Determination of Left Main Coronary Artery Luminal Area Using CT Angiography in Individuals with Un-Obstructive Coronary Arteries

Authors

  • Zohair Aziz Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Syed Khurram Shahzad Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Fahd Ur Rehman Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Ismail Ahmed Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Asma Zafar Khawaja Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Hafiz Muhammad Shafique Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Abdul Hameed Siddiqui Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Zahoor Aslam Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-1.10637

Keywords:

CT coronary angiogram, Left main coronary artery, Minimal luminal area

Abstract

Objective: To assess the Minimal Luminal Area of the left main coronary artery in cardiac patients having un-obstructed coronary arteries.

Study Design: Analytical, Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from April-Sep 2023.

Methodology: Total eighty six individuals with low risk pre-test probability for Coronary artery disease (via CAD consortium calculator) underwent a CT angiogram and their Left Main Coronary Artery Minimal Luminal Area was calculated using dedicated software over a 2-month period. Approval from the Ethical Review Board was sought. Sampling was done by using non-probability consecutive sampling. Student t-test was applied to find the mean difference of LM-MLA between factors such as diabetes mellitus, hypertension, gender, and smoking status with Minimal Luminal Area. Pearson correlation was applied to find correlation between Left Main Coronary Artery Minimal Luminal with age, BMI, BSA, and LV-mass. p<0.05 was taken as statistically significant.

Results: Out of total n=86 individuals, 67(77.9%) were males and 19(22.1%) were females with average age of 45.78±11.40 years. The mean Minimal Luminal Area of study sample was 12.07±4.17mm2 with males having a mean Minimal Luminal Area of 12.79±4.31mm2 and females having a mean MLA of 9.50±2.26mm2. It was noted that an increased LV mass leads to an increase in LM-MLA (r=0.579, p < 0.001).

Conclusion: Variety of factors influence the Left Main Coronary Artery Minimal Luminal which means local guidelines would have to be set up to dictate treatment threshold in patients with  ...

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References

Faisal AW, Shahid NA, Habib G, Latif W, Khan SA. The Mortality in Left Main Stem Disease; A single-centre study from Pakistan. The Journal of Cardiovascular Diseases. 2021 Dec 31; 17(4).

Athappan G, Patvardhan E, Tuzcu ME, Ellis S, Whitlow P, Kapadia SR. Left main coronary artery stenosis: a meta-analysis of drug-eluting stents versus coronary artery bypass grafting. JACC Cardiovasc Interv. 2013; 6: 1219-1230.

https://doi.org/10.1016/j.jcin.2013.07.008

Mintz GS, Lefèvre T, Lassen JF, Testa L, Pan M, Singh J,et al. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EuroIntervention. 2018 Jul 20; 14(4): e467-74. https://doi.org/10.4244/10.4244/EIJ-D-18-00194

Punamiya K, Jha T, Punamiya V, Pradham J. IVUS determination of normal left main stem artery size and plaque burden, and correlation with body surface area in an Indian population. AsiaIntervention. 2022; 8(2): 116-22.

https://doi.org/10.4244/AIJ-D-22-00041

Skowronski J, Cho I, Mintz GS, Wolny R, Opolski MP, Cha MJ, et al. Inter-ethnic differences in normal coronary anatomy between Caucasian (Polish) and Asian (Korean) populations. European Journal of Radiology. 2020 Sep 1; 130: 109185.

https://doi.org/10.1016/j.ejrad.2020.109185

Hashmi KA, Khan MR, Hashmi AA, Adnan F, Irfan M. Left main stem disease on coronary angiography in patients with non-st segment elevation myocardial infarction. Pakistan Heart Journal. 2021 May 26; 54(1): 30-3.

Fischer C, Hulten E, Belur P, Smith R. Coronary CT angiography versus intravasvular ultrasound for estimation of coronary artery stenosis and atherosclerotic plaque burden: a meta-analysis. J Cardiovasc Comput Tomogr. 2013; 7: 256-266

https://doi.org/10.1016/j.jcct.2013.08.006

Konstantinos Dean Boudoulas MD, Bittenbender PM, Nagaraja HN, Omar Kahaly MD, Dickerson JA, Raman SV, et al. Factors Determining Left Main Coronary Artery Luminal Area. Journal of Invasive Cardiology. 2017 Feb 15; 29(7).

Probst S, Seitz A, Martínez Pereyra V, Hubert A, Becker A, Storm K, et al., Safety assessment and results of coronary spasm provocation testing in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronary arteries. European Heart Journal Acute Cardiovascular Care. 2021 Apr 1; 10(4): 380-7.

Bittencourt MS, Hulten E, Polonsky TS, Hoffman U, Nasir K, Abbara S, et al. European Society of Cardiology–recommended coronary artery disease consortium pretest probability scores more accurately predict obstructive coronary disease and cardiovascular events than the Diamond and Forrester Score: the Partners Registry. Circulation. 2016 Jul 19; 134(3): 201-11. https://doi.org/10.1161/CIRCULATIONAHA.116.023396

Veselka J, Cadova P, Tomasov P, Theodor A, Zemanek D. Dual-source CT angiography for detection and quantification of in-stent restenosis in the left main coronary artery: comparison with intracoronary ultrasound and coronary angiography. Journal of Invasive Cardiology. 2011 Oct 25; 23(11).

Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. The American journal of cardiology. 1986 Feb 15; 57(6): 450-8.

https://doi.org/10.1016/0002-9149(86)90771-X

Gao XF, Wang ZM, Wang F, Gu Y, Ge Z, Kong XQet al. Intravascular ultrasound guidance reduces cardiac death and coronary revascularization in patients undergoing drug-eluting stent implantation: results from a meta-analysis of 9 randomized trials and 4724 patients. The International Journal of Cardiovascular Imaging. 2019 Feb 15; 35: 239-47.

https://doi.org/10.1007/s10554-019-01555-3

El-Menyar AA, Al Suwaidi J, Holmes Jr DR. Left main coronary artery stenosis: state-of-the-art. Current problems in cardiology. 2007 Mar 1; 32(3): 103-93.

https://doi.org/10.1016/j.cpcardiol.2006.12.002

Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, et al. CAD-RADS™ 2.0–2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). Cardiovascular Imaging. 2022 Nov 1; 15(11): 1974-2001.

https://doi.org/10.1016/j.jcmg.2022.07.002

Ramjattan NA, Lala V, Kousa O, Makaryus AN. Coronary CT angiography. 2022

O’Keefe JH, Owen RM, Bove AA. Influence of left ventricular mass on coronary artery cross-sectional area. Am J Cardiol. 1987; 59: 1395-1397. https://doi.org/10.1016/0002-9149(87)90927-1

Kim SG, Apple S, Mintz GS, McMillan T, Caños DA, Maehara A, et al. The importance of gender on coronary artery size: In‐vivo assessment by intravascular ultrasound. Clinical cardiology. 2004 May; 27(5): 291-4. https://doi.org/10.1002/clc.4960270511

Litovsky SH, Farb A, Burke AP, Rabin IY, Herderick EE, Cornhill JF, et al. Effect of age, race, body surface area, heart weight and atherosclerosis on coronary artery dimensions in young males. Atherosclerosis. 1996 Jun 1; 123(1-2): 243-50.

https://doi.org/10.1016/0021-9150(96)05815-7

Chatterjee A, Leesar MA, Hillegass WB. Intravascular ultrasound of normal left main arteries: Insights for stent optimization and standardization. Catheterization and Cardio-vascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2019 Feb 1;93(2):239-40.

https://doi.org/10.1002/ccd.28077

Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease epidemic in Pakistan: women and men at equal risk. American heart journal. 2005 Aug 1; 150(2): 221-6.

https://doi.org/10.1016/j.ahj.2004.09.025

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Published

30-05-2024

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Original Articles

How to Cite

1.
Aziz Z, Shahzad SK, Rehman FU, Khan IA, Khawaja AZ, Shafique HM, et al. Determination of Left Main Coronary Artery Luminal Area Using CT Angiography in Individuals with Un-Obstructive Coronary Arteries. Pak Armed Forces Med J [Internet]. 2024 May 30 [cited 2024 Jun. 17];74(SUPPL-1):S27-S31. Available from: https://pafmj.org/PAFMJ/article/view/10637