Screening for proximal coronary artery anomalies with 3-dimensional MR coronary angiography |
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Authors: | Niek H Prakken Maarten J Cramer Marlon A Olimulder Pierfrancesco Agostoni Willem P Mali Birgitta K Velthuis |
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Institution: | (1) Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;(2) Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands |
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Abstract: | Under 35 years of age, 14% of sudden cardiac death in athletes is caused by a coronary artery anomaly (CAA). Free-breathing
3-dimensional magnetic resonance coronary angiography (3D-MRCA) has the potential to screen for CAA in athletes and non-athletes
as an addition to a clinical cardiac MRI protocol. A 360 healthy men and women (207 athletes and 153 non-athletes) aged 18–60 years
(mean age 31 ± 11 years, 37% women) underwent standard cardiac MRI with an additional 3D-MRCA within a maximum of 10 min scan
time. The 3D-MRCA was screened for CAA. A 335 (93%) subjects had a technically satisfactory 3D-MRCA of which 4 (1%) showed
a malignant variant of the right coronary artery (RCA) origin running between the aorta and the pulmonary trunk. Additional
findings included three subjects with ventral rotation of the RCA with kinking and possible proximal stenosis, one person
with additional stenosis and six persons with proximal myocardial bridging of the left anterior descending coronary artery.
Coronary CT-angiography (CTA) was offered to persons with CAA (the CAA was confirmed in three, while one person declined CTA)
and stenosis (the ventral rotation of the RCA was confirmed in two but without stenosis, while two people declined CTA). Overall
3D MRCA quality was better in athletes due to lower heart rates resulting in longer end-diastolic resting periods. This also
enabled faster scan sequences. A 3D-MRCA can be used as part of the standard cardiac MRI protocol to screen young competitive
athletes and non-athletes for anomalous proximal coronary arteries. |
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