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Coronary artery fistula with or without aneurysm: A large comparative study

Li-Han Yang1, Ren-Hui Cai2, Lu-Jing Wang3

  • 1Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China.

Heliyon
|July 31, 2023
PubMed

Insights

Coronary artery fistula (CAF) with aneurysm is associated with heart murmur and larger fistulous diameter. Coronary atherosclerosis is more common in CAF without aneurysm, while larger fistulous diameter and coronary-cardiac chamber fistulas are risk factors for CAF with aneurysm.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Knowledge of coronary artery fistula (CAF) with coronary aneurysm is limited, primarily from case reports.
  • Management strategies differ for CAF with and without aneurysms, necessitating better understanding of their features.
  • This study presents the first large-scale comparative analysis of CAF with and without coronary aneurysms.

Purpose of the Study:

  • To investigate and compare the distinct imaging and clinical features of coronary artery fistula (CAF) in adult patients with and without coronary aneurysms.
  • To identify specific characteristics that differentiate these two patient cohorts.

Main Methods:

  • A retrospective review of 96,037 coronary computed tomography angiograms (CCTA) identified 429 adult patients with CAF.
  • Patients were categorized into two groups: CAF with aneurysm (321 cases) and CAF without aneurysm (108 cases).
  • Clinical data, ECG, coronary atherosclerosis, symptoms, and fistula characteristics (origin, entry, number, diameter) were analyzed using statistical tests, including logistic regression.

Main Results:

  • Significant differences were observed in heart murmur, coronary atherosclerosis, infective endocarditis, fistulous diameter, and fistulous entry site between the groups (P < 0.05).
  • Multivariate logistic regression identified large fistulous diameter and coronary-cardiac chamber fistulas as independent risk factors for CAF complicated with aneurysm.
  • CAF patients with aneurysms showed a higher incidence of heart murmur compared to those without aneurysms.

Conclusions:

  • Coronary artery fistula with aneurysm is linked to a higher prevalence of heart murmur.
  • Coronary atherosclerosis is more frequently observed in CAF cases without aneurysms.
  • Increased fistulous diameter and the presence of coronary-cardiac chamber fistulas are significant risk factors for developing aneurysms in patients with CAF.
Abstract

Keywords:
Coronary artery aneurysmCoronary artery fistulaCoronary computed tomography angiography

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