The Relation between Left Coronary Dominancy and Atherosclerotic Involvement of Left Anterior Descending Artery Origin

Limited information is available regarding the relationship between coronary vessel dominance and atherosclerotic involvement. Rheological factors have been implicated in the pathogenesis of coronary lesions. More than 90% of the coronary blood flow enters the left coronary if it is the dominant artery. The main purpose of this study was to determine the relation between left coronary dominance and atherosclerotic involvement of left anterior descending artery (LAD) origin. In addition, the prevalence and degree of associated ischemic mitral regurgitation (MR) in these patients were assessed. The study included 678 consecutive patients with an indication for coronary angiography. One hundred and twenty two patients with right dominant and 61 patients with left dominant arteries were randomly selected for analysis. All demographics, risk factors, coronary dominancy and involvement, left ventricular ejection fraction (LVEF), and MR were recorded. One hundred and eighty three patients (mean age of 57.7 years) were studied. The types of coronary circulation included right, left, and balanced in 78.6%, 8.9%, and 12.5%, of the patients respectively. In 64 patient with significant LAD lesions, 22 (34.9%) had ostial while the remainder had non-ostial involvement. Ischemic MR was present in 5 (2.7%) patients. There was no difference in demographics, risk factors, LVEF, MR, extent of coronary artery disease, and LAD ostial involvement between left and right dominant circulations. In this study, left coronary dominance was not associated with atherosclerotic involvement of LAD ostium and ischemic MR.