The significant coronary tortuosity and atherosclerotic coronary artery disease; What is the relation?

Analysis of the correlations between the extracranial internal carotid artery and extracranial vertebral artery and mild cognitive impairment

BACKGROUND

Vascular tortuosity is a prevalent morphological change that frequently occurs in arteries across different parts of the body.

OBJECTIVE

To analyze the relationship between the tortuosities of the extracranial internal carotid artery (EICA) and extracranial vertebral artery (EVA) with mild cognitive impairment.

METHODS

The tortuosity index (TI), vascular deviation degree, tortuosity degree, and angle number of the EICA and EVA were retrospectively analyzed and calculated in 160 patients who underwent computed tomography angiography (CTA) in this study's department, and the Montreal cognitive assessment was adopted to evaluate the cognitive function of the patients.

RESULTS

The differences in age, gender, arterial hypertension (AH), and diabetes mellitus (DM) between the normal group and the mild cognitive impairment group were statistically significant (p< 0.01). The TI was negatively correlated with the score of cognitive function. The tortuosities of the EICA and EVA were correlated with mild cognitive impairment (p< 0.05). The reduction in visual-spatial ability was correlated with the right EICA tortuosity, and the reduction in memory was correlated with the EVA tortuosity. Age, gender, HP, DM, and coronary heart disease (CHD) were potential risk factors for carotid tortuosity (p< 0.05).

CONCLUSION

There was a significant correlation observed between the TIs of both the EICA and EVA and the presence of mild cognitive impairment. Advanced age, female, HP, DM, and CHD were independent risk factors for EICA and EVA tortuosities.

Coronary Tortuosity Index vs. Angle Measurement Method for the Quantification of the Tortuosity of Coronary Arteries in Non-Obstructive Coronary Disease

Coronary tortuosity has been recognized as a potential pathophysiological mechanism in the development of non-obstructive coronary artery disease (CAD). The aim of this study was to examine the role of two coronary tortuosity measurement methods in the detection of clinically significant coronary tortuosity. The study included 160 patients with angina symptoms and myocardial ischemia detected by cardiac stress tests in chronic settings and those diagnosed with acute coronary syndrome. After coronary angiography, tortuosity of coronary arteries was assessed by two methods, including measurement of tortuosity angles and calculating of tortuosity index. Significantly more tortuous coronary arteries were detected in the group with non-obstructive CAD (p < 0.01 for all three arteries), with significantly higher tortuosity index (TI) for all three coronary arteries in this group of patients, compared to patients with obstructive CAD. The highest TI for LCX was found in patients with lateral ischemia (p < 0.001) and for LAD in patients with anterior ischemia (p < 0.001). When measured by the angle method, the only association was found between LCX tortuosity and lateral ischemia (OR 4.9, p = 0.046). In conclusion, coronary tortuosity represents a pathophysiological mechanism for myocardial ischemia in non-obstructive CAD. The coronary tortuosity index could be a reliable and widely applicable tool for the quantification of coronary tortuosity.

The Association of Severe Coronary Tortuosity and Non-Obstructive Coronary Artery Disease

Background and Objectives: There is an increasing interest in the coronary tortuosity as a novel pathophysiological mechanism of ischemia in coronary artery disease without significant obstruction, but there are a lack of studies to confirm this relationship in the clinical setting. The aim of our study was to evaluate the association of severe coronary tortuosity and the potential role of coronary blood supply dominance in the appearance of myocardial ischemia in patients with non-obstructive coronary artery disease (non-CAD), compared to patients with obstructive coronary artery disease (CAD). Materials and Methods: The study enrolled 131 participants (71 male and 60 female), recruited among patients referred to cardiologists due to angina symptoms with ischemic alterations established by cardiac stress tests, as well as those admitted to the hospital for acute coronary syndrome. Results: Mean age of recruited patients was 61.6 (±10.1) years. According to the coronary angiography, they were divided into two groups: non-obstructive and obstructive CAD (77 and 54, respectively). There were significantly more women (61% vs. 24%, p < 0.001) in the non-CAD group. Both tortuous coronary arteries (50.6% vs. 14.8%, p < 0.001) and left coronary dominance (37.7% vs. 16.7%, p = 0.006) were more frequent in the non-CAD group compared to the CAD group. Female sex (OR = 17.516, p = 0.001), tortuous coronary arteries (OR = 7.962, p = 0.006) and left dominance of blood supply were significant predictors for non-CAD. Conclusions: Non-obstructive CAD is common among patients, especially women, who are referred for coronary angiography. Severe coronary artery tortuosity is the strongest independent predictor of non-obstructive CAD, followed by female gender and left coronary dominance.

Non-electrocardiography- and electrocardiography-gated computed tomography angiography for the evaluation of feline coronary arteries

Objectives

Few studies have directly compared the clinical feasibility of electrocardiography-gated and non-electrocardiography-gated multidetector computed tomography for evaluating coronary arteries in veterinary medicine. We aimed to characterize and visualize feline coronary arteries using these two imaging modalities. We hypothesed that ECG-gated MDCT is superior to or advantageous to the non-ECG gated.

Methods

This prospective, controlled, comparative pilot study examined six client-owned cats (five clinically normal and one with hypertrophic cardiomyopathy) using non-electrocardiography-gated and retrospective electrocardiography-gated scans. Optimal non-electrocardiography scan timing or electrocardiography-gated R-R reconstruction interval for coronary artery visualization was determined. The degree of opacification and sharpness of proximal coronary branches was subjectively graded; coronary dominance, left coronary artery branching types, and the diameter and length of coronary artery branches were also assessed.

Results

Non-electrocardiography-gated images provided the least information on the bilateral coronary artery ostium and proximal segments, while electrocardiography-gated images clarified the detailed course of the main coronary branches at diastole in all cats. The degree of opacification and sharpness of the coronary arteries was subjectively evaluated as good/excellent in all cats. Coronary dominance (left: four; right: two) and left coronary artery branching types (three different patterns, two additional tortuous branches) varied. Body weight and sex were not significantly associated with coronary artery length or diameter. Vertebral heart score positively correlated with the right coronary artery and negatively correlated with the left main coronary artery.

Clinical significance

Electrocardiography-gated multidetector computed tomography provides images with adequate resolution to identify the anatomy of feline coronary arteries. Detailed morphological knowledge of feline coronary vessels will enable novel diagnostic and therapeutic methods in veterinary medicine.

Correlation analysis of coronary artery tortuosity and calcification score

Background

Coronary artery tortuosity (CAT) is regarded as a variation of vascular anatomy, and its relationship with coronary artery calcification (CAC) score is still not well clarified. Studying the correlation between coronary artery calcification scores and CAT to determine specific prevention and intervention populations seems to have more meaningful.

Methods

The study is a cross-sectional retrospective study, including 1280 patients. CAT is defined as the presence of at least three consecutive curvatures of more than 45°measured during systole or diastole of a major epicardial coronary artery. Multivariable regression analysis was used to adjust the clinical parameters directly affecting CAT.

Results

Of these individuals, 445 (35%) were evaluated having CAT, of which females are higher than males (59.1% vs. 40.9%). Moderate CAC score (101–400) (odds ratio (OR) 1.49, 95% confidence interval [95%CI] 1.05–2.10, P = 0.025) revealed significantly associated with CAT on univariable analysis. However, multivariable analysis after adjusting for confounding factors only indicated that CAT was positively correlated with female (OR 1.68, 95%CI 1.30–2.17, P < 0.001), hypertension (OR 1.35, 95% CI 1.04–1.75, P = 0.024), and age (OR 1.02, 95% CI 1.01–1.03, P = 0.001), while was negatively associated with body mass index (BMI) 24–27.9(OR 0.76, 95% CI 0.58–1.00, P = 0.044), and BMI > 28 (OR 0.46, 95% CI 0.31–0.68, P < 0.001). Further analysis stratified by gender showed that compared with non-CAT, CAT was significantly linked with moderate CAC score (OR 1.79, 95% CI 1.00–3.20, P = 0.048), hypertension (OR 1.54, 95% CI 1.07–2.22, P = 0.021), and high-density lipoprotein (HDL) (OR 1.86, 95% CI 1.07–3.24, P = 0.028), while was negatively related to BMI > 28 (OR 0.51, 95% CI 0.31–0.84, P = 0.008) in female patients.

Conclusions

CAT is more likely to be found in females, connected with hypertension, age, and BMI. No significant correlation is found between the presence of tortuosity and calcium score or diameter stenosis on multivariable analysis. Whereas the CAT is associated with moderate CAC score in correlation analysis when women are selected as the main group.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-022-01470-w.

Accuracy of vascular tortuosity measures using computational modelling

Severe coronary tortuosity has previously been linked to low shear stresses at the luminal surface, yet this relationship is not fully understood. Several previous studies considered different tortuosity metrics when exploring its impact of on the wall shear stress (WSS), which has likely contributed to the ambiguous findings in the literature. Here, we aim to analyze different tortuosity metrics to determine a benchmark for the highest correlating metric with low time-averaged WSS (TAWSS). Using Computed Tomography Coronary Angiogram (CTCA) data from 127 patients without coronary artery disease, we applied all previously used tortuosity metrics to the left main coronary artery bifurcation, and to its left anterior descending and left circumflex branches, before modelling their TAWSS using computational fluid dynamics (CFD). The tortuosity measures included tortuosity index, average absolute-curvature, root-mean-squared (RMS) curvature, and average squared-derivative-curvature. Each tortuosity measure was then correlated with the percentage of vessel area that showed a < 0.4 Pa TAWSS, a threshold associated with altered endothelial cell cytoarchitecture and potentially higher disease risk. Our results showed a stronger correlation between curvature-based versus non-curvature-based tortuosity measures and low TAWSS, with the average-absolute-curvature showing the highest coefficient of determination across all left main branches (p < 0.001), followed by the average-squared-derivative-curvature (p = 0.001), and RMS-curvature (p = 0.002). The tortuosity index, the most widely used measure in literature, showed no significant correlation to low TAWSS (p = 0.86). We thus recommend the use of average-absolute-curvature as a tortuosity measure for future studies.