A single-center experience of detecting coronary anomalies on 64-slice computed tomography

The detection of coronary anomalies is of major clinical significance. Coronary anomalies have been identified as a frequent cause of sudden death, particularly in young athletes. Multiple series have successfully demonstrated the ability of 64-slice computed tomography (CT) to identify coronary anomalies. However, the relationship of these anatomical variants with cardiac symptoms at presentation or cardiac events has not been well established.

Here, we report our experience over an approximately 3-year period identifying coronary anomalies with 64-slice CT coronary angiography.

Coronary anomalies and myocardial bridging were found to be common among patients undergoing cardiac CT at our institution with an overall incidence of 8.9%. Cardiac symptoms in patients with isolated coronary anomalies or myocardial bridging detected on 64-slice CT coronary angiography included chest pain, shortness of breath, arm pain, palpitations and dizziness. A large percentage of patients with isolated coronary anomalies or myocardial bridging were noted to be asymptomatic (26.7%). The majority of patients reported chest pain (57.1%). Exertional symptoms were also relatively common (21.4%). A logistic regression analysis was conducted in which symptoms were used to predict patients with myocardial bridging as opposed to those with anomalies of origination and course, intrinsic coronary arterial anatomy or coronary termination, and no significant difference was found. Of the patients identified as having isolated coronary anomaly or bridging, 26% also underwent cardiac catheterization. In this group, all of the anomalies of origination and course (6/6) were identified by traditional angiography, whereas none of the patients (0/4) with bridging or anomalies of intrinsic coronary anatomy (right coronary artery aneurysm) were identified by angiography. No deaths or cardiac events were detected during the limited follow-up period.

Overall, 64-slice CT coronary angiography is a well suited imaging modality for detecting coronary anomalies and myocardial bridging. Further study in this area is necessary to better delineate the clinical significance of certain coronary anomalies and the incidence of clinical manifestations associated with each type of anomaly.