Degrees of Cross-Sectional-Area Luminal Narrowing of the Four Major Epicardial Coronary Arteries in Patients With Otherwise Functionally and Anatomically Normal Hearts

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Described herein are necropsy findings in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries in 86 patients aged 10-70 years who never had symptoms of myocardial ischemia, and at autopsy had otherwise anatomically normal hearts. All 86 died of a non-cardiovascular condition. In each of these patients all 4 major epicardial coronary arteries were excised intact from the heart, divided into 5-mm segments, and each segment prepared for histologic examination. The degrees of cross-sectional area (CSA) narrowingwere determined from histologic examination of each 5-mm segment. The degree of narrowing in each 5 mm segment was divided into 4 categories: 0% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. Twelve patients (14%) had ≥1 artery narrowed >75% in CSA, a single artery in 9 patients, and 2 arteries in each of 3 patients. In contrast to the relative infrequency of narrowing >75%, narrowing 51-75% was common, and was present in 36 (42%) of the 86 patients. Of the 258 major coronary arteries (excludes the left main) studied in the 86 patients, 15 (6%) were narrowed >75%, and 70 (24%) were narrowed 51% to 75% in CSA. Even mild narrowing (26% to 50%) of the left main coronary artery (66 patients) was generally accompanied by 51% to 75% or greater narrowing of at least one of the other major coronary arteries. In conclusion, even hearts which have functioned normally and are otherwise anatomically normal, usually have some degree of atherosclerotic plaque in the major epicardial coronary arteries.

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Method

The 86 asymptomatic (from a cardiac standpoint) patients, aged 10 to 70 years, 43 male and 45 female, were studied in the Pathology Branch of the National Heart, Lung, and Blood Institute of the National Institutes of Health in the years 1975 and 1976. Of the 86 patients, 77 (90%) had died from neoplastic diseases (carcinoma 37, lymphoma 19, leukemia 15, sarcoma 6) and 9, from non­neoplastic diseases (systemic lupus erythematosus 2, and one each from 7 different conditions). Among the 86

Results

The maximal degree of CSA luminal narrowing of any of the 3 major epicardial coronary arteries (left anterior descending, left circumflex, and right) is shown in Table 3. Of the 22 patients aged 10 to 30 years, 2 (9%) (single artery in both) had a coronary artery narrowed >75%; of the 27 patients aged 31 to 50 years, 3 (11%) had a coronary artery narrowed >75%, and among the 37 patients aged 51 to 70 years, 7 (19%) had at least one artery narrowed >75%. A total of 258 coronary arteries (3 per

Discussion

This study is unique in several ways. First, the clinical histories of all the patients were available and were reviewed in detail. All 86 patients studied had died of non-cardiovascular causes, mainly cancer. Their hearts were of normal size, neither ventricle was dilated, and the wall thicknesses of both ventricles were normal. There were no areas of myocardial necrosis or fibrosis. The epicardial coronary arteries in each patient were removed intact, and all histologic sections were stained

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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