Prevalence and Morphology of Coronary Artery Ectasia with Dual-source CT Coronary Angiography
Amr AbdAlwahab Ismail;
Abstract
Coronary artery ectasia (CAE) has been observed by pathologists and cardiologists for more than two centuries.
The most recent definitions of Coronary artery aneurysms are defined as coronary artery segments that (a) have a diameter that exceeds the diameter of normal adjacent coronary segments or the diameter of the patient’s largest coronary vessel by 1.5 times and (b) involve less than 50% of the total length of the vessel. Coronary artery ectasiais used to describe diffuse dilatation (>1.5times the normal diameter) of the coronary arteries that involves 50% or more of the length of the artery. In children, according to the criteria established by the Japanese Ministry of Health in 1984, a coronary artery aneurysm is present when the diameter of the lumen is more than 3 mm in children younger than 5 years old or more than 4 mm in those 5 years old or older.
The exact mechanism of CAE development is unknown, but evidences suggest a combination of genetic predisposition, common risk factors for coronary artery disease and abnormal vessel wall metabolism.
Recent advances in multi-detector row computed tomography coronary angiography (CTCA) have continuously increased its role in non-invasive imaging of the coronary arteries.
CTCA is now routinely performed as a non-invasive filter test for demonstrating or excluding coronary artery stenosis in patients with low to intermediate pre-test probability of CAD. Thus, a variety of associated cardiac abnormalities are increasingly encountered in patients for the first time with CTCA.
The aim of this study was to assess the prevalence and morphologic characteristics of Coronary Artery Ectasia with CT coronary angiography in Egyptian population.
Our study included 224 patients underwent CT coronary angiography in KobryAlkobba Military Hospital throughout the period from December 2013 to May 2014.
All patients were subjected to thorough history taking including age, sex, cardiovascular risk factors.
The study included 224 patients with mean age of 55.8 years, with male predominance (74%), 47% were diabetics and 47% had hypertension 42% with dyslipidemia.
6.2% of patients showed dilated coronaropathy and 93.8% without dilated coronaropathy.Male gender, Smoking, hypertension and positive family history of CAD were significantly prevalent among patients with CAE.Age and Diabetes mellitus were inversely associated with the presence of CAE.
Ectasia was most frequently found in LAD (46%). According to Markis classification type I was in 43% of the patients (43%). Diffuse affection was more common than segmental (focal) affection in all vessels. Fusiform shape was found more frequently than Saccular shape with no significant difference among their distribution. Worth notice that saccular type was usually focal & mostly coexists with obstructive coronary lesions.
Thus as compared to coronary angiography, the current gold standard in detection of coronary ectasia, Specificity of CTCA was 100 %, with 89.5 % Sensitivity in detection and assessment of CAE.
The most recent definitions of Coronary artery aneurysms are defined as coronary artery segments that (a) have a diameter that exceeds the diameter of normal adjacent coronary segments or the diameter of the patient’s largest coronary vessel by 1.5 times and (b) involve less than 50% of the total length of the vessel. Coronary artery ectasiais used to describe diffuse dilatation (>1.5times the normal diameter) of the coronary arteries that involves 50% or more of the length of the artery. In children, according to the criteria established by the Japanese Ministry of Health in 1984, a coronary artery aneurysm is present when the diameter of the lumen is more than 3 mm in children younger than 5 years old or more than 4 mm in those 5 years old or older.
The exact mechanism of CAE development is unknown, but evidences suggest a combination of genetic predisposition, common risk factors for coronary artery disease and abnormal vessel wall metabolism.
Recent advances in multi-detector row computed tomography coronary angiography (CTCA) have continuously increased its role in non-invasive imaging of the coronary arteries.
CTCA is now routinely performed as a non-invasive filter test for demonstrating or excluding coronary artery stenosis in patients with low to intermediate pre-test probability of CAD. Thus, a variety of associated cardiac abnormalities are increasingly encountered in patients for the first time with CTCA.
The aim of this study was to assess the prevalence and morphologic characteristics of Coronary Artery Ectasia with CT coronary angiography in Egyptian population.
Our study included 224 patients underwent CT coronary angiography in KobryAlkobba Military Hospital throughout the period from December 2013 to May 2014.
All patients were subjected to thorough history taking including age, sex, cardiovascular risk factors.
The study included 224 patients with mean age of 55.8 years, with male predominance (74%), 47% were diabetics and 47% had hypertension 42% with dyslipidemia.
6.2% of patients showed dilated coronaropathy and 93.8% without dilated coronaropathy.Male gender, Smoking, hypertension and positive family history of CAD were significantly prevalent among patients with CAE.Age and Diabetes mellitus were inversely associated with the presence of CAE.
Ectasia was most frequently found in LAD (46%). According to Markis classification type I was in 43% of the patients (43%). Diffuse affection was more common than segmental (focal) affection in all vessels. Fusiform shape was found more frequently than Saccular shape with no significant difference among their distribution. Worth notice that saccular type was usually focal & mostly coexists with obstructive coronary lesions.
Thus as compared to coronary angiography, the current gold standard in detection of coronary ectasia, Specificity of CTCA was 100 %, with 89.5 % Sensitivity in detection and assessment of CAE.
Other data
| Title | Prevalence and Morphology of Coronary Artery Ectasia with Dual-source CT Coronary Angiography | Other Titles | شيوع و الخصائص المورفولوجية لتمدد الشرايين التاجية للقلب باستخدام الأشعة المقطعية ثنائية المصدر | Authors | Amr AbdAlwahab Ismail | Issue Date | 2014 |
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