Hemodynamic mechanisms of coronary insufficiency development in patients with coronary artery tortuosity

  • Y. Lebedieva Interventional Cardiology Department, SI «Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine»
  • V. Lazoryshynets Interventional Cardiology Department, SI «Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine»
  • M. Grusha Biology Department, Bogomolets National Medical University
  • M. Brianskyi Interventional Cardiology Department, SI «Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine»
Keywords: ischemic heart disease, coronary artery tortuosity, coronary hemodynamics violation, myocardial ischemia, hemodynamic resistance

Abstract

In the article we considered the potential mechanisms of coronary insufficiency development in patients with tortuous coronary arteries (CA) in the absence of hemodynamically significant atherosclerotic lesions. In particular, the role of resistance change due to the increase in length, the number and angles of CA bends, in the development of clinical manifestations of myocardial ischemia had been examined in patients with such a configuration anomaly of CA. The results of clinical studies and stress tests (stress vector-echocardiography, stress vector-cardiography, veloergometry) were presented. These results testified to the presence of latent myocardial ischemia in patients with tortuous CA in the absence of hemodynamically significant atherosclerotic lesions. That myocardial ischemia can be caused by the increase of hemodynamic resistance of tortuous CA on condition that the atherosclerotic lesion of the vascular wall is absent. The increase of hemodynamic resistance, primarily, is associated with the increase of resistance along the length of CA and the appearance of resistance amount which created by the bends of tortuous vessels. The article substantiates the reason for the decrease of the leading role of vascular configuration as a factor of coronary hemodynamics violation under the conditions of development of hemodynamically significant atherosclerotic lesion of their vascular wall. The presented data testify to the existence of a potential threat of development of ischemic myocardial damage in patients with tortuous CA, mainly caused by a decrease in the relative volume of blood supply and/or functional reserve of coronary bed.

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Published
2018-12-05
How to Cite
Lebedieva, Y., Lazoryshynets, V., Grusha, M., & Brianskyi, M. (2018). Hemodynamic mechanisms of coronary insufficiency development in patients with coronary artery tortuosity. Likarsʹka Sprava, (3-4), 51-62. https://doi.org/10.31640/3-4.2018(8)
Section
Original intestigations