Friedman M H, Brinkman A M, Qin J J, Seed W A
Biomedical Engineering Center, Ohio State University, Columbus 43210.
Atherosclerosis. 1993 Jan 25;98(2):193-9. doi: 10.1016/0021-9150(93)90128-h.
The relationship between the angle formed by the left circumflex (LCX) and left anterior descending (LAD) coronary arteries at the bifurcation of the left main coronary artery (LM) and the location of sudanophilia in the proximal portions of the LCX and LAD, was investigated, using a normalized index of disease severity (relative proximal involvement, RPI) to isolate the local effect of geometry on the predisposition to disease from that of other risk factors. Multiplane angiograms of the left coronary artery system of 15 hearts were digitized and processed to form a three-dimensional representation of the centerline of the lumen (termed the 'axis') of each coronary segment; the LM branch angle was objectively computed from the reconstruction. The coronary vessels were fixed in situ, removed from the hearts, opened longitudinally and stained with Sudan IV. The RPIs of the LAD and LCX were obtained by dividing the percentage sudanophilia seen en face in the first 1 cm of each vessel by the percentage sudanophilia in the first 5 cm. RPI was correlated negatively with LM branch angle, suggesting that a small LM branch angle may be a 'geometric risk factor' for proximal atherosclerotic disease in the daughter vessels. The correlation was stronger for the LCX than the LAD. These results would appear to be consistent with the notion that atherosclerosis is favored where a larger extent of the vessel experiences fluid dynamic wall shears near zero for an appreciable part of the pulsatile cycle.
研究了左冠状动脉主干（LM）分叉处左旋支（LCX）与左前降支（LAD）冠状动脉形成的角度，以及LCX和LAD近端嗜苏丹性的位置之间的关系，使用疾病严重程度的标准化指数（相对近端受累，RPI）来分离几何形状对疾病易感性的局部影响与其他危险因素的影响。对15颗心脏的左冠状动脉系统的多平面血管造影进行数字化处理，以形成每个冠状动脉节段管腔中心线（称为“轴”）的三维表示；从重建中客观计算LM分支角度。冠状动脉原位固定，从心脏中取出，纵向切开并用苏丹IV染色。LAD和LCX的RPI通过将每根血管前1 cm正面观察到的嗜苏丹性百分比除以5 cm处的嗜苏丹性百分比来获得。RPI与LM分支角度呈负相关，表明较小的LM分支角度可能是子血管近端动脉粥样硬化疾病的“几何危险因素”。LCX的相关性比LAD更强。这些结果似乎与以下观点一致，即动脉粥样硬化在血管的较大范围在脉动周期的相当一部分时间内经历接近零的流体动力壁切应力的地方更易发生。
