Anatomic features in SCAD assessed by CCT: A propensity score matching case control study

Ann Cardiol Angeiol (Paris). 2021 Jun;70(3):161-167. doi: 10.1016/j.ancard.2021.01.003. Epub 2021 May 3.

Abstract

Purpose: Spontaneous coronary artery dissection (SCAD) may occur in middle age population without any cardiovascular risk factor. We retrospectively evaluated anatomic features of 11 patients with SCAD using a coronary arteries computed tomography (CCT), compared to age and sex balanced patients who underwent CCT.

Material and methods: CCT was performed in 11 patients (7 females and 4 males) as follow-up in patients with SCAD (left anterior descending - LAD or circumflex artery - Cx) and compared, using the propensity score matching analysis, with 11 healthy patients. Several anatomic features were evaluated: Left main (LM) length, angle between descending coronary artery (LAD) and its first branch, angle between LAD and LM, distance from the annulus to RCA (a-RCA distance) and LM (a-LM distance) ostia and their ratio; ratio between LM length and length a-LM and tortuosity score of the vessel with SCAD. A fluid dynamic analysis has been performed to evaluate the effects on shear stress of vessels wall.

Results: LM length was significantly shorter in patients with SCAD versus healthy subjects (P=0.01) as well as LM length/a-LM (P=0.03) and the angle between LAD and the first adjacent branch was sharper (P<0.01). Tortuosity score showed a statistically significant difference between groups (P<0.001). Fluid dynamic analysis demonstrates that, in SCAD group, an angle<90 degree is present at the first bifurcation and it can be a cause of increased strain on vessel wall in patients with high tortuosity of coronary artery.

Conclusion: Tortuosity and angle between the LAD and the adjacent arterial branch combined may determine increased shear stress on the vessel wall that increases the risk of SCAD.

Keywords: Anatomic features; Caractéristiques anatomiques; Coefficient de propension; Coronary arteries computed tomography; Coroscanner; Dissection spontanée des artères coronaires; Dynamique des fluides; Fluid dynamics; Propensity score matching; Spontaneous coronary artery dissection.

MeSH terms

  • Age Factors
  • Case-Control Studies
  • Computed Tomography Angiography*
  • Coronary Angiography / methods*
  • Coronary Vessel Anomalies / diagnostic imaging*
  • Coronary Vessel Anomalies / etiology
  • Coronary Vessel Anomalies / physiopathology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology
  • Coronary Vessels / physiopathology
  • Female
  • Hemorheology / physiology
  • Humans
  • Male
  • Middle Aged
  • Propensity Score*
  • Retrospective Studies
  • Sex Factors
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / etiology
  • Vascular Diseases / physiopathology

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous