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Tortuosity of coronary arteries in chronic pressure and volume overload
M Jakob1, D Spasojevic, O N Krogmann
1Department of Cardiology, University Hospital, Zurich, Switzerland.
Insights
Coronary tortuosity, a measure of vessel winding, is increased in chronic pressure overload compared to volume overload. Factors like age, gender, and left ventricular mass influence this condition.
Area of Science:
- Cardiovascular physiology
- Medical imaging analysis
Background:
- The role of coronary artery tortuosity in chronic pressure and volume overload conditions remains poorly understood.
- Assessing coronary tortuosity is crucial for understanding its impact on cardiovascular pathophysiology.
Purpose of the Study:
- To evaluate a novel method for measuring coronary artery tortuosity in patients with chronic pressure and volume overload.
- To investigate the relationship between coronary tortuosity and hemodynamic changes in these patient groups.
Main Methods:
- A new method for quantifying coronary tortuosity was applied to 62 patients, including controls, hypertensives, and aortic regurgitation patients.
- Coronary tortuosity was measured using the tortuosity index (TI) in the left anterior descending (LAD) and circumflex (LCX) arteries.
- Measurements were taken at end-diastole and end-systole using specific radiographic projections (RAO and LAO).
Main Results:
- Coronary tortuosity was significantly higher in hypertensive patients (pressure overload) compared to controls and patients with aortic regurgitation (volume overload) at end-diastole.
- At end-systole, coronary tortuosity was significantly elevated in both hypertensive and aortic regurgitation patients compared to controls, with higher values in hypertensives.
- Tortuosity index showed significant correlations with left ventricular muscle mass, left ventricular volume, and patient age, and females tended to have greater tortuosity.
Conclusions:
- Coronary tortuosity is more pronounced in chronic pressure overload than in volume overload.
- Gender, age, left ventricular volume, and muscle mass are identified as determinants of coronary tortuosity.
- Coronary tortuosity appears to be a significant physiological factor influencing coronary blood flow and vessel wall mechanics.
Abstract:
The role of coronary tortuosity in the pathophysiology of chronic pressure and volume overload is still unclear. A new method for measuring coronary tortuosity in patients with chronic pressure and volume overload was evaluated in 62 patients. Sixteen controls, 14 patients with arterial hypertension, and 32 patients with aortic regurgitation were included in the present analysis. The left anterior descending (LAD) and circumflex (LCX) coronary arteries were traced, and tortuosity was determined in the 30 degrees right (RAO) and 60 degrees left (LAO) anterior oblique projection. Tortuosity index (TI, %) was defined as the percent ratio of calculated shortest distance divided by total length of the coronary artery. TI was 104.1 +/- 3.2% at end-diastole in controls, 105.7 +/- 3.8% in hypertensives (P < 0.05 vs. controls), and 102.9 +/- 2.5% in patients with aortic regurgitation (P < 0.05 vs. controls, P < 0.001 vs. hypertensives). Respective values at end-systole were 107.8 +/- 4.7% in controls, 109.8 +/- 7.1% in hypertensives (ns vs. controls), and 104.3 +/- 3.3% in patients with aortic regurgitation (P < 0.001 vs. controls and vs. hypertensives). No differences were found in tortuosity between RAO and LAO projection or between LAD and LCX artery. There was a significant correlation between TI and left ventricular (LV) muscle mass, LV volume, and age. Females tended to have more tortuous vessels than males. Coronary tortuosity is more pronounced in patients with chronic pressure than with volume overload. Determinants of coronary tortuosity are gender, age, LV volume, and muscle mass. Thus, coronary tortuosity seems to play an important role as a physiologic determinant for the flow and the mechanics of the vessel wall.