Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China; PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Atherosclerosis. 2019 May;284:187-193. doi: 10.1016/j.atherosclerosis.2019.03.001. Epub 2019 Mar 8.
Atherosclerosis is the first etiology of coronary artery aneurysm (CAA). It is, however, challenging to inhibit the development of CAA. The aim of the study is to carry out morphometric and hemodynamic analyses in epicardial coronary arteries of patients with CAAs caused by atherosclerosis.
Various morphometric parameters were obtained from the reconstructed epicardial coronary arterial trees of 61 patients and multiple hemodynamic parameters were determined from the computed flow fields. A two-step analysis method was proposed to enhance the risk assessment of CAAs, i.e., coronary artery bifurcation is the major risk factor for CAA followed by high aneurysm shape index (L/W, where L and W refer to the aneurysm length and maximum diameter, respectively).
Patients with CAA covering a bifurcation have the higher occurrence (71% and 55% for L/W ≥ 2 and L/W < 2, respectively) of myocardial ischemia relevant to abnormal hemodynamic parameters in comparison with those with CAA in one vessel (43% and 40% for L/W ≥ 2 and L/W < 2, respectively). Patients with CAA of L/W ≥ 2 covering a bifurcation show the worst hemodynamic environment.
Morphometric and hemodynamic studies support the two-step analysis method, which provides a clinical rationale for the noninvasive assessment of CAAs.
动脉粥样硬化是导致冠状动脉瘤（CAA）的首要病因。然而，抑制 CAA 的发展颇具挑战。本研究旨在针对动脉粥样硬化导致的 CAA 患者，开展心外膜冠状动脉的形态计量学和血流动力学分析。
从 61 例 CAA 患者的重建心外膜冠状动脉树中获得了各种形态计量学参数，并从计算的血流场中确定了多个血流动力学参数。提出了一种两步分析方法来增强 CAA 的风险评估，即冠状动脉分叉是 CAA 的主要危险因素，其次是高动脉瘤形状指数（L/W，其中 L 和 W 分别指动脉瘤的长度和最大直径）。
与单一血管 CAA 患者（L/W≥2 时为 43%和 40%，L/W<2 时为 43%和 40%）相比，分叉处有 CAA 覆盖的患者发生与异常血流动力学参数相关的心肌缺血的发生率更高（L/W≥2 时为 71%和 55%，L/W<2 时为 71%和 55%）。L/W≥2 且分叉处有 CAA 覆盖的患者血流动力学环境最差。
形态计量学和血流动力学研究支持两步分析方法，为 CAA 的非侵入性评估提供了临床依据。
