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Wu B, Kheiwa A, Swamy P, Mamas MA, Tedford RJ, Alasnag M, Parwani P, Abramov D. Clinical Significance of Coronary Arterial Dominance: A Review of the Literature. J Am Heart Assoc 2024; 13:e032851. [PMID: 38639360 PMCID: PMC11179863 DOI: 10.1161/jaha.123.032851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.
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Affiliation(s)
- Bovey Wu
- Department of MedicineLoma Linda University Medical CenterLoma LindaCAUSA
| | - Ahmed Kheiwa
- Department of CardiologyLoma Linda University Medical CenterLoma LindaCAUSA
| | - Pooja Swamy
- Department of CardiologyLoma Linda University Medical CenterLoma LindaCAUSA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Ryan J. Tedford
- Department of Medicine, Division of CardiologyMedical University of South CarolinaCharlestonSCUSA
| | - Mirvat Alasnag
- Cardiac CenterKing Fahd Armed Forces HospitalJeddahSaudi Arabia
| | - Purvi Parwani
- Department of CardiologyLoma Linda University Medical CenterLoma LindaCAUSA
| | - Dmitry Abramov
- Department of CardiologyLoma Linda University Medical CenterLoma LindaCAUSA
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Schwarz JCV, van Lier MGJTB, van den Wijngaard JPHM, Siebes M, VanBavel E. Topologic and Hemodynamic Characteristics of the Human Coronary Arterial Circulation. Front Physiol 2020; 10:1611. [PMID: 32038291 PMCID: PMC6989553 DOI: 10.3389/fphys.2019.01611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background Many processes contributing to the functional and structural regulation of the coronary circulation have been identified. A proper understanding of the complex interplay of these processes requires a quantitative systems approach that includes the complexity of the coronary network. The purpose of this study was to provide a detailed quantification of the branching characteristics and local hemodynamics of the human coronary circulation. Methods The coronary arteries of a human heart were filled post-mortem with fluorescent replica material. The frozen heart was alternately cut and block-face imaged using a high-resolution imaging cryomicrotome. From the resulting 3D reconstruction of the left coronary circulation, topological (node and loop characteristics), topographic (diameters and length of segments), and geometric (position) properties were analyzed, along with predictions of local hemodynamics (pressure and flow). Results The reconstructed left coronary tree consisted of 202,184 segments with diameters ranging from 30 μm to 4 mm. Most segments were between 100 μm and 1 mm long. The median segment length was similar for diameters ranging between 75 and 200 μm. 91% of the nodes were bifurcations. These bifurcations were more symmetric and less variable in smaller vessels. Most of the pressure drop occurred in vessels between 200 μm and 1 mm in diameter. Downstream conductance variability affected neither local pressure nor median local flow and added limited extra variation of local flow. The left coronary circulation perfused 358 cm3 of myocardium. Median perfused volume at a truncation level of 100 to 200 μm was 20 mm3 with a median perfusion of 5.6 ml/min/g and a high local heterogeneity. Conclusion This study provides the branching characteristics and hemodynamic analysis of the left coronary arterial circulation of a human heart. The resulting model can be deployed for further hemodynamic studies at the whole organ and local level.
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Affiliation(s)
- Janina C V Schwarz
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Monique G J T B van Lier
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Maria Siebes
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ed VanBavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Dai Y, Yi K, Shimada K, Ren K, Wang Z, Terayama H, Li XK, Yi SQ. Anatomy of the coronary arteries in fetal pigs: comparison with human anatomy. Anat Sci Int 2019; 95:265-276. [PMID: 31836958 DOI: 10.1007/s12565-019-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/07/2019] [Indexed: 11/29/2022]
Abstract
In this study, 94 fetal pigs were used to comprehensively investigate the origins, number, location, and distribution of the coronary arteries to enrich knowledge on the coronary circulation in fetal pigs, and allow comparison with adult pigs and humans. In fetal pigs, the posterior interventricular sulcus branch always arose from the right coronary artery and the circumflex artery was rarely extended to the posterior interventricular sulcus, while it is variable in humans. In fetal pigs, there was sometimes anastomosis (8.5%) between the left and right conus branches as nutrient arteries of the pulmonary cone. Other branches were not significantly different between fetal pigs and humans, including the acute marginal branch, obtuse marginal branch, and sinoatrial nodal artery. Coronary dominance was also similar. In conclusion, compared with adult pigs, dissection of the coronary arteries in fetal pigs provided a more faithful overview of the porcine coronary circulation. The coronary arteries in fetal pigs were also more suitable for comparison with humans when pigs are used as experimental animals for studying the coronary vessels, which could be an important reference for investigation of clinical treatment of the coronary arteries. In summary, our data provide reliable information about the distribution and ramifications of the coronary arteries, and could be useful for clinicians and surgeons who wish to comprehensively understand coronary anatomy.
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Affiliation(s)
- Yidan Dai
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Kai Yi
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan.,College of Life Sciences and Technology, Wuhan University Bioengineering, Wuhan, China
| | - Kazuyuki Shimada
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Ke Ren
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan.,Project Division for Healthcare Innovation, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Zhidan Wang
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Hayato Terayama
- Deptment of Anatomy, Tokai University Graduate School of Medicine, Isehara, Japan
| | - Xiao-Kang Li
- Project Division for Healthcare Innovation, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Shuang-Qin Yi
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan.
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Gebhard C, Gick M, Ferenc M, Stähli BE, Ademaj F, Mashayekhi K, Buettner HJ, Neumann FJ, Toma A. Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 91:669-678. [DOI: 10.1002/ccd.27174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Cathérine Gebhard
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Michael Gick
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Barbara E. Stähli
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Fadil Ademaj
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Heinz Joachim Buettner
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
| | - Aurel Toma
- Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen; Germany
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Accuracy of exercise tolerance test in the diagnosis of coronary artery disease in patients with left dominant coronary circulation. Indian Heart J 2017; 69:624-627. [PMID: 29054187 PMCID: PMC5650573 DOI: 10.1016/j.ihj.2017.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/11/2017] [Accepted: 02/16/2017] [Indexed: 11/23/2022] Open
Abstract
Background Exercise is a physiologic stress that helps the physicians to clarify the presence or absence of cardiovascular disease which may be obscure at rest. Although it is sensitive, its specificity is affected by several parameters, such as some metabolic conditions, some structural heart diseases, and some baseline electrocardiogram abnormalities. Currently, the relationship between coronary dominance and accuracy of EET is not examined. Therefore, this study was conducted to determine the potential impact of coronary dominance on the accuracy of EET. Methods In this retrospective study, data were gathered from 720 patients from four medical centers. The pattern of dominancy was determined, and the coronary dominance pattern of the patients who had normal angiograms despite abnormal EETs was compared to that from all the patients. Results Among the patients who had a normal angiogram despite an abnormal EET, 27% were left dominant while the frequency of left dominancy in the whole population of the study was only 10.9% (P = 0.013). There were no significant differences in baseline characteristics, such as age and sex, between the two studied groups. Conclusion The results indicated that the presence of left dominance in patients who had normal angiograms despite an abnormal EET was significantly higher than general population. Therefore, left dominance may be considered a confounding factor for EET, producing false positive results.
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