Journal of Hypertension and Cardiology

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ISSN: 2329-9487
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    Variations in Diameter of the Left Coronary Artery and its Main Branches among Adult Population of Khartoum State, Sudan

    Muntaser Alhassen 1   Abuzer Abdalla 2   Tahir Ali 3   Mohamed Akeel 2  

    1Department of Anatomy, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia

    2Department of Anatomy, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia

    3Department of Anatomy, Faculty of Medicine, The National Ribat University, Khartoum, Sudan

    Abstract

    Themain left coronary artery and its branches have wide variability in its morphology regarding caliber, as seen through angiographic imaging. This study aims to determine the diameters of the left coronary artery and its branches among the Sudanese population & to correlate these diameters and the personal and health data. Angiography of 441 patients of both sexes was used in this study. Personal and health information was obtained from the records. We found that the left coronary artery's diameter was between 2.90- 4.90mm, with an average of 3.96mm. The diameter of the left circumflex artery in the range between 1.70- 4.70mm, with an average of 2.73mm, and that of the anterior descending artery in the range between 1.20- 4.70mm, with an average of 2.78mm. We correlated the diameters of the three arteries and the variables of age, gender, BMI, coronary artery disease, smoking habits, and hypertension. Wefound many correlations to be significant. We concluded that the diameters of the left coronary artery and its branches are affected by age, gender, BMI, coronary artery disease, smoking habits, and hypertension.

    Author Contributions
    Received 23 Feb 2021; Accepted 09 Mar 2021; Published 11 Mar 2021;

    Academic Editor: Sanjiv Sharma, Chairman, Dept of Medicine Director, Research and Education Chairman, Health Education and CME Committee Interventional Cardiologist, United States.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright ©  2021 Muntaser Alhassen, et al.

    License
    Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Muntaser Alhassen, Abuzer Abdalla, Tahir Ali, Mohamed Akeel (2021) Variations in Diameter of the Left Coronary Artery and its Main Branches among Adult Population of Khartoum State, Sudan. Journal Of Hypertension And Cardiology - 3(2):1-5.

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    DOI 10.14302/issn.2329-9487.jhc-21-3754

    Introduction

    The great advances in managing patients with coronary artery diseases enable treatment of these patients to be guided by coronary artery angiogram. Such improvement in the angiographic analysis is required to allow more effective application of information that depends on the coronary angiograms for the patients' diagnosis and therapy with ischemic coronary syndromes1. There is great variability in the dimensions of the coronary arteries in the average population2. The study of coronary artery variations, especially the left main coronary artery, can help the clinician plan interventional procedures such as stenting, balloon dilatation, or graft surgery.3 The main left coronary artery (MLCA) is shorter and larger than the right coronary artery 4. Usually, it is the first vessel to show blockages. It has a wide variability in its morphology regarding caliber, length, and the number of branching from the main trunk. These variations should be considered, not as anatomical characteristics only but also in interpreting different clinical events and the corresponding intervention maneuvers. The left coronary artery's mean diameter was reported to range from 3.0 to 6.8mm (4.64 ± 1.03)5. These wide variations are present in different branching patterns. The variation is also due to the effect of ethnicity, gender, age groups, and health condition. There is a lack of reports about the diameters of the left main coronary artery and its branches in the Sudanese population. This study covers this part and also contributes to the worldwide reports in this field. The objective of the study is to determine the angiographic diameters of the main left coronary artery, the left circumflex artery, and the anterior descending artery. It also aims to set a correlation between the diameters of these arteries and other variables like age, sex, surface area, and health problems.

    Materials and Methods

    This is a descriptive retrospective study of coronary angiography. The participants were 441 patients of both sexes. All the patients were above 18 years old and all without congenital heart diseases. Those patients were visitors of 3 Heart Centres in Khartoum State, Sudan. In each patient, a catheter was inserted, and dye was injected into coronary arteries, and X-Ray images were taken from different angles. Measurements of the diameters of the left coronary artery, the left circumflex artery, and the anterior descending artery were taken by 2 independent readers, with negligible variability. Ethical approval was obtained from the Heart centers, and history of personal data and health status was collected from the records. Mean, and standard deviation was calculated for each reading. ANOVA, Mann–Whitney U, and t-Tests were used to calculate the correlations (p-value of .05 or less was considered significant).

    Results

    General Personal & Clinical Data

    A total of 441 patients were included in this study. The general personal data were taken through history, clinical examination, and previous records. Items in descriptive statistics include age (range 43-68years), gender (189males and 252females), BMI (normal:84, overwt:147, obese:210), smoking habit (168 smokers and 273 non-smokers), hypertension (420 hypertensive and 21 normotensives), and coronary diseases(421diseased and 20 non).

    Diameters of the Left Coronary Artery and its Main Branches

    The angiography of these arteries is illustrated in Figure 1.

    Figure 1. AP- anteroposterior angiographic view showing, Left coronary artery: LC, left anterior interventricular ( anterior descending) artery: LAD, and Left Circumflex artery: LCX
    Figure 1.

    The angiographic measurement of the left coronary (LC) diameter was found in the range between 2.90- 4.90mm, mean 3.96, and Std. Dev. 0.549mm. The left circumflex artery's diameter was found in the range between1.70- 4.70mm, mean 2.73 and Std. Deviation .687mm. The diameter of the anterior interventricular artery was found in the range between 1.20- 4.70mm, mean 2.78, and Std. Deviation .825mm. these diameters are blotted in the Graph 1.

    Graph 1. The average diameter of the left coronary (LC) artery, the left circumflex artery (CIR), and anterior interventricular (anterior descending) artery (AI)
    Graph 1.

    Correlations with Personal & Clinical Variables

    Correlations of the diameters with age, sex, BMI, smoking, hypertension, and coronary diseases are shown in Table 1 below.

    Table 1. left coronary (LC) artery, left circumflex artery (CIR), and anterior interventricular artery (AI); p-value of .05 or less was considered significant ( EX.SIG: extremely significant, V.
    Variable: test Age: ANOVA Sex: T-Test BMI: ANOVA Hypertension: Mann–Whitney U test Smoking: T-Test coronary diseases: T-Test
    LC: p. value .000EX.SIG 0.738N.SIG .001V.SIG .000EX.SIG .001V.SIG .000EX.SIG
    CIR: p. value .000EX.SIG 0.094 N.SIG .239N.SIG. .000EX.SIG .000EX.SIG .121N.SIG.
    AI: p. value .000EX.SIG 0.003V.SIG .000EX.SIG. .000EX.SIG. .000EX.SIG. .020SIG

    SIG: very significant, SIG: significant), p-value of more than .05 are stated as. N.SIG

    Discussion

    This study provided insight into the diameters of the left coronary artery (LCA) and its main branches in 441 cases. Measurements were collected from Coronary angiography, supported by personal and clinical data where relevant. The left coronary artery (LCA) diameter in this study was found in the range between 2.90 to 4.90mm, with an average of 3.96 mm for Sudanese. The (LCA) average lumen diameter of the (LCA) was reported 4.4± 0.4mm in an American study6, 3.8±0.8 mm in an African study 5, and 4.64 ± 1.03 mm in an Indian study3. The diameters of the left circumflex artery (CIR) and anterior interventricular (descending) artery (AI) in Sudanese were found to be 2.74 and 2.78 on average, respectively. This could be compared to an American report of 3.6±0.73. And 7±0.5 respectively7. The size of coronary vessels is influenced by factors such as age, sex, body weight, body surface area, weight of the heart, and ethnicity/race8.However, it was reported that there was no correlation between the length of the LCA and its diameter; it also showed no correlation between the diameter of the LCA and its angle of division9. In our study, most of the factors such as ethnicity, gender, age, and health conditions have a significant effect on the variations of the diameters of the three arteries, with p-value less than .05. Exceptions were the sex effect on (LCA) and (CIR), BMI effect on (CIR), and coronary diseases effect on (CIR), which seemed to have less significant effects. In 1992 a study from South Africa 5 reported no statistically significant difference between sexes (p= 0.696). This was true for Sudanese in our study regarding the (LCA) and (CIR), but could not be applied to the (LI). However, another study from New England, only one year later from that of South Africa, stated that the mean luminal diameters of the coronary arteries were larger among men than among women10. The definition of the severity of coronary arterial narrowing depends on proper knowledge of the range of the average size of the coronary arterial tree11. It has been reported that patients with small vessels are at a higher risk of having an adverse outcome following coronary stent placement due to a higher incidence of re-stenosis 12. In coronary artery bypass surgery, the most important factor in predicting the success of the operation is the size of the vessel to which the bypass is anastomosed 13

    Hypertension in our study has a highly positive effect on the diameter of the left coronary artery. It may be on all coronary circulation, although a previous study on multivariate analysis demonstrated that hypertension has less effect 14. The BMI and obesity likewise may have effects on coronary vessels variable with body effort and level of stress, but, despite increased technical difficulty caused by obesity, it is not an independent risk factor 15. The effect of coronary artery disease on the diameter of the main left coronary artery. It may be on the other coronary vessels could be explained by the significant changes in resting and reactive hyperemic coronary flows and resting pressure gradients occurred as the length of a given degree of narrowing of the artery was increased 16.

    Conclusion

    Measurements of the diameters of the Left Coronary Artery (LCA), the left circumflex artery, and the anterior descending artery revealed much variations among the Sudanese population. The variations are due to age, gender, BMI, coronary artery disease, smoking habits, and hypertension.

    References

    1.Johnson M R. (1992) A normal coronary artery: what size is it?. , Circulation 86(1), 331-3.
    2.Saikrishna C, Talwar S, Gulati G, A S Kumar. (2006) Normal coronary artery dimensions in Indians. , IJTCVS 22, 159-64.
    3.Rahalkar A M, Rahalkar M D. (2009) Pictorial essay: Coronary artery variants and anomalies. , The Indian journal of radiology & imaging 19(1), 49.
    4.Ballesteros L, Ramirez L. (2008) Morphological expression of the left coronary artery: a direct anatomical study. Folia morphologica. 67(2), 135-42.
    5.N O Ajayi, Lazarus L, E A Vanker, K S Satyapal. (2013) Anatomic Parameters of the Left Coronary Artery: an Angiographic Study in a South African Population. , International Journal of Morphology 31(4).
    6.Dharmendra P, Anitha T, Madan S. (2013) Clinically significant anatomical variations of the left coronary artery in human cadaveric hearts. , International Journal of Current Research and Review 5(12), 39.
    7.W H Leung, M L Stadius, E L Alderman. (1991) Determinants of normal coronary artery dimensions in humans. 84(6), 2294-306.
    8.Dodge J T Jr, B G, E L Bolson, H T Dodge. (1992) Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. , Circulation 86(1), 232-46.
    9.Fox C, M J Davies, M. (1973) Length of left main coronary artery. , British heart journal 35(8), 796.
    10.O'connor G T, Morton J R, Diehl M J, Olmstead E M, Coffin L H et al.Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. , Circulation 88(5), 2104-10.
    11.W V Vieweg, J S Alpert, A D Hagan. (1976) Caliber and distribution of normal coronary arterial anatomy. , Cathet. Cardiovasc. Diagn 2(3), 269-80.
    12.Elezi S, Kastrati A, Neumann F, Hadamitzky M, Dirschinger J et al. (1998) Vessel Size and Long-Term Outcome After Coronary Stent Placement. , Circulation 98(18), 1875-80.
    13.H L Abrams. (1982) Coronary Arteriography: Pathologic and Prognostic Implications. , AJR Am. J. Roentgenol 139(1), 1-18.
    14.P S Hees, J L Fleg, E G Lakatta, E P Shapiro. (2002) Left ventricular remodeling with age in normal men versus women: novel insights using three-dimensional magnetic resonance imaging. The American journal of cardiology. 90(11), 1231-1236.
    15.J C McClish, Ragosta M, E R Powers, K G Barringhaus, L W Gimple et al. (2004) Effect of acute myocardial infarction on the utility of fractional flow reserve for the physiologic assessment of the severity of coronary artery narrowing. The American journal of cardiology. 93(9), 1102-1106.
    16.Jr Vassiliades, A T, J L Nielsen, J L Lonquist. (2003) Effects of obesity on outcomes in endoscopically assisted coronary artery bypass operations. , In Heart Surg Forum 6(2), 99-101.