Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Konishi, Takao; Funayama, Naohiro; Yamamoto, Tadashi; Hotta, Daisuke; Tanaka, Shinya

doi:10.1371/journal.pone.0198566

Cited by 7 publications

(8 citation statements)

References 37 publications

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“…Because vessels with advanced atherosclerosis also may show a complex morphology due to curvature or tortuosity in the actual clinical setting, measurement of the bifurcation would optimally be better performed by three-dimensional analysis. However, similar to our experience in previous studies [ 9 , 18 , 19 , 25 ], it was quite difficult to assess the bifurcation angle by three-dimensional analysis. Moreover, complex vessel morphology may affect blood flow leading to paradoxical FFR CT changes.…”

Section: Limitationssupporting

confidence: 58%

“…As in previous studies [ 18 , 19 ], each bifurcation angle was measured as the crossing angle between the center lines of the left main trunk and each coronary artery (LAD or LCX) on the three-dimensional volume-rendered image of the coronary artery tree. For the left coronary artery bifurcation angle both LAD angle and LCX were determined by assessing the crossing line with the left main trunk (Supplementary Figure 2 : center panel).…”

Section: Methodsmentioning

confidence: 99%

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Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

et al. 2022

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Objectives Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases from the proximal to the distal part due to a variety of factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive decline in FFRCT. However, the association of the bifurcation angle with FFRCT is still not entirely understood. This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial relevance of 0.80 in vessels with no apparent coronary artery disease (CAD). Methods A total of 83 patients who underwent both CT angiography including FFRCT and invasive coronary angiography, exhibiting no apparent CAD were evaluated. ΔFFRCT was defined as the change in FFRCT from the proximal to the distal in the left anterior descending artery (LAD) and left circumflex artery (LCX). The bifurcation angle was calculated from three-dimensional volume rendered images. Vessel morphology and plaque characteristics were also assessed. Results ΔFFRCT significantly correlated with the bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.55, p = 0.0003), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, sensitivity 88%, specificity 85%). Conclusions In vessels with no apparent CAD, vessel length was the most influential factor on FFRCT, directly followed by the bifurcation angle. Key Points • Both LAD and LCX bifurcation angles are factors influencing FFRCT. • Bifurcation angle is one of the predictors of a distal FFRCTof ≤ 0.80 and an optimal cut-off value of 31.0° for the LAD and 52.6° for the LCX. • Bifurcation angle should be taken into consideration when interpreting numerical values of FFRCT.

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Section: Limitationssupporting

confidence: 58%

Section: Methodsmentioning

confidence: 99%

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

et al. 2022

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“…The presence of high-risk (71±19° vs. 55±19°) and non-calcified plaques (74±20° vs. 50±14°) in the proximal MV was associated with wider Angle B values [ 46 ]. A narrower Angle A in the LMCA in patients with chronic kidney disease was likely to present with more calcified lesions [ 20 ]. Another CCTA study revealed that angle change due to the cardiac motion was more prominent in the Angle A (LMCA-LCX angle) compared to the Angle C (LMCA-LAD angle) [ 33 ].…”

Section: Review and Discussionmentioning

confidence: 99%

“…However, two modes of defining the BA related to the MV and SB have been reported to date, which has led to some confusion in the understanding of the results of each analysis. Although the angle between the centerline of the proximal MV and the SB (BA-α, complementary angle of Angle A) has been defined as the BA in several reports [14][15][16][17][18][19][20] (Fig 2B ), Angle B has been considered as the more accepted form of the BA [21][22][23][24][25][26][27][28][29]. The curvature of the vessels is responsible for the difference in the assessment of the BA by these two methods.…”

Section: Plos Onementioning

confidence: 99%

Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review

et al. 2022

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Background A coronary bifurcation stenting is still a challenging issue due to frequent restenosis and stent thrombosis even with drug-eluting stents. The bifurcation angle (BA) between a main vessel and a side branch is one of the crucial determinants of coronary flow and shear stress that affect the plaque distribution. Previous bench and clinical studies have evaluated the impact of the BA between the proximal main vessel and the side branch (Angle A) and the BA between the distal main vessel and the side branch (Angle B) on the clinical outcomes of bifurcation stenting. However, the impact has not yet been fully elucidated due to a lack of statistical power or different manner of the assessment of BA. Objectives To analyze the published studies on coronary artery BA, the modalities used for assessment, and the impact of BA on interventions and attempt to define the pre-procedural protocols. Data sources A scoping review was performed using the Joanna Briggs Institute Methodology. A total of 52 relevant references were selected from PubMed, Cochrane Library, and CINAHL databases and categorized into three topic areas. Results and conclusions A wider Angle A is associated with the increased likelihood of carina shift and a wider Angle B, with that of side branch occlusion. A wider Angle B promotes stent malapposition and deformation in the side branch ostium and has been reported as an independent predictor of major adverse cardiac events after bifurcation stenting; however, improvement of the drug-eluting stent, refinement of the stenting technique, and accurate 3-dimensional assessment may attenuate the adverse clinical impact of a wider BA. Implications of key findings Assessment of the BA is necessary to predict the effect of bifurcation intervention procedure on the stent configuration and coronary flow at the bifurcated vessels. This will help to optimize stent selection and the stenting technique.

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“…There was an increase in the total calcium volume in the LAD, LCX and RCA by 7.6%. Coronary artery disease and cardiovascular events can be predicted using coronary artery calcium score (CACS), which is a measurement of subclinical coronary atherosclerosis [ 9 ]. Plaque regression leads to an increase in calcium volume [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Use of reverse diet kit as a treatment to regress atheroma in a known CAD patient: A case report

Sane

Rahul²,

Amin³

2022

Journal of Ayurveda and Integrative Medicine

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The way people eat have changed rapidly across the globe and is one of the reasons for developing coronary artery disease (CAD). Atheroma is caused due to the accumulation of fatty deposits and scar tissue leading to the degeneration of the walls of the arteries, restriction of the circulation and a risk of thrombosis. This single case experimental study shows that regression in atheroma may be achieved by replacing the normal diet with a low calories diet used in the reverse diet kit. The patient complained of angina on minor exertion. Post admission the patient underwent a computed tomography angiogram (CT-angiogram) to measure the plaque volumes of left anterior descending artery (LAD), left circumflex artery (LXC) and right coronary artery (RCA) of the heart. The patient was monitored for 12 weeks with the administration of reverse diet as a treatment method. The change in weight, blood pressure and heart rate was monitored every week. After 12 weeks, CT-angiogram was performed again. There was a 7.3 kg decrease in weight along with normalization of blood pressure (BP). A 92.8 mm 3 regression of the total atheroma volume was observed. The diet provided may help in reducing atheroma burden in this CAD patient.

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Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Cited by 7 publications

References 37 publications

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review

Use of reverse diet kit as a treatment to regress atheroma in a known CAD patient: A case report

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