Geerlings-Batt Jade, Sun Zhonghua
Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia.
J Clin Med. 2022 Aug 31;11(17):5143. doi: 10.3390/jcm11175143.
Recent studies have suggested a relationship between wide left coronary artery bifurcation (left anterior descending [LAD]-left circumflex [LCx]) angle and coronary artery disease (CAD). Current literature is multifaceted. Different studies have analysed this relationship using computational fluid dynamics, by considering CAD risk factors, and from simple causal-comparative and correlational perspectives. Hence, the purpose of this systematic review was to critically evaluate the current literature and determine whether there is sufficient evidence available to prove the relationship between LAD-LCx angle and CAD. Five electronic databases (ProQuest, Scopus, PubMed, CINAHL Plus with Full Text, and Emcare) were used to locate relevant texts, which were then screened according to predefined eligibility criteria. Thirteen eligible articles were selected for review. Current evidence suggests individuals with a wide LAD-LCx angle experience altered haemodynamics at the bifurcation site compared to those with narrower angles, which likely facilitates a predisposition to developing CAD. However, further research is required to determine causality regarding relationships between LAD-LCx angle and CAD risk factors. Insufficient valid evidence exists to support associations between LAD-LCx angle and degree of coronary stenosis, and future haemodynamic analyses should explore more accurate coronary artery modelling, as well as CAD progression in already stenosed bifurcations.
近期研究表明，左冠状动脉宽分叉（左前降支[LAD] - 左旋支[LCx]）角度与冠状动脉疾病（CAD）之间存在关联。当前的文献具有多面性。不同的研究从计算流体动力学、考虑CAD危险因素以及简单的因果比较和相关性角度分析了这种关系。因此，本系统评价的目的是批判性地评估当前文献，并确定是否有足够的证据证明LAD - LCx角度与CAD之间的关系。使用五个电子数据库（ProQuest、Scopus、PubMed、CINAHL Plus with Full Text和Emcare）来查找相关文本，然后根据预定义的纳入标准进行筛选。选择了13篇符合条件的文章进行综述。目前的证据表明，与角度较窄的个体相比，LAD - LCx角度宽的个体在分叉部位的血流动力学发生了改变，这可能促进了CAD的易感性。然而，需要进一步的研究来确定LAD - LCx角度与CAD危险因素之间关系的因果性。没有足够的有效证据支持LAD - LCx角度与冠状动脉狭窄程度之间的关联，未来的血流动力学分析应探索更准确的冠状动脉建模，以及已狭窄分叉处的CAD进展情况。
