The role of septal perforators and "myocardial bridging effect" in atherosclerotic plaque distribution in the coronary artery disease.
The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon, particularly flow patterns in the left and right coronary artery. Nevertheless, it does not explain the difference in lesion frequency between the LAD and the LCx as these are both parts of the left coronary artery. Branching points are considered to be the risk points of atherosclerosis. In the LCx, the number of side branches is lower than in the LAD or RCA and there are no septal perforators with intramuscular courses like in the proximal third of the LAD and the posterior descending artery (PDA). We hypothesized that septal branches generate disturbed flow in the LAD and PDA in a similar fashion to the myocardial bridge (myocardial bridging effect). This coronary architecture determines the non-uniform plaque distribution in coronary arteries and LAD predisposition to plaque formation.
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Jarosław
J
Wasilewski
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Marcin
M
Roleder
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Jacek
J
Niedziela
Department of Mechanical Engineering, University of Sheffield, Sheffield, U.K.
Andrzej
A
Nowakowski
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Tadeusz
T
Osadnik
Department of Diagnostic Imaging, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Jan
J
Głowacki
Department of Mechanical Engineering Fundamentals, Faculty of Mechanical Engineering and Computer Science, University of Bielsko-Biała, Bielsko-Biała, Poland.
Kryspin
K
Mirota
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Lech
L
Poloński
Atherosclerosis; Haemodynamics; Myocardial Bridge; Septal Branch