Sun, Zhonghua and Chaichana, Thanapong (2017) An investigation of correlation between left coronary bifurcation angle and hemodynamic changes in coronary stenosis by coronary computed tomography angiography-derived computational fluid dynamics. Quantitative Imaging in Medicine and Surgery, 7 (5). ISSN 2223-4306
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Abstract
Background: To investigate the correlation between left coronary bifurcation angle and coronary stenosis
as assessed by coronary computed tomography angiography (CCTA)-generated computational fluid
dynamics (CFD) analysis when compared to the CCTA analysis of coronary lumen stenosis and plaque lesion
length with invasive coronary angiography (ICA) as the reference method.
Methods: Thirty patients (22 males, mean age: 59±6.9 years) with calcified plaques at the left coronary
artery were included in the study with all patients undergoing CCTA and ICA examinations. CFD
simulation was performed to analyze hemodynamic changes to the left coronary artery models in terms of
wall shear stress, wall pressure and flow velocity, with findings correlated to the coronary stenosis and degree
of bifurcation angle. Calcified plaque length was measured in the left coronary artery with diagnostic value
compared to that from coronary lumen and bifurcation angle assessments.
Results: Of 26 significant stenosis at left anterior descending (LAD) and 13 at left circumflex (LCx) on
CCTA, only 14 and 5 of them were confirmed to be >50% stenosis at LAD and LCx respectively on ICA,
resulting in sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of
100%, 52%, 49% and 100%. The mean plaque length was measured 5.3±3.6 and 4.4±1.9 mm at LAD and
LCx, respectively, with diagnostic sensitivity, specificity, PPV and NPV being 92.8%, 46.7%, 61.9% and
87.5% for extensively calcified plaques. The mean bifurcation angle was measured 83.9±13.6º and 83.8±13.3º
on CCTA and ICA, respectively, with no significant difference (P=0.98). The corresponding sensitivity,
specificity, PPV and NPV were 100%, 78.6%, 84.2% and 100% based on bifurcation angle measurement on
CCTA, 100%, 73.3%, 78.9% and 100% based on bifurcation angle measurements on ICA, respectively. Wall
shear stress was noted to increase in the LAD and LCx models with significant stenosis and wider angulation
(>80º), but demonstrated little or no change in most of the coronary models with no significant stenosis and
narrower angulation (<80º).
Conclusions: This study further clarifies the relationship between left coronary bifurcation angle and
significant stenosis, with angulation measurement serving as a more accurate approach than coronary lumen
assessment or plaque lesion length for determining significant coronary stenosis. Left coronary bifurcation
angle is suggested to be incorporated into coronary artery disease (CAD) assessment when diagnosing
significant CAD.
| Item Type: | Article |
|---|---|
| Keywords: | Angulation; coronary artery disease (CAD); calcification; coronary plaques; computational fluid dynamics (CFD); correlation; coronary computed tomography angiography (CCTA) |
| Faculty / Department: | Faculty of Human and Digital Sciences > Mathematics and Computer Science |
| Depositing User: | Thanapong Chaichana |
| Date Deposited: | 23 Oct 2017 08:50 |
| Last Modified: | 08 Jan 2018 11:27 |
| URI: | https://hira.hope.ac.uk/id/eprint/2223 |
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