diffuse coronary artery disease using clinical coronary arteriograms.
- To determine the normal relationship between coronary artery size and distal myocardial bed size.
- To identify the physical principles governing human coronary artery tree structure.
Main Methods:
- Analysis of clinical coronary arteriograms from 12 healthy individuals and 17 patients with coronary artery disease.
- Quantitative coronary arteriography to measure lumen area, distal branch lengths, and regional myocardial mass.
- Comparison of observed vascular geometry with three theoretical physical principles.
Main Results:
- A strong correlation exists between coronary artery lumen area and distal myocardial mass/branch lengths in both healthy and diseased states.
- Coronary arteries in patients with diffuse disease show a 30-50% smaller lumen area relative to distal myocardial bed size compared to controls.
- The coronary artery tree structure aligns with principles of minimum energy loss and adaptive shear stress, not constant flow velocity.
Conclusions:
- Established correlations provide a foundation for quantifying diffuse coronary artery disease from clinical arteriograms.
- This approach enables objective assessment of diffuse atherosclerosis, improving diagnostic capabilities.
Background:
Quantitative coronary arteriography has been validated for stenotic segments of coronary arteries. However, it does not currently account for diffuse coronary artery disease, because the normal size of the coronary artery for its distal myocardial bed size is not known and cannot be measured directly with diffuse involvement of the artery.
Methods And Results:
From clinical coronary arteriograms of 12 patients without coronary artery disease (group 1) and in 17 patients with coronary artery disease (group 2), we determined by quantitative coronary arteriography 1) the relations among measured coronary artery cross-sectional lumen area, summed distal branch lengths, and regional myocardial mass distal to each point in each coronary artery; 2) the ratio of coronary artery lumen area between parent and daughter vessels at 50 bifurcations; and 3) which of three different theoretical physical principles could underlie the tree structure of the human coronary artery system, by comparing the coronary artery size, branch lengths, regional mass, and relations between parent-to-daughter lumen area ratios with those for the different theoretical physical principles to test which principle best fit the observed data and therefore which principle most probably characterizes the human coronary artery tree structure. The results showed that 1) there is a close correlation between the lumen area of a coronary artery at each point along its length and the corresponding summed distal branch lengths and regional myocardial mass in patients without and with coronary artery disease; 2) measured coronary artery lumen area in patients with coronary artery disease is diffusely 30-50% too small for distal myocardial bed size compared with normal subjects; and 3) the observed relations among coronary artery size, distal summed lengths, myocardial bed size, and parent-to-daughter size ratios are not consistent with the theoretical principle of constant mean blood flow velocity in the coronary circulation but are consistent with the principles of minimum viscous energy loss and of limited/adaptive vascular wall shear stress characterized by a 2/3 power law relating coronary artery lumen area to distal summed branch lengths and regional mass or parent-to-daughter branching ratios.
Conclusions:
These observations provide a basis for quantifying diffuse coronary artery disease on clinical arteriograms.
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