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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Visualization of anomalous origin and course of coronary arteries in 748 consecutive symptomatic patients by 64-slice
Franz von Ziegler1, Marco Pilla, Lori McMullan
1Ludwig-Maximilians-University, Department of Cardiology, Grosshadern Campus, Munich, Germany. franz.ziegler@med.uni-muenchen.de
Insights
Coronary artery anomalies (CAAs) were found in 2.3% of symptomatic patients using cardiac computed tomography angiography. This study highlights the effectiveness of 64-slice MDCTA in identifying these coronary artery variations.
Area of Science:
- Cardiovascular Imaging
- Anatomical Variations
- Radiology
Background:
- Coronary artery anomalies (CAAs) are increasingly recognized as significant in cardiovascular pathophysiology.
- Understanding the prevalence and types of CAAs is crucial for patient management.
- Cardiac computed tomography angiography (MDCTA) offers advanced visualization of coronary anatomy.
Purpose of the Study:
- To determine the prevalence of anomalous origin and course of coronary arteries.
- To investigate CAAs in a consecutive cohort of symptomatic patients.
- To evaluate the utility of 64-slice MDCTA in diagnosing CAAs.
Main Methods:
- Analysis of cardiac 64-slice multidetector-row computed tomography angiography (MDCTA) datasets.
- Inclusion of 748 consecutive symptomatic patients.
- Classification of CAAs based on the Angelini et al. scheme.
Main Results:
- Overall prevalence of CAAs of origin and course was 2.3% (17/748 patients).
- No CAAs were found in Subgroups 1 or 2.
- Subgroup 4 (improper sinus origin) was the most common, including variations in the origin of the right coronary artery and left circumflex coronary artery.
Conclusions:
- The prevalence of CAAs in this symptomatic population mirrors large angiographic series.
- 64-slice MDCTA is a valuable tool for identifying and characterizing coronary artery anomalies.
- Findings support the diagnostic accuracy of MDCTA for CAAs in symptomatic individuals.
Background:
Coronary artery anomalies (CAAs) are currently undergoing profound changes in understanding potentially pathophysiological mechanisms of disease. Aim of this study was to investigate the prevalence of anomalous origin and course of coronary arteries in consecutive symptomatic patients, who underwent cardiac 64-slice multidetector-row computed tomography angiography (MDCTA).
Methods:
Imaging datasets of 748 consecutive symptomatic patients referred for cardiac MDCTA were analyzed and CAAs of origin and further vessel course were grouped according to a recently suggested classification scheme by Angelini et al.
Results:
An overall of 17/748 patients (2.3%) showed CAA of origin and further vessel course. According to aforementioned classification scheme no Subgroup 1- (absent left main trunk) and Subgroup 2- (anomalous location of coronary ostium within aortic root or near proper aortic sinus of Valsalva) CAA were found. Subgroup 3 (anomalous location of coronary ostium outside normal "coronary" aortic sinuses) consisted of one patient with high anterior origin of both coronary arteries. The remaining 16 patients showed a coronary ostium at improper sinus (Subgroup 4). Latter group was subdivided into a right coronary artery arising from left anterior sinus with separate ostium (subgroup 4a; n = 7) and common ostium with left main coronary artery (subgroup 4b; n = 1). Subgroup 4c consisted of one patient with a single coronary artery arising from the right anterior sinus (RAS) without left circumflex coronary artery (LCX). In subgroup 4d, LCX arose from RAS (n = 7).
Conclusions:
Prevalence of CAA of origin and further vessel course in a symptomatic consecutive patient population was similar to large angiographic series, although these patients do not reflect general population. However, our study supports the use of 64-slice MDCTA for the identification and definition of CAA.
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