Diversity and Determinants of the Three-dimensional Anatomical Axis of the Heart as Revealed Using Multidetector-row Computed Tomography

The location of the heart within the thorax varies significantly between individuals. The resultant diversity of the anatomical cardiac long axis, however, and its determinants, have yet to be systematically investigated. We enrolled 100 consecutive patients undergoing coronary arterial computed tomographic angiography, decomposing the vector of the anatomical cardiac long axis by projecting it to horizontal, frontal, and sagittal planes. The projected vectors on each plane were then converted into three rotation angles using coordinate transformation. We then measured the extent of aortic wedging, using the vertical distance between the inferior margins of the non-adjacent aortic sinus and the epicardium. We took the aortic root rotation angle to be zero when an en face view of the right coronary aortic sinus was obtained in the frontal view, defining leftward rotation to be positive. The mean horizontal, frontal, and sagittal rotation angles were 48.7 degrees +/- 9.5 degrees, 52.3 degrees +/- 12.0 degrees, and 34.0 degrees +/- 11.2 degrees, respectively. The mean extent of aortic wedging, and the aortic root rotation angle, were 42.7 +/- 9.8 mm, and 5.3 degrees +/- 16.4 degrees. Horizontal rotation of the anatomical axis was associated with leftward and ventral rotation, and vice versa. Multivariate analysis showed aortic root rotation to be associated with horizontal cardiac rotation, while aortic wedging is associated with frontal and sagittal cardiac rotation. We have quantified the marked individual variation observed in the anatomical axis of the living heart, identifying the different mechanisms involved in producing the marked three-dimensional diversity of the living heart. (C) 2017 Wiley Periodicals, Inc.