Knyshov G. V., Lebedeva E. O., Kundin V. Yu., Pliska A. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

This article is devoted to the diagnostics issues of phenomenon of tortuosity of the coronary arteries. Certain information that is founded in the literature about effect of coronary artery tortuosity on myocardial perfusion and function ability testifies to the lack of attention of cardiologists to this characteristic of vessels, on the background a sufficiently high frequency detection (9,2-12,45 %) of this phenomenon on the results of angiography. As the coronary artery tortuosity which was detected during selective coronary angiography still remains for practitioners only as clinically insignificant finding and is not considered as a pathological condition, respectively, this phenomenon is reflected in modern nomenclature of ischemic heart disease. Given to the lack of literature about the role of coronary artery tortuosity in the genesis of ischemic myocardial damage, the purpose of this study was to determine the clinical significance as well as necessity for prevention and treatment of this vascular anomaly. Myocardial scintigraphy was performed 22 patients with tortuous coronary arteries without atherosclerotic lesions, which were examined by coronary angiography in SI “Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine”. Total average index of left ventricular perfusion of all examined patients was 79 ± 3,9 %. According to coronary angiography of patients were identified 25 intact and 41 tortuous coronary arteries. Further were determined indexes of left ventricular perfusion for each area of myocardium that supplying from both intact and tortuous coronary arteries. Average index of left ventricular perfusion was 76,9 ± 6,9 % (in 19 areas of vascularization of circumflex and right coronary arteries) for tortuous coronary arteries and 85,9 ± 7,0 % (in 25 areas of vascularization of circumflex and right coronary arteries) for intact coronary arteries. Analysis of these data obtained significant differences of left ventricular perfusion for areas of vascularization of tortuous and intact coronary arteries (t = 4,213, p < 0,05). Further were determined ability to accumulate myocardial radiotracer for areas of myocardium that supplying from intact as well as tortuous circumflex and right coronary arteries. Also was obtained significant difference of indexes of left ventricular perfusion for circumflex and right coronary arteries (p < 0,05). The average index of left ventricular perfusion for tortuous left anterior descending artery (n = 22) was 74,8 ± 4,4 %. For tortuous left anterior descending artery comparison group was absent. Аccording to the data of other tortuous branches can be assumed that in the area of vascularization of left anterior descending artery is also reduced ability to accumulate myocardial radiotracer. Similar results were obtained in other studies devoted to the myocardial perfusion disorders is caused by tortuous coronary arteries. Based on the analysis of myocardial scintigraphy patients with tortuous coronary arteries without atherosclerotic lesions it was revealed that tortuosity of the coronary arteries is an independent cause of myocardial perfusion disorders as well as of ischemic heart disease. Although, despite to the optimistic results of this study, in order to determine the standards for diagnosing as well as the clinical significance of the coronary artery tortuosity, it is important to conduct further research in this direction.

tortuous coronary arteries, myocardial ischemia, ischemic heart disease, myocardial scintigraphy

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