Coronary Dominance on Coronary CT Angiography: Prevalence and Potential Implications for Electrocardiographic
William Andrés Prada Mancilla1, Katherine Díaz1, Fernando Ortiz1
1Department of Cardiac Imaging, Clínica Reina Sofía, Bogota 110121, Colombia.
Insights
Coronary dominance, a heart anatomy variant, isn't linked to disease severity or gender. Left dominance, though rare, can mask heart issues on electrocardiograms (ECG), impacting diagnosis.
Area of Science:
- Cardiology
- Radiology
- Anatomy
Background:
- Coronary dominance is a significant anatomical variant influencing coronary artery disease (CAD) interpretation and electrocardiogram (ECG) correlation.
- While right dominance is common, left dominance may alter clinical and ECG presentations, necessitating further investigation.
Purpose of the Study:
- To determine the prevalence of coronary dominance using coronary CT angiography (CCTA).
- To evaluate the association of coronary dominance with CAD severity, gender, and ECG findings.
- To highlight the clinical relevance of left dominance in CCTA reporting.
Main Methods:
- Retrospective analysis of 677 patients undergoing CCTA.
- Classification of coronary dominance: right, left, or codominant.
- Assessment of disease severity using CAD-RADS and correlation with demographic, clinical, anatomical, and ECG variables.
Main Results:
- Right coronary dominance was most prevalent (89.7%), followed by left (8%) and codominance (2.3%).
- No significant association found between coronary dominance and disease severity or gender (p=0.32).
- Left dominance subgroup showed a high rate of normal ECGs (72.2%) despite potential severe disease, with male gender linked to severe CAD (p<0.005).
Conclusions:
- Coronary dominance is not associated with disease severity or gender.
- Left dominance is a clinically relevant finding, often presenting with atypical or normal ECGs, potentially masking acute coronary syndromes.
- Systematic reporting of coronary dominance in CCTA is recommended for improved clinical correlation and patient management.
Abstract:
Background/Objectives: Coronary dominance is a key anatomical variant in the interpretation of coronary artery disease and its correlation with electrocardiographic (ECG) findings. While right dominance is the most common pattern, left dominance may influence clinical and ECG presentations. This study aimed to determine the prevalence of coronary dominance using coronary CT angiography (CCTA) and evaluate its association with disease severity, gender, and ECG findings. Methods: A retrospective observational analytical study was conducted including 677 patients who underwent CCTA. Coronary dominance was classified as right, left, or codominant. Disease severity was assessed using CAD-RADS. Demographic, clinical, anatomical, and ECG variables were analyzed. Statistical analysis included descriptive statistics, chi-square tests, and multivariable logistic regression analysis. Results: Right coronary dominance was predominant (89.7%), followed by left dominance (8%) and codominance (2.3%). No significant association was found between coronary dominance and disease severity or gender (p = 0.32). Male gender was significantly associated with severe disease (CAD-RADS 4-5) (p < 0.005). The left anterior descending (LAD) artery was the most frequently affected vessel. In the left dominance subgroup, 72.2% of patients had a normal ECG, with a low prevalence of ischemic findings (3%). Cases of left dominance with severe disease and confirmed acute coronary syndrome were identified. Conclusions: Coronary dominance is not associated with disease severity or gender; however, left dominance represents a clinically relevant finding due to its association with atypical or normal ECG presentations. Its systematic inclusion in CCTA reports is recommended to improve clinical correlation and decision-making.
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