scholarly journals 108 Atrial fibrillation effects on coronary perfusion across the different myocardial layers: a computational analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Andrea Saglietto ◽  
Stefania Scarsoglio ◽  
Matteo Fois ◽  
Luca Ridolfi ◽  
Gaetano Maria De Ferrari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Frequency Analysis ◽  
Haemodynamic Effect ◽  
Coronary Perfusion ◽  
P Values ◽  
Left Circumflex Artery ◽  
Myocardial Layers ◽  
Computational Fluid Dynamics Analysis

Abstract Aims Atrial fibrillation (AF) patients may present ischaemic chest pain in the absence of classical obstructive coronary disease. Among the possible causes, the direct haemodynamic effect exerted by the irregular arrhythmia has not been studied in detail. Methods and results A computational fluid dynamics analysis was performed by means of a 1D-0D multiscale model of the entire human cardiovascular system, characterized by a detailed mathematical modelling of the coronary arteries and their downstream distal microcirculatory districts (subepicardial, midwall, and subendocardial layers). Three mean ventricular rates were simulated in both sinus rhythm (SR) and AF: 75, 100, 125 b.p.m. We conducted inter-layer and inter-frequency analysis of the ratio between mean beat-to-beat blood flow in AF compared to SR (Q¯AP/Q¯SR Inter-layer analysis showed that, for each simulated ventricular rate, Q¯AP/Q¯SR progressively decreased from the epicardial to the endocardial layer in the distal left coronary artery districts (P-values < 0.001 for both left anterior descending artery—LAD, and left circumflex artery—LCx), while this was not the case for the distal right coronary artery (RCA) district. Inter-frequency analysis showed that, focusing on each myocardial layer, Q¯AP/Q¯SR progressively worsened as the ventricular rates increased in all investigated microcirculatory districts (LAD, LCx, and RCA) (P-values < 0.001 for all layer-specific comparisons). Conclusions AF exerts direct haemodynamic consequences on the coronary microcirculation, causing a reduction in microvascular coronary flow particularly at higher ventricular rates; the most prominent reduction was seen in the subendocardial layers perfused by left coronary arteries (LAD and LCx).

scholarly journals Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Murat Yuksel ◽  
Abdulkadir Yildiz ◽  
Mustafa Oylumlu ◽  
Nihat Polat ◽  
Halit Acet ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Ventricular Rate ◽  
Fistula Formation ◽  
New Onset

Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement.

scholarly journals A case of coronary artery disease with rapid progress triggered by stent implantation

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091878
Author(s):  
Chao Feng ◽  
Liang Li ◽  
Shudong Xia
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Distal Segment ◽  
Rapid Progress ◽  
Severe Stenosis ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Stent Restenosis ◽  
Artery Disease

Drug-eluting stents (DESs) have a low prevalence of in-stent restenosis. However, we describe a patient with coronary artery disease with rapid progress, which might have been triggered by implantation of a DES. The patient was a 72-year-old woman who was first admitted to hospital with non-ST-segment elevated myocardial infarction and had a DES implanted after coronary angiography showed severe stenosis of the left circumflex artery. However, although she kept taking dual antiplatelet therapy, her condition deteriorated and she was admitted to hospital three more times. Angiography showed that the coronary stenosis had become more severe and was more severe not just in the stent-implanted segments, but also in other coronary arteries. Another DES and drug-eluted balloon were used. However, the stent-implanted and balloon-dilated segments became severely stenosed within 1 month. Tests for auto-immune diseases and allergies were negative. We speculate that the first DES triggered an unknown response of the coronary arteries and led to severe stenosis from the stent-implanted segment to the distal segment and other arteries.

scholarly journals Extraction of morphometry and branching angles of porcine coronary arterial tree from CT images

2009 ◽  
Vol 297 (5) ◽  
pp. H1949-H1955 ◽  
Author(s):  
Thomas Wischgoll ◽  
Jenny S. Choy ◽  
Ghassan S. Kassab
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Topological Analysis ◽  
Minimum Energy ◽  
Power Laws ◽  
Ct Images ◽  
Arterial Tree ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
The Right

The morphometry (diameters, length, and angles) of coronary arteries is related to their function. A simple, easy, and accurate image-based method to seamlessly extract the morphometry for coronary arteries is of significant value for understanding the structure-function relation. Here, the morphometry of large (≥1 mm in diameter) coronary arteries was extracted from computed tomography (CT) images using a recently validated segmentation algorithm. The coronary arteries of seven pigs were filled with Microfil, and the cast hearts were imaged with CT. The centerlines of the extracted vessels, the vessel radii, and the vessel lengths were identified for over 700 vessel segments. The extraction algorithm was based on a topological analysis of a vector field generated by normal vectors of the extracted vessel wall. The diameters, lengths, and angles of the right coronary artery, left anterior descending coronary artery, and left circumflex artery of all vessels ≥1 mm in diameter were tabulated for the respective orders. It was found that bifurcations at orders 9–11 are planar (∼90%). The relations between volume and length and area and length were also examined and found to scale as power laws. Furthermore, the bifurcation angles follow the minimum energy hypothesis but with significant scatter. Some of the applications of the semiautomated extraction of morphometric data in applications to coronary physiology and pathophysiology are highlighted.

Analysis of blood flow in the entire coronary arterial tree

2005 ◽  
Vol 289 (1) ◽  
pp. H439-H446 ◽  
Author(s):  
N. Mittal ◽  
Y. Zhou ◽  
C. Linares ◽  
S. Ung ◽  
B. Kaimovitz ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Blood Flow ◽  
Flow Distribution ◽  
Model Parameters ◽  
Coronary Perfusion ◽  
Arterial Tree ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
The Right

A hemodynamic analysis of coronary blood flow must be based on the measured branching pattern and vascular geometry of the coronary vasculature. We recently developed a computer reconstruction of the entire coronary arterial tree of the porcine heart based on previously measured morphometric data. In the present study, we carried out an analysis of blood flow distribution through a network of millions of vessels that includes the entire coronary arterial tree down to the first capillary branch. The pressure and flow are computed throughout the coronary arterial tree based on conservation of mass and momentum and appropriate pressure boundary conditions. We found a power law relationship between the diameter and flow of each vessel branch. The exponent is ∼2.2, which deviates from Murray’s prediction of 3.0. Furthermore, we found the total arterial equivalent resistance to be 0.93, 0.77, and 1.28 mmHg·ml−1·s−1·g−1 for the right coronary artery, left anterior descending coronary artery, and left circumflex artery, respectively. The significance of the present study is that it yields a predictive model that incorporates some of the factors controlling coronary blood flow. The model of normal hearts will serve as a physiological reference state. Pathological states can then be studied in relation to changes in model parameters that alter coronary perfusion.

scholarly journals Features of coronary artery patterns and percutaneous coronary intervention in patients with acute coronary syndrome and stable angina in patients aged below 40 years

2020 ◽  
Vol 101 (1) ◽  
pp. 18-24 ◽  
Author(s):  
F Z Abdullaev ◽  
N M Babaev ◽  
L S Shikhieva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim. To study the features of risk profile, coronary artery patterns, and percutaneous coronary intervention in patients aged below 40 years with acute coronary syndrome and stable angina. Methods. 208 patients with coronary artery disease aged below 40 years were examined: 51 (24.5%) patients aged 35 years and younger and 157 (75.5%) aged 3640 years. 98 (47.1%) patients were admitted with acute coronary syndrome; 110 (52.9%) patients with stable angina. In groups of acute coronary syndrome and stable angina, myocardial infarction in past medical history was revealed in 23.5% and 36.4%, respectively. 165 patients underwent percutaneous coronary intervention: 84 (50.9%) with acute coronary syndrome; 81 (40.1%) with stable angina. Results. Patients with stable angina differed by prevalence of myocardial infarction in past medical history, overweight, and family history of coronary artery disease. In group of acute coronary syndrome urban cohort prevailed as well as consumption of energy drinks among patients below 35 years; high prevalence of left ventricular dysfunction. Patients with acute coronary syndrome were characterized by involvement of one and three coronary arteries, and patients with stable angina by pathology of two and three coronary arteries. Involvement of three coronary arteries was equal in both groups. In both groups, anterior interventricular artery was target coronary artery. Patients with stable angina had the same rate of right coronary artery and left circumflex artery involvement. In patients with stable angina, right coronary artery involvement was rarer, and left main coronary artery involvement was two times more frequent than in patients with acute coronary syndrome. The group with acute coronary syndrome was characterized by predominance of discrete lesions and coronary occlusions over diffuse lesions; and the group of stable angina by diffuse lesions, and two-times less frequent coronary occlusions. Conclusion. Among patients with acute coronary syndrome aged below 36 years, revascularization of right coronary artery was predominant, and among patients aged 3640 years with acute coronary syndrome revascularization of left circumflex artery.

scholarly journals Normal coronary diameters in coronary angiogram at Patan Hospital, Nepal

2021 ◽  
Vol 23 (3) ◽  
pp. 247-251
Author(s):  
Ashok Adhikari ◽  
Kunal Bikram Shaha
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Angiogram ◽  
Left Main ◽  
Left Circumflex Artery ◽  
Software Analysis ◽  
Coronary Artery Diameter

This study aims to assess the normal coronary diameters of patient who underwent coronary angiogram in Patan Hospital. Angiographic and demographic data of a total of 307 patients (155 males, 152 females; mean age 62.09±11.06 years) who underwent elective coronary angiography in Patan Hospital due to suspicion of coronary artery disease between 2017 and 2020 and in whom coronary angiography documented normal coronary arteries without any intra-luminal irregularity were analyzed retrospectively. Proximal diameters of the main epicardial coronary arteries were measured quantitatively using automated software analysis (Allura, Philips). The mean diameter of unadjusted/adjusted left main coronary artery, proximal left anterior descending artery, proximal left circumflex artery, proximal right coronary artery were 4.87±0.85mm/2.8±0.54, 3.8±0.7/2.19±0.439, 3.4±0.7/1.98±0.44, 3.6±0.85/2.07±0.53 respectively. Our study findings contradict the traditional belief that females have narrower coronary arteries than males. Our study showed the females have statistically significant larger unadjusted Right Coronary Artery diameter and adjusted Left Main Coronary Artery diameter. We believe that our findings may contribute to the global data pool of normal coronary diameters and can be utilized in future studies as a database.

Abstract 1680: Spatial Distribution of Myocardial Infarction in Patients with Diabetes Mellitus

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pallav Garg ◽  
Susana Candia ◽  
John C Wang ◽  
Richard E Kuntz ◽  
Laura Mauri
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Spatial Distribution ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Diabetic Patients ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Detection Technology ◽  
Patients With Diabetes

BACKGROUND: Acute coronary occlusions occur most frequently as a result of rupture of an atherosclerotic plaque. Previous studies have found greater extent of atherosclerotic disease in the coronary arteries of diabetic patients. While the burden of disease is higher in diabetics, less is known about the spatial distribution of myocardial infarction in this population. METHODS: We sought to compare the spatial distribution of myocardial infarction (STEMI and Non-STEMI) in patients with diabetes mellitus and in those without, based on quantitative coronary and statistical analysis. We analyzed 756 patients with STEMI (n = 556) and NSTEMI (n=200), of which 175 patients comprised the diabetic cohort, and mapped the location of the acute coronary occlusion. RESULTS: Coronary occlusions were not uniformly distributed throughout each of the major epicardial coronary arteries but tended to cluster within the proximal third of each of the vessels in both cohorts. There was no difference in the distribution of occlusions in diabetics vs. non-diabetics in any of the vessels (left anterior descending artery, P=0.35; left circumflex artery; P=0.33 right coronary artery, P=0.20; Figure). CONCLUSIONS: Acute coronary occlusions leading to STEMI and NSTEMI in both diabetics and non-diabetics tend to cluster in predictable “hot spots” within the proximal third of the coronary arteries. Identification of these high-risk zones for acute coronary occlusions will lead to future advances in vulnerable plaque detection technology and potentially locally directed preventive strategies. Spatial distribution of myocardial infarction in diabetics vs. non-diabetics using distance to lesion from the ostium of the coronary artery.

scholarly journals The prevalence of coronary artery anomalies in adults: Studied with computed tomography coronary angiography

2018 ◽  
Vol 75 (1) ◽  
pp. 16-22
Author(s):  
Dragana Ilic ◽  
Dragan Stojanov ◽  
Goran Koracevic ◽  
Sladjana Petrovic ◽  
Zoran Radovanovic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Sinus ◽  
Coronary Anomalies ◽  
Coronary Artery Anomalies ◽  
Therapeutic Treatment ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Background/Aim. Coronary artery anomalies are an uncommon but important cause of chest pain, and in some cases of hemodynamically significant abnormalities, sudden cardiac death. The aim of the research was to establish the prevalence of the coronary arteries anomalies in our population. Methods. The study group included 1,562 patients (810 men, 752 women, average age 64.3 ? 12.0 years; range 32?80 years) who were scheduled for 64-slice computed tomography (MSCT), which enables detailed visualization of coronary arteries and heart anatomy. All examinations were made due to suspicion (atypical chest pain, angina equivalent symptoms or multiple risk factors for cardiovascular disease) or assumption of progression of coronary artery disease. Results. From January 2010 till December 2014 a total number of 1,562 patients were sent for evaluation of coronary arteries. The coronary anomalies were found in 45 (2.88%) patients. The most frequent coronary anomaly seen in our population group was absence of left main trunk with the separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) originating from a left coronary sinus (LCS). This was found in 12 patients (an incidence of 0.77% or 26.7% of all coronary anomalies). Anomalous location of coronary ostium outside normal aortic sinuses in our study was present as right coronary artery (RCA) that arises from left anterior sinus in 5 (0.32%) patients and left coronary artery from non-coronary sinus in two (0.13%) patients. Conclusion. Knowledge of anomalies of the coronary arteries and their recognition on the multislice computed tomography is of great importance for the further planning of a possible therapeutic treatment. Coronary anomalies that are considered insignificant will require no further therapeutic treatment. But the detection of malignant coronary anomalies will certainly save many lives.

scholarly journals P728 Left main coronary artery thrombus found in a teenager with Kawasaki disease following cardiac arrest

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Roque ◽  
D Monteiro De Sousa ◽  
M Bowes
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Arteries ◽  
Cardiac Mri ◽  
Anticoagulation Therapy ◽  
Left Ventricular ◽  
System Response ◽  
Coronary Artery Abnormalities ◽  
Left Circumflex Artery

Abstract Background A male teenager presented with an out of hospital cardiac arrest while exercising requiring CPR and DC Cardioversion. Incidentally, he was stung by a wasp minutes before the event. After being admitted, the patient was intubated, ventilated and treated for anaphylaxis and seizures. The patient had no significant past medical or family history of note. Investigations were performed after the patient was stabilized including 15 lead ECG, 24 hours ECG monitor, Echocardiogram and blood sample for troponins and cardiomyopathy screening. The ECG and 24 Hours ECG were reported as normal. The patient also had an exercise treadmill test which showed ischaemic changes at peak exercise. Cardiomyopathy screening was negative. Echocardiogram showed globally mildly impaired left ventricular systolic function with no other significant abnormalities. The patient underwent a cardiac MRI a couple of weeks later which showed an aneurysmal and tortuous proximal left coronary artery with a thrombus and also an aneurysmal mid left circumflex artery. Anticoagulation therapy was initiated, and a Cardioverter Defibrillator was implanted. Another echo was performed focused on the LV function and visualisation of the coronary arteries. This confirmed the cardiac MRI findings, demonstrating two coronary artery aneurysms and a filling defect suggestive of thrombus in the more distal of the two aneurysms. Due to the lack of evidence of any other potential condition, a diagnosis of Kawasaki disease was made and anticoagulation therapy was continued. Conclusion Although Kawasaki disease (KD) has been investigated for over four decades, its cause is still unknown. Current understanding of the immune system response indicates response to a classic antigen, that in most patients is protective against future exposure (1). KD is an acute, self-limited vasculitis that affects young children. In a significant proportion of patients, it can originate coronary artery abnormalities, predominantly if the diagnosis is not achieved or treatment gets delayed. In the course of acute illness, the vascular architecture is destroyed by a necrotizing arteritis, causing hydrostatic pressure and leading to aneurysms in the affected areas (2). The imaging modality preferred for assessment of myocardial function and detection of coronary artery abnormalities is Echocardiography (2). In this case, given the unusual presentation of cardiac arrest and the diagnosis of KD we recommend a thorough assessment of the coronary arteries in echocardiography routinely. Abstract P728 Figure.

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