Detection of Anatomical Variations and Pathological Findings of Coronary Arteries Using CT Coronary Angiography (CTCA) in Sudanese Adults in a Tertiary Hospital

TL;DR

This study uses CT coronary angiography to detect heart artery issues in Sudanese adults, finding common stenosis patterns and anatomical variations.

Contribution

The study provides new insights into coronary artery disease patterns and anatomical variations specific to the Sudanese population.

Findings

The left anterior descending artery was most commonly affected by stenosis.

Myocardial bridging was the most frequent congenital anomaly detected.

Malignant RCA origin from the left cusp was the most common anatomical variation observed.

Abstract

Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Traditional diagnostic methods relied on electrocardiography (ECG) and cardiac enzyme testing, with limited accuracy. With advances in imaging, ECG-gated CT coronary angiography (CTCA) has become a reliable, non-invasive tool for risk assessment and diagnosis of coronary artery disease (CAD).

Methods: A retrospective, cross-sectional study was conducted in the radiology department of Ahmed Gasim Hospital, Sudan. Data were extracted from 95 CTCA reports between January 2020 and June 2022 using a structured 14-item questionnaire. Patient demographics, calcium scores, coronary stenosis/occlusion, congenital anomalies, and anatomical variations were analysed.

Results: The mean patient age was 51 years (range: 20-87), with male patients comprising 56.8%. Most patients (63.2%) had a calcium score of zero. Among positive scores, 17.9% were <100, 13.7% were 100-500, 2.1% were 500-1000, and 3.2% were >1000. The left anterior descending artery (LAD) was the most frequently affected artery (20.0%), followed by the right coronary artery (RCA) (13.7%), and left circumflex artery (LCX) (10.5%); left main coronary artery (LMCA) showed no stenosis. Proximal severe stenosis was the predominant pattern. Congenital anomalies were detected in six patients (6.3%), most commonly myocardial bridging. Anatomical variations were also found in five patients (5.3%), with malignant RCA origin from the left cusp being the most frequent.

Conclusion: CTCA effectively identified calcium scores, stenosis, congenital anomalies, and anatomical variations in Sudanese patients. Findings highlight a predominance of proximal severe stenosis in LAD and RCA, with myocardial bridging as the most frequent congenital anomaly and malignant RCA origin as the most common variation.