Key result
Male sex is linked to ~3.9-fold higher odds of a high coronary sinus ostium level.
Why the study?
Variations in coronary sinus anatomy may complicate cardiac resynchronization therapy procedures, and preoperative computed tomography angiography may improve procedural planning by characterizing coronary sinus morphometry and spatial orientation.
Cross-Sectional (n=300)
No
Odds Ratio: 3.86 (95% CI 2.05–7.26)
p-value: p=<0.001
Preoperative computed tomography angiography can identify patient-specific differences in coronary sinus morphometry and spatial orientation, potentially aiding in navigating challenging anatomy during cardiac resynchronization therapy implantation.
These associations should not yet change practice; hypothesis-generating for sex- and age-specific coronary sinus anatomy in future studies.
BACKGROUND: This study aimed to characterize the morphometric features and three-dimensional spatial orientation of the coronary sinus ostium (CSO) within the right atrium using computed tomography angiography, and to identify demographic and anatomical determinants of CSO level. MATERIALS AND METHODS: A total of 300 individuals (147 women and 153 men; mean age, 50.27 ± 10.39 years) who underwent coronary computed tomography angiography (CTA) were included in this retrospective cross-sectional study. Morphometric parameters included the proximal and distal coronary sinus diameters, CSO diameter, CSO-right atrial floor distance (CSO level), mean left ventricular wall thickness, septal wall thickness, proximal diameters of four major coronary arteries, and axial, coronal, and sagittal spatial angles of the CSO. RESULTS: All coronary artery diameters and both ventricular wall-thickness measures were significantly greater in men. Coronary sinus and CSO diameters increased with age, whereas CSO level decreased (r = -0.221, p < 0.001). The CSO formed angles of 65.15° ± 11.08°, 33.51° ± 17.95°, and 32.58° ± 17.47° with the axial, coronal, and sagittal planes, respectively, with no significant sex differences. In multivariable logistic regression analysis, male sex was independently associated with a higher CSO level, whereas older age, greater septal wall thickness, larger CSO diameter, and a larger sagittal angle were associated with a lower CSO level; mean left ventricular (LV) free-wall thickness (anterior and lateral) was not an independent predictor. CONCLUSIONS: Selected coronary sinus and cardiac morphometric parameters exhibited sex-related differences, while coronary sinus and CSO diameters increased progressively with age. The three-dimensional spatial orientation of the CSO within the right atrium appears to be a sex-independent anatomical parameter.Preoperative CTA may contribute to a better understanding of coronary sinus anatomy and, in selected cases, may facilitate procedural planning for coronary sinus-based cardiac interventions.
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Aygün et al. (2026) conducted a cross-sectional in Coronary computed tomography angiography indications (n=300). Male sex vs. Female sex was evaluated on High coronary sinus ostium (CSO) level (≥ 43 mm from the lower border of the right atrium) (OR 3.86, 95% CI 2.05-7.26, p=<0.001). Male sex was independently associated with a higher coronary sinus ostium level (OR 3.86), whereas older age, greater septal wall thickness, and larger ostium diameter were associated with a lower level.
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