Circulation, Vol 86, 232-246, Copyright © 1992 by American Heart Association
JT Dodge Jr, BG Brown, EL Bolson and HT Dodge
BACKGROUND. Precise knowledge of the expected "normal" lumen diameter at a
given coronary anatomic location is a first step toward developing a
quantitative estimate of coronary disease severity that could be more
useful than the traditional "percent stenosis." METHODS AND RESULTS.
Eighty-three arteriograms were carefully selected from among 9,160
consecutive studies for their smooth lumen borders indicating freedom from
atherosclerotic disease. Of these, 60 men and 10 women had no abnormalities
of cardiac function, seven men had idiopathic dilated cardiomyopathy, and
six men had left ventricular hypertrophy associated with significant aortic
stenosis. Lumen diameter was measured at 96 points in 32 defined coronary
segments or major branches. Measurements were scaled to the catheter,
corrected for imaging distortion, and had a mean repeat measurement error
of 0.12 mm. When sex, anatomic dominance, and branch length were accounted
for, normal lumen diameter at each of the standard anatomic points could
usually be specified with a population variance of +/- 0.6 mm or less (SD)
and coefficient of variation of less than 0.25 (SD/mean). For example, the
left main artery measured 4.5 +/- 0.5 mm, the proximal left anterior
descending coronary artery (LAD) 3.7 +/- 0.4 mm, and the distal LAD 1.9 +/-
0.4 mm. For the LAD, lumen diameter was not affected by anatomic dominance
(right versus left), but for the right coronary artery, proximal diameter
varied between 3.9 +/- 0.6 and 2.8 +/- 0.5 mm (p less than 0.01) and for
the left circumflex, between 3.4 +/- 0.5 and 4.2 +/- 0.6 mm (p less than
0.01). Women had smaller epicardial arterial diameter than men (-9%; p less
than 0.001), even after normalization for body surface area (p less than
0.01). Branch artery caliber was unaffected by the anatomic dominance but
increased with branch length, expressed as a fraction of the origin-to-apex
distance (p less than 0.001). Lumen diameter was not affected by age or by
vessel tortuosity but was significantly increased among men with left
ventricular hypertrophy (+ 17%; p less than 0.001) or dilated
cardiomyopathy (+ 12%; p less than 0.001). CONCLUSIONS. This is a reference
normal data set against which to compare lumen dimensions in various
pathological states. It should be of particular value in the investigation
of diffuse atherosclerotic disease.
ARTICLES
Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation
Department of Medicine, University of Washington, Seattle.
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