Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan.
Department of Cancer Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
PLoS One. 2018 Jun 12;13(6):e0198566. doi: 10.1371/journal.pone.0198566. eCollection 2018.
A high coronary artery calcium score (CACS) predicts a poor prognosis in patients with coronary artery disease. We examined the relationship between the bifurcation angle and the CACS of the left main (LM) and left anterior descending (LAD) arteries in patients suffering from chronic kidney disease (CKD).
We analyzed the data of 121 patients who underwent coronary computed tomography between October 2014 and June 2015 and whose estimated glomerular filtration rate (eGFR) was <60 ml/min/1.73 m2. The LM-LAD bifurcation angle was measured by 3-dimensional coronary computed tomography. The CACS of the LM-LAD arteries was also calculated. We excluded stent recipients and patient who had undergone coronary artery bypass graft surgery.
In the overall sample, the mean ± standard deviation (range) LM-LAD bifurcation angle was 35.9 ± 11.4° (6.8-79.4°) and mean CACS was 227 ± 351 (0 to 1,695). The mean LM-LAD arteries angle was 40.3° ± 10.0° in 39 patients whose CACS was ≥200, versus 33.8° ± 11.6° in 82 patients with CACS <200 (p = 0.003). A weak, but positive correlation (r = 0.269, p = 0.003) was observed between the LM-LAD arteries angle and CACS of the LM-LAD arteries. By multiple variable analysis, hemoglobin A1c, triglycerides, eGFR and the LM-LAD arteries angle were independent predictors of a high CACS of the LM-LAD arteries.
In patients with CKD, a wide LM-LAD arteries angle was associated with a high CACS of the LM-LAD arteries. The prognostic value of this observation warrants further evaluation.
高冠状动脉钙评分（CACS）可预测冠心病患者的预后不良。我们研究了慢性肾脏病（CKD）患者左主干（LM）和左前降支（LAD）冠状动脉分叉角度与 CACS 之间的关系。
我们分析了 2014 年 10 月至 2015 年 6 月期间接受冠状动脉计算机断层扫描检查且估算肾小球滤过率（eGFR）<60 ml/min/1.73 m2 的 121 例患者的数据。通过三维冠状动脉计算机断层扫描测量 LM-LAD 分叉角度。还计算了 LM-LAD 动脉的 CACS。我们排除了支架置入患者和接受冠状动脉旁路移植术的患者。
在总体样本中，LM-LAD 分叉角度的平均值±标准差（范围）为 35.9±11.4°（6.8-79.4°），平均 CACS 为 227±351（0 至 1695）。CACS≥200 的 39 例患者的平均 LM-LAD 动脉角度为 40.3°±10.0°，而 CACS<200 的 82 例患者的平均 LM-LAD 动脉角度为 33.8°±11.6°（p=0.003）。LM-LAD 动脉角度与 LM-LAD 动脉 CACS 之间存在弱但呈正相关（r=0.269，p=0.003）。多变量分析显示，血红蛋白 A1c、甘油三酯、eGFR 和 LM-LAD 动脉角度是 LM-LAD 动脉高 CACS 的独立预测因子。
在 CKD 患者中，LM-LAD 动脉角度较宽与 LM-LAD 动脉 CACS 较高相关。这种观察结果的预后价值需要进一步评估。
