Coronary computed tomography angiography findings in young adults

Objective: Various clinically significant cardiovascular anomalies of coronary arteries that are not associated with atherosclerosis have been previously described. This study aimed to evaluate coronary anomalies or variations on coronary computed tomography angiography (CCTA) images in patients aged under 40 years and to compare them with clinical findings, thereby contributing to the literature. Material and Methods: Patients under 40 years who underwent CCTA with current clinical indications between 2015 and 2018 were included in the study. The scans were performed using a 128-slice CT device and electrocardiography triggering in different phases. During the examination, 35%–75% of phases were frequently evaluated although the percentage varied according to the heart rate. Outlet, course, internal structure and termination anabolites, and pathologies, as well as anatomical dominance of coronary arteries, were evaluated. However, unlike this classification, myocardial bridges (MBs) were specified as variations. Coronary artery disease reporting and data system (CAD-RADS) was used to standardize stenosis rates in the walls of coronary arteries and their lumen. Results: Of the 927 CCTAs taken over a 3-year period, 188 belonged to patients under 40 years. The study included 156 men and 32 women with a mean age of 34.99±4.78 years. In the comparison between the patients with and without chest pain in terms of the presence of CAD-RADS 1 and above, a statistically significant higher rate of CAD was found in the group with chest pain (p

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1. World Health Organization. Global Health Observatory (GHO) data. Top 10 causes of death [Internet]. Cited September 2020. Available at: https://www.who.int/gho/mortality_burden_disease/causes_death/ top_10/en/. Accessed Apr 22, 2022.
2. Tsai RJ, Lai HY, Ni CF, Tsao SM, Lan GY, Hsieh KL. Young adult cardiovascular diseases: A single center coronary computed tomography angiography study. Clin Imaging 2018;52:343-9.
3. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012;126:e354-471.
4. Sun Z, Lin C, Davidson R, Dong C, Liao Y. Diagnostic value of 64-slice CT angiography in coronary artery disease: A systematic review. Eur J Radiol 2008;67:78-84.
5. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324-36.
6. Knickelbine T, Lesser JR, Haas TS, Brandenburg ER, Gleason-Han BK, Flygenring B, et al. Identification of unexpected nonatherosclerotic cardiovascular disease with coronary CT angiography. JACC Cardiovasc Imaging 2009;2:1085-92.
7. Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol 2016;8:537-55.
8. Angelini P. Coronary artery anomalies: An entity in search of an identity. Circulation 2007;115:1296-305.
9. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, et al. CAD-RADS(TM) coronary artery disease - reporting and data system. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr 2016;10:269-81.
10. Zhang LR, Xu DS, Liu XC, Wu XS, Ying YN, Dong Z, et al. Coronary artery lumen diameter and bifurcation angle derived from CT coronary angiographic image in healthy people. Zhonghua Xin Xue Guan Bing Za Zhi 2011;39:1117-23. [Article in Chinese]
11. Medrano-Gracia P, Ormiston J, Webster M, Beier S, Young A, Ellis C, et al. A computational atlas of normal coronary artery anatomy. EuroIntervention 2016;12:845-54.
12. Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999;107:254-61.
13. Otaki Y, Gransar H, Cheng VY, Dey D, Labounty T, Lin FY, et al. Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: A study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry. Eur Heart J Cardiovasc Imaging 2015;16:490-9.
14. La Grutta L, Runza G, Lo Re G, Galia M, Alaimo V, Grassedonio E, et al. Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography. Radiol Med 2009;114:1024-36.
15. Lee MS, Chen CH. Myocardial bridging: An up-to-date review. J Invasive Cardiol 2015;27:521-8.
16. Miakinkova LO, Teslenko YV, Tsyhanenko IV. Myocardial bridge as the only cause of acute coronary syndrome among the young patients. Wiad Lek 2018;71:607-11. [Article in Ukrainian]
17. Jiang L, Zhang M, Zhang H, Shen L, Shao Q, Shen L, et al. A potential protective element of myocardial bridge against severe obstructive atherosclerosis in the whole coronary system. BMC Cardiovasc Disord 2018;18:105.
18. Hao Z, Xinwei J, Ahmed Z, Huanjun P, Zhanqi W, Yanfei W, et al. The outcome of percutaneous coronary intervention for significant atherosclerotic lesions in segment proximal to myocardial bridge at left anterior descending coronary artery. Int Heart J 2018;59:467-73.
19. Rubin JB, Borden WB. Coronary heart disease in young adults. Curr Atheroscler Rep 2012;14:140-9.
20. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-77.