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Çamci S, Ari H, Sünbül A, Ari S, Melek M, Bozat T. Safety and efficacy results of percutaneous renal stent implantation in patients with acute coronary syndrome with ectatic and aneurysmatic coronary arteries. Postgrad Med 2024; 136:95-102. [PMID: 38299468 DOI: 10.1080/00325481.2024.2313447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND For the treatment of stenotic lesions developing in dilated coronary arteries, it is difficult to find an appropriately sized coronary stent given that the vessel diameter is too large. This poses a greater problem, especially in patients who require urgent intervention, such as acute coronary syndrome. OBJECTIVE We aimed to evaluate the efficacy and safety of renal stents implanted in ectatic/aneurysmatic coronary arteries in such patients. METHODS In total, 18 patients (renal stent group) who underwent renal stent implantation in ectatic/aneurysmatic coronary arteries requiring percutaneous coronary intervention (PCI) and 45 patients who underwent large-sized bare-metal coronary stent (BMCS) implantation (BMCS group) at our center were included in the study. The primary endpoints were MACE (myocardial infarction and cardiovascular mortality), and the secondary endpoints were restenosis and all-cause mortality. RESULTS In the study patients with a mean follow-up of 25.3 ± 14.6 months (1-48 months), the control coronary angiography duration was 24.6 ± 14.8 months for the renal stent group and 22.8 ± 15.7 months for the BMCS group (p = 0.06). The MACE was observed in 2 (11.1%) patients in the renal stent group and 4 (8.9%) patients in the BMCS group (HR: 1.39 (0.24-7.82), p = 0.70). The secondary composite outcome was identified in 4 (22.2%) patients in the renal stent group and 6 (13.7%) patients in the BMCS group (HR: 1.93 (0.53-6.91), p = 0.31). No significant differences in primary and secondary outcomes were noted between the groups. CONCLUSION Renal stents used during PCI in patients with acute coronary syndrome with ectatic/aneurysmatic coronary arteries have similar efficacy, and mid-term follow-up results those noted for BMCS. These findings support that renal stents can be used in ectatic and aneurysmatic coronary arteries when necessary. CLINICAL TRIAL REGISTRATION This study has been registered on ClinicalTrials.gov (NCT05410678).
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Affiliation(s)
- Sencer Çamci
- Department of Cardiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Hasan Ari
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Ayşe Sünbül
- Unye State Hospital, Department of Cardiology, Ordu, Turkey
| | - Selma Ari
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Mehmet Melek
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Tahsin Bozat
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
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Robinson DL, Minich LL, Menon SC, Ou Z, Eckhauser AW, Ware AL. Coronary artery dilation associated with bicuspid and unicuspid aortic valve disease in children: a series of 17 patients. Cardiol Young 2023; 33:2610-2615. [PMID: 37078183 DOI: 10.1017/s104795112300077x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Coronary artery dilation associated with bicuspid/unicuspid aortic valves is described in adults with limited data in children. We aimed to describe the clinical course of children with bicuspid/unicuspid aortic valves and coronary dilation including coronary Z-score changes over time, association of coronary changes with aortic valve anatomy/function, and complications. MATERIALS AND METHODS Institutional databases were searched for children ≤18 years with both bicuspid/unicuspid aortic valves and coronary dilation (1/2006-6/2021). Kawasaki disease and isolated supra-/subvalvar aortic stenosis were excluded. Statistics were descriptive with associations measured by Fisher's exact test and overlapping 83.7% confidence intervals. RESULTS Of 17 children, bicuspid/unicuspid aortic valve was diagnosed at birth in 14 (82%). Median age at coronary dilation diagnosis was 6.4 years (range: 0-17.0). Aortic stenosis was present in 14 (82%) [2 (14%) moderate, 8 (57%) severe]; 10 (59%) had aortic regurgitation; 8 (47%) had aortic dilation. The right coronary was dilated in 15 (88%), left main in 6 (35%), and left anterior descending in 1 (6%) with no relationship between leaflet fusion pattern or severity of aortic regurgitation/stenosis on coronary Z-score. Follow-up evaluations were available for 11 (mean 9.3 years, range 1.1-14.8) with coronary Z-scores increasing in 9/11 (82%). Aspirin was used in 10 (59%). There were no deaths or coronary artery thrombosis. DISCUSSION In children with bicuspid/unicuspid aortic valves and coronary dilation, the right coronary artery was most frequently involved. Coronary dilation was observed in early childhood and frequently progressed. Antiplatelet medication use was inconsistent, but no child died nor developed thrombosis.
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Affiliation(s)
- David L Robinson
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, Utah
| | - L LuAnn Minich
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, Utah
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Aaron W Eckhauser
- Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Adam L Ware
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, Utah
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Lionakis N, Briasoulis A, Zouganeli V, Koutoulakis E, Kalpakos D, Xanthopoulos A, Skoularigis J, Kourek C. Coronary artery aneurysms: Comprehensive review and a case report of a left main coronary artery aneurysm. Curr Probl Cardiol 2023; 48:101700. [PMID: 36931332 DOI: 10.1016/j.cpcardiol.2023.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Coronary artery aneurysms (CAAs) are rare anatomical disorders of the coronary arteries. Atherosclerosis and Kawasaki disease are the principal causes of CCAs, while other causes including genetic factors, inflammatory arterial diseases, connective tissue disorders, endothelial damage after cocaine use, iatrogenic complications after interventions and infections, are also common among patients with CAAs. Although there is a variety of non-invasive methods including echocardiography, computed tomography, and magnetic resonance imaging, coronary angiography remains the gold standard diagnostic method. There is still no consensus about the most appropriate therapeutic strategy. Medical therapy including antiplatelets, anticoagulants, statins and ACEs are preferred either in patients with atherosclerosis, inflammatory status and stable CAAs, while percutaneous or surgery interventions are usually applied in patients with acute coronary syndrome due to a CAA culprit, obstructive coronary artery disease or large saccular aneurysms at a high risk of rupturing.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece; Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Emmanouil Koutoulakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece.
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Papadopoulos K, Christophides T, Eftychiou C, Eteokleous N, Mitsis A, Zittis I, Avraamides P. Syncope in a Patient With Giant Left Main Coronary Aneurysm: Is There a Link With Ventricular Arrhythmias? Tex Heart Inst J 2022; 49:487434. [PMID: 36223218 PMCID: PMC9632393 DOI: 10.14503/thij-21-7557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Giant aneurysm of the left main coronary artery is exceedingly rare and accounts for less than 2% of patients undergoing coronary angiography. The etiology varies depending on the patient's age and geographic area, but half are of atherosclerotic origin. In most cases, coronary aneurysms are asymptomatic, however, symptomatic patients present with symptoms characteristic of coronary artery disease such as chest pain (angina pectoris), myocardial infarction, congestive heart failure, and even sudden death. Coronary angiography is considered the gold standard tool to determine the presence or absence of coronary artery disease, and if present, its size and location. Herein, we report a case of giant aneurysm of the left main coronary artery presenting as syncope and documented nonsustained ventricular tachycardia.
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Affiliation(s)
| | | | | | - Nicos Eteokleous
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Ioannis Zittis
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
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5
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Rodríguez Falla DA, Rafael-Horna EA, Quiroz Burgos J, Lévano-Pachas G, Meneses G. [Clinical and angiographic characteristics of patients with coronary ectasia in a reference hospital]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:139-144. [PMID: 37284577 PMCID: PMC10241337 DOI: 10.47487/apcyccv.v3i2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 06/08/2023]
Abstract
Objective To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography. Materials and methods : Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined. Results 7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000). Conclusions coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.
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Affiliation(s)
- David Alejandro Rodríguez Falla
- Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. Departamento de Cardiología, Hospital Nacional Guillermo Almenara Lima Perú
| | - Eliana Alejandra Rafael-Horna
- Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. Departamento de Cardiología, Hospital Nacional Guillermo Almenara Lima Perú
| | - José Quiroz Burgos
- Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. Departamento de Cardiología, Hospital Nacional Guillermo Almenara Lima Perú
| | - Gerald Lévano-Pachas
- Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. Departamento de Cardiología, Hospital Nacional Guillermo Almenara Lima Perú
| | - Giovanni Meneses
- Departamento Académico de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Universidad Nacional Mayor de San Marcos Departamento Académico de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Nacional Mayor de San Marcos Lima Peru
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Cinteză E, Voicu C, Filip C, Ioniță M, Popescu M, Bălgrădean M, Nicolescu A, Mahmoud H. Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis. Diagnostics (Basel) 2022; 12:diagnostics12040884. [PMID: 35453932 PMCID: PMC9025069 DOI: 10.3390/diagnostics12040884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/19/2022] Open
Abstract
Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.
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Affiliation(s)
- Eliza Cinteză
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristiana Voicu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristina Filip
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihnea Ioniță
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Monica Popescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihaela Bălgrădean
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Alin Nicolescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Hiyam Mahmoud
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Royal Brompton Hospital, London SW3 6NP, UK
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7
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Esenboğa K, Kurtul A, Yamantürk YY, Akbulut İM, Tutar DE. Comparison of systemic immune-inflammation index levels in patients with isolated coronary artery ectasia versus patients with obstructive coronary artery disease and normal coronary angiogram. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:132-137. [PMID: 35143364 DOI: 10.1080/00365513.2022.2034034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Coronary artery ectasia (CAE) is associated with increased risk of mortality, equivalent to that of patients with obstructive coronary artery disease (CAD). Considering the role of inflammation in the pathogenesis of CAE, we aimed to investigate whether there is an association between systemic immune-inflammation index (SII) and isolated CAE. The study population included 510 patients of which 170 patients with isolated CAE, 170 patients with obstructive CAD and 170 patients with normal coronary angiograms (NCA). The severity of CAE was determined according to the Markis classification. Patients with isolated CAE had significantly higher SII values compared to those with obstructive CAD and NCA [median 550 IQR (404-821), median 526 IQR (383-661), and median 433 IQR (330-555), respectively, p < .001]. In multivariate analysis, SII (OR 1.032, 95% CI 1.020-1.044, p = .003), male gender (OR 2.083, p = .008), eGFR (OR 0.979, p = .016), and CRP (OR 1.105, p = .005) were independent factors of isolated CAE. Moreover, in the Spearman correlation analysis, there was a moderate but significant positive correlation between SII and CRP (r = 0.379, p < .001). In conclusion, higher SII levels were independently associated with the presence of isolated CAE. This result suggests that a more severe inflammatory process may play a role in the development of this variant of CAD.
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Affiliation(s)
- Kerim Esenboğa
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Alparslan Kurtul
- Department of Cardiology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | | | - İrem Müge Akbulut
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Durmuş Eralp Tutar
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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8
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Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
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Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
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Parvathareddy KKR, Maale S, Nagula P, Ravi S, Rayapu M, Balla NR. Clinical and angiographic characteristics of coronary artery ectasia and its correlation with high-sensitivity c-reactive protein and serum uric acid. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Arslan F, Núñez-Gil IJ, Rodríguez-Olivares R, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, De la Torre Hernández JM, Pascual I, Liebetrau C, Alkhouli M, Fernández-Ortiz A. Sex differences in treatment strategy for coronary artery aneurysms: Insights from the international Coronary Artery Aneurysm Registry. Neth Heart J 2021; 30:328-334. [PMID: 34910278 PMCID: PMC9123134 DOI: 10.1007/s12471-021-01649-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD. Methods Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding. Results Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, p = 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, p = 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, p = 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, p = 0.015). Conclusions These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.
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Affiliation(s)
- F Arslan
- Department of Cardiology, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - I J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - M Bollati
- Policlinico San Donato, Milan, Italy
| | - L Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - B Terol
- Hospital Severo Ochoa, Leganés, Spain
| | | | | | | | - I J Amat Santos
- CIBERCV, Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | | | - I Pascual
- Hospital Central de Asturias, Oviedo, Spain
| | - C Liebetrau
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - M Alkhouli
- West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - A Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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11
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Ghetti G, Minnucci M, Chietera F, Donati F, Gagliardi C, Bruno AG, Orzalkiewicz M, Nardi E, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Sino-tubular junction to sinuses of Valsalva ratio: An echocardiographic parameter to predict coronary artery ectasia in patients with aortic enlargement. Int J Cardiol 2021; 344:226-229. [PMID: 34655674 DOI: 10.1016/j.ijcard.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary artery ectasia (CAE) is associated with ascending aortic (AA) ectasia. The purpose of this study is to evaluate the diagnostic performance of different echocardiographic parameters (EP) in predicting the presence of CAE. METHODS Four hundred-eighteen patients with AA ectasia candidate to coronary angiography were identified and divided in two groups in respect of the presence of CAE. Receiver-operating characteristic curves areas (AUC) were used to assess the discrimination power of the following EP: aortic annulus diameter, sinuses of Valsalva (SV) diameter, sino-tubular junction (STJ) diameter, AA diameter, STJ to SV ratio (STJ-to-SV) and STJ to AA ratio (STJ-to-AA). All these parameters were indexed by body surface area. The relationship between the best EP and the presence of CAE was investigated by means of multivariable logistic regression. RESULTS The rate of CAE in the study population was 32%. On univariable logistic regression, aortic annulus, STJ, STJ-to-SV and STJ-to-AA were associated with the presence of CAE after Bonferroni correction. STJ-to-SV emerged as the parameter with the best discrimination power (AUC = 0.81) compared to STJ (AUC = 0.69), STJ-to-AA (AUC = 0.68), aortic annulus (AUC = 0.59), AA (AUC = 0.56) and SV (AUC = 0.55); (p for comparison <0.01). An 89.6% value for STJ-to-SV ratio emerged as the best cut-off to diagnose CAE with a sensitivity = 75%, specificity = 82%, positive predictive value = 66% and negative predictive value = 88%. On multivariable analysis, STJ-to-SV was still associated with the presence of CAE (OR = 1.15;95%CI:1.11-1.19;p < 0.01). CONCLUSION In patients with dilated aorta, STJ-to-SV sampled by transthoracic echocardiography shows a good diagnostic performance in predicting the presence of CAE.
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Affiliation(s)
- Gabriele Ghetti
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy.
| | - Matteo Minnucci
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Chietera
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Donati
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Christian Gagliardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Antonio Giulio Bruno
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Mateusz Orzalkiewicz
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Elena Nardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Tullio Palmerini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Saia
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Cinzia Marrozzini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nazzareno Galié
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nevio Taglieri
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
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12
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D'Ascenzo F, Saglietto A, Ramakrishna H, Andreis A, Jiménez-Mazuecos JM, Nombela-Franco L, Cerrato E, Liebetrau C, Alfonso-Rodríguez E, Bagur R, Alkhouli M, De Ferrari GM, Núñez-Gil IJ. Usefulness of oral anticoagulation in patients with coronary aneurysms: Insights from the CAAR registry. Catheter Cardiovasc Interv 2021; 98:864-871. [PMID: 32902099 DOI: 10.1002/ccd.29243] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the Usefulness of oral anticoagulation therapy (OAT) in patients with coronary artery aneurysm (CAA). BACKGROUND Data on the most adequate antithrombotic CAA management is lacking. METHODS Patients included in CAAR (Coronary Artery Aneurysm Registry, Clinical Trials.gov: NCT02563626) were selected. Patients were divided in OAT and non-OAT groups, according to anticoagulation status at discharge and 2:1 propensity score matching with replacement was performed. The primary endpoint of the analysis was a composite and mutual exclusive endpoint of myocardial infarction, unstable angina (UA), and aneurysm thrombosis (coronary ischemic endpoint). Net adverse clinical events, major adverse cardiovascular events, their single components, cardiovascular death, re-hospitalizations for heart failure, stroke, aneurysm thrombosis, and bleeding were the secondary ones. RESULTS One thousand three hundred thirty-one patients were discharged without OAT and 211 with OAT. In the propensity-matched sample (390 patients in the non-OAT group, 195 patients in the OAT group), after 3 years of median follow-up (interquartile range 1-6 years), the rate of the primary endpoint (coronary ischemic endpoint) was significantly less in the OAT group as compared to non-OAT group (8.7 vs. 17.2%, respectively; p = .01), driven by a significant reduction in UA (4.6 vs. 10%, p < .01) and aneurysm thrombosis (0 vs. 3.1%, p = .03), along with a non-significant reduction in MI (4.1 vs. 7.7%, p = .13). A non-significant increase in bleedings, mainly BARC type 1 (55%), was found in the OAT-group (10.3% in the non-OAT vs. 6.2% in the OAT group, p = .08). CONCLUSION OAT decreases the composite endpoint of UA, myocardial infarction, and aneurysm thrombosis in patients with CAA, despite a non-significant higher risk of bleeding.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Cardiology, Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Andrea Saglietto
- Cardiology, Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Harish Ramakrishna
- Division of Cardiovascular Anesthesiology, Mayo Clinic Rochester, Arizona
| | - Alessandro Andreis
- Cardiology, Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | | | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (Turin), Italy
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,Partner Site Rhein-Main, DZHK (German Centre for Cardiovascular Research), Frankfurt am Main, Germany
| | | | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | | | - Gaetano M De Ferrari
- Cardiology, Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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13
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Mir T, Sattar Y, Uddin M, Changal KH, Kumar K, Attique HB, Kabashneh S, Ullah W, Lohia P, Alraies MC, Blank N, Afonso L, Qureshi WT. Post-PCI outcomes in STEMI patients with coronary ectasia: meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:349-356. [PMID: 33587017 DOI: 10.1080/14779072.2021.1889370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate. METHODS Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0-1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06-1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44-3.32;p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42-6.84;p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48-0.86;p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39-1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities. CONCLUSION Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.
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Affiliation(s)
- Tanveer Mir
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Yasar Sattar
- Department of Internal medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mohammed Uddin
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Khalid Hamid Changal
- Department of Cardiovascular Medicine, University of Toledo Health Sciences, Toledo, USA
| | - Kartik Kumar
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Hassan Bin Attique
- Department of Internal Medicine, University of Connecticut, Farmington, USA
| | - Sohaip Kabashneh
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Prateek Lohia
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - M Chadi Alraies
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Nimrod Blank
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Luis Afonso
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Waqas T Qureshi
- Department of Cardiology,University of Massachusetts School of Medicine, Worcester, MA, USA
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14
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Bjelobrk M, Dodic S, Miljkovic T, Samardzija G, Bjeljac I, Dabovic D, Dodic B, Rosic M, Kovacevic M, Redzek A, Fabri M. Asymptomatic Giant Aneurysm of the Left Anterior Descending Coronary Artery: A Case Report and Review of the Literature. J Tehran Heart Cent 2021; 15:178-182. [PMID: 34178087 PMCID: PMC8217192 DOI: 10.18502/jthc.v15i4.5944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The most common cause of coronary artery aneurysms is atherosclerosis, which is associated with over 50% of all aneurysms diagnosed in adults. Although patients can be asymptomatic throughout their lives, giant coronary artery aneurysms can manifest themselves as myocardial infarction, aneurysmal rupture, and sudden cardiac death as well. Herein, we describe an asymptomatic patient with numerous risk factors and a positive cardiopulmonary exercise test who was admitted to the cardiology clinic for coronary angiography. A giant coronary artery aneurysm (3.0×2.0 cm in diameter) in the left anterior descending coronary artery and significant stenosis in both left and right coronary arteries were found. After discussing possible treatment options, the hospital's heart team recommended the surgical resection of the aneurysm and double coronary artery bypass graft. Four years after the cardiac surgery, at the time of writing the current manuscript, the patient is still in good condition and with no symptoms.
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Affiliation(s)
- Marija Bjelobrk
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Slobodan Dodic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Tatjana Miljkovic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Golub Samardzija
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Ilija Bjeljac
- Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Dragana Dabovic
- Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | | | - Milenko Rosic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Mila Kovacevic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Aleksandar Redzek
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
| | - Miklos Fabri
- Institute of Cardiovascular Diseases Vojvodina, Clinic of Cardiology, Sremska Kamenica, Serbia
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15
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Ben Abderrahim S, Gharbaoui M, Zaara MA, Rammeh-Rommani S, Hamdoun M, Ben Khelil M. Fatal coronary ectasia: An autopsy case report and review of literature. J Forensic Leg Med 2021; 79:102132. [PMID: 33667793 DOI: 10.1016/j.jflm.2021.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
Coronary ectasia is a rare vessel defect that represents a pathological and incidental finding in routine coronary angiography performed for other coronary syndromes. This defect exposes to the risk of intra-coronary thrombosis by blood stasis due to the turbulent blood flow in those dilated areas that can lead to sudden death. We report an autopsy case of a male subject suddenly deceased. A medico-legal autopsy concluded an ischemic heart failure due to a vascular thrombosis by a blood clot in a coronary ectasia. Our case report aimed to discuss the mechanisms of sudden death attributed to coronary artery ectasia.
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Affiliation(s)
- Sarra Ben Abderrahim
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Meriem Gharbaoui
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Mohamed Amine Zaara
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Soumaya Rammeh-Rommani
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Pathological Anatomy and Cytology, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Moncef Hamdoun
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Mehdi Ben Khelil
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia.
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16
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Zhang Y, Wu X, Zhang W, Gao J, Zhang Y, Zhang X. Platelet indices and varicocele: A systematic review and meta-analysis. Andrologia 2020; 53:e13939. [PMID: 33369777 DOI: 10.1111/and.13939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 01/11/2023] Open
Abstract
The updated systematic review and meta-analysis was conducted to assess the platelet indices between patients with varicocele and healthy subject. The main purpose of our study was to explore the relationship between platelet and the pathogenesis of varicocele. Databases including Cochrane Library, PubMed, and MEDLINE were retrieved to identify studies. Two independent investigators extracted the related information of the included original passages. In order to estimate the difference of varicocele patients and healthy subjects, we applied the standardised mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs). 1,156 patients and 797 healthy subjects of nine studies met the pre-set inclusion criteria. The estimated SMD in MPV between varicocele patients and healthy subjects was 0.61 (95% CI: 0.29-0.93, p < 0.001). The estimated SMD in MPV between preoperative varicocele patients and post-operative varicocele patients was 0.22 (95% CI: 0.03-0.41, p = 0.02). The estimated SMD in PLT between varicocele patients and healthy subjects was -0.19 (95% CI: -0.28, -0.08, p = 0.001). The available data suggest that a higher MPV level in varicocele patients, and the varicocele operation can normalise the preoperatively elevated mean platelet volume levels. Further researches are needed to investigate the potential role of platelet with varicocele.
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Affiliation(s)
- Yuyang Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Wu
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Gao
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yao Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiansheng Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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17
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Zhu X, Zhou Q, Tong S, Zhou Y. Challenges and strategies in the management of coronary artery aneurysms. Hellenic J Cardiol 2020; 62:112-120. [PMID: 32937198 DOI: 10.1016/j.hjc.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Coronary artery aneurysms (CAAs) are infrequent but not rare. Because of the lack of supportive data and a substantial knowledge gap in this field, clinicians are in a dilemma how to manage patients with coronary artery aneurysms. Most often, CAAs are discovered incidentally, while symptomatic patients present with diverse complications of unstable angina, myocardial infarction, arrhythmias, or sudden cardiac death. Therapeutical approaches consist of surgical procedure, percutaneous coronary intervention (PCI), and medical management. Because of the scarcity of randomized trials or large-scale data on symptomatic and asymptomatic patients with coronary artery aneurysms, the management of these patients poses considerable challenges for the cardiologists. This review summarizes the current literature, a proposed algorithm for the management of CAAs is highlighted in the text. In view of the majority of current proposal information based on small series of case reports or observational studies, an individualized therapeutic regimen should be on the basis of the location, expansion by time, morphology, complications, and etiologies of the coronary artery aneurysms, the clinical presentations, and the patient's characteristics.
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Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China; Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou Province, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, China
| | - Shan Tong
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China.
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18
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Ma W, Li C, Zhang W, Ji Z, Li Y. Anterior wall myocardial infarction in a 16-year-old man caused by coronary artery aneurysm during the outbreak of COVID-19. BMC Cardiovasc Disord 2020; 20:314. [PMID: 32611362 PMCID: PMC7327480 DOI: 10.1186/s12872-020-01593-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/22/2020] [Indexed: 01/02/2023] Open
Abstract
Background Coronary artery aneurysm (CAA) is a potential cause of infarction. During the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability. Here, we report a case of sudden acute myocardial infarction caused by large CAA during the home isolation. Case presentation During the outbreak of coronavirus disease 2019 (COVID-19),a 16-year-old man with no cardiac history was admitted to CCU of Tang du hospital because of severe chest pain for 8 h. The patient reached the hospital its own, his electrocardiogram showed typical features of anterior wall infarction, echocardiography was performed and revealed local anterior wall dysfunction, but left ventricle ejection fraction was normal, initial high-sensitivity troponin level was 7.51 ng/mL (<1.0 ng/mL). The patient received loading dose of aspirin and clopidogrel bisulfate and a total occlusion of the LAD was observed in the emergency coronary angiography (CAG). After repeated aspiration of the thrombus, TIMI blood flow reached level 3. Coronary artery aneurysm was visualized in the last angiography. No stent was implanted. Intravascular ultrasound (IVUS) was performed and the diagnosis of coronary artery aneurysm was further confirmed. The patient was discharged with a better health condition. Conclusions Coronary artery aneurysm is a potential reason of infarction, CAG and IVUS are valuable tools in diagnosis in such cases, during the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability, and activities at home should be increased in the high-risk patients.
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Affiliation(s)
- Wenshuai Ma
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Chunyu Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Wei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhaole Ji
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710032, China.
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19
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Giant right coronary artery aneurysm: Insights from the experience of a peripheral national health system institute. Hellenic J Cardiol 2020; 61:214-216. [DOI: 10.1016/j.hjc.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
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20
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Yavcin O, Askin L, Seçen O, Turkmen S, Akturk E, Tanriverdi O, Necati Dagli M. Copeptin levels in patients with coronary artery ectasia. Interv Med Appl Sci 2020; 11:112-116. [PMID: 32148915 PMCID: PMC7044535 DOI: 10.1556/1646.11.2019.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aims The etiology and pathophysiology of coronary artery ectasia (CAE) has not been fully elucidated. A rapid rise in plasma copeptin has been observed in cardiovascular diseases, stroke, sepsis, and shock. This increase has diagnostic and prognostic value. The aim of this study was to investigate whether copeptin has a relationship with CAE. Methods This observational prospective study was carried out between October 2012 and March 2013 in the cardiology catheter laboratory with the inclusion of 44 subjects with a diagnosis of CAE and 44 age- and gender-matched individuals with normal coronary arteries. Blood samples obtained from the patients were stored at -70 °C until analysis and copeptin levels in sera were measured by ELISA. Results This study comprised 88 study participants, among whom 44 were patients meeting ectasia criteria [mean age: 58.0 ± 11.5 years; 59% (n = 26) male], and 44 were control subjects with angiographically normal coronary anatomy [mean age: 49.2 ± 10.1 years; 30% (n = 13) male]. Copeptin levels were similar between the groups (p > 0.05). In addition, there was no correlation between copeptin levels and CAE. Conclusion In this study, it is examined that copeptin levels were not elevated in CAE patients.
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Affiliation(s)
- Ozkan Yavcin
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
| | - Lutfu Askin
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
| | - Ozlem Seçen
- Department of Cardiology, Elazig Education and Research Hospital, Elazig, Turkey
| | - Serdar Turkmen
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
| | - Erdal Akturk
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
| | - Okan Tanriverdi
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
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Al-Makhamreh HK, Shaban AE, AlHaddadin SS, AlSharif AA, Ghalayni RA, Daoud LF, Alshraideh BM. Is Lipoprotein (a) a Risk Factor for Coronary Artery Ectasia? Cardiol Res 2020; 11:50-55. [PMID: 32095196 PMCID: PMC7011929 DOI: 10.14740/cr992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background The pathophysiology of coronary artery ectasia (CAE) is under investigated and not well understood. Atherosclerosis is considered as the main etiologic factor for CAE in adults where more than 50% of CAE patients have atherosclerosis. Recently, lipoprotein (a) (Lp(a)) has emerged as a powerful risk factor for atherosclerosis and coronary artery disease (CAD). Serum levels of Lp(a) in patients with CAE have not been investigated. We assumed that Lp(a) may play a role in the pathogenesis of CAE. Principally, our study aims to identify whether Lp(a) is an independent risk factor for CAE. Methods Our study is a prospective pilot study. Study population was collected prospectively from pool of patients referred for elective cardiac catheterization at Jordan University Hospital (JUH) in the period extending from February 17, 2018 to June 31, 2018. Patients were referred for elective coronary angiography after being interviewed and physically examined by a cardiologist (HA). Patients with known history of CAD or who are already on anti-lipidemic drugs either documented in the medical records or by interviewing patients for history of revascularization were excluded from the study. Results Regarding the primary outcome, there was no significant difference in Lp(a) concentrations between normal and ectasia groups in the general sample (median: 17.5mg/dL vs. 20.4 mg/dL, P value = 0.38). Conclusions Our study concludes that there is no detected relationship between elevated Lp(a) levels and developing CAE. CAE was more common in patients with low high-density lipoprotein (HDL) level (compared with patients with normal coronaries), higher total cholesterol level (compared with patients with non-obstructive stenosis) and higher hemoglobin A1c (HbA1c).
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Affiliation(s)
| | - Ala' E Shaban
- Cardiology Department, University of Jordan, Amman, Jordan
| | | | | | | | - Lana F Daoud
- Cardiology Department, University of Jordan, Amman, Jordan
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Oztekin U, Turan Y, Selmi V. The association between high‐grade varicocele and endothelial dysfunction. Andrologia 2019; 51:e13424. [DOI: 10.1111/and.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 01/23/2023] Open
Affiliation(s)
- Unal Oztekin
- Department of Urology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
| | - Yasar Turan
- Department of Cardiology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
| | - Volkan Selmi
- Department of Urology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
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Núñez-Gil IJ, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, de la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez-Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Bagur R, Ugo F, Medda M, Louka BF, Kala P, Escaned J, Bautista D, Feltes G, Salinas P, Alkhouli M, Macaya C, Fernández-Ortiz A. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR). Int J Cardiol 2019; 299:49-55. [PMID: 31378382 DOI: 10.1016/j.ijcard.2019.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Mario Bollati
- Interventional Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Belén Terol
- Cardiology Department, Hospital Severo Ochoa, Leganés, Spain
| | | | | | - Pedro A Villablanca
- Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; University of Oviedo, Oviedo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Benjamín Camacho
- Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Marco Pavani
- Cardiology, Città della Salute e della Scienza, Molinnette II, Torino, Italy
| | - Juan Albistur
- Cardiology, Hospital de Clínicas Dr, Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Emodinamica, Azienda Ospedaliera Universitaria Policlinico "P,Giaccone" Palermo, Italy
| | - Massimo Mancone
- Is Sapienza University of Rome, Policlinico Umberto I. Department of Cardiovascular, Respiratory, Neurological, Anaesthesiology and Geriatric Sciences
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Alfonso Ielasi
- Cardiology Division, ASST Bergamo Est, Bolognini Hospital Seriate, Italy
| | - Íñigo Lozano
- Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | - Pierluigi Omedè
- Cardiology, Città della Salute e della Scienza, Molinnette I, Torino, Italy
| | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fabrizio Ugo
- Interventional Cardiology, H San Giovanni Bosco, Turin, Italy
| | - Massimo Medda
- Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, USA
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Bautista
- Cardiology, Instituto dominicano de Cardiología, Santo Domingo, Dominican Republic
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Mohamad Alkhouli
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Uygun T, Demir B, Tosun V, Ungan İ, Kural A, Çiftçi R, Fatullayev F. Relationship between interleukin-17A and isolated coronary ectasia. Cytokine 2018; 115:84-88. [PMID: 30470660 DOI: 10.1016/j.cyto.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/04/2018] [Accepted: 11/13/2018] [Indexed: 01/22/2023]
Abstract
The aim of this study was to evaluate serum interleukin (IL)-17A levels in patients with coronary artery ectasia (CAE), the relationship between IL and 17A and CAE, and to determine the relationship between the severity of coronary ectasia and the level of IL-17A. In total, 41 patients (19 female and 22 male) with ischemic symptoms whose non-invasive cardiac tests were positive for myocardial ischemia, and in whom coronary artery ectasia were detected after coronary angiography, and 45 patients (32 female and 13 male) with normal coronary arteries were included in this study. Echocardiographic assessments were performed. Serum IL-17A levels of all patients were evaluated using an enzyme-linked immunosorbent assay. IL-17A levels of the group with isolated coronary artery ectasia were significantly higher compared with the control group (4.86 ± 3.24 and 1.37 ± 1.56 ng/ml, respectively; p < 0.001). There was no correlation between the levels of IL-17A and the extension of the CAE, but IL-17A levels were high in both groups. CAE patients have significantly increased levels of IL-17A, fibrinogen, and RDW compared to patients with normal coronary arteries. It was demonstrated that increased levels of IL-17A were associated with ectasia formation in CAE patients.
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Affiliation(s)
- Turgut Uygun
- Department of Cardiology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Bülent Demir
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Veysel Tosun
- Department of Cardiology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey.
| | - İsmail Ungan
- Department of Cardiology, Yalova State Hospital, Yalova, Turkey
| | - Alev Kural
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Rumeysa Çiftçi
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Fuad Fatullayev
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Gunasekaran P, Stanojevic D, Drees T, Fritzlen J, Haghnegahdar M, McCullough M, Barua R, Mehta A, Hockstad E, Wiley M, Earnest M, Tadros P, Genton R, Gupta K. Prognostic significance, angiographic characteristics and impact of antithrombotic and anticoagulant therapy on outcomes in high versus low grade coronary artery ectasia: A long-term follow-up study. Catheter Cardiovasc Interv 2018; 93:1219-1227. [DOI: 10.1002/ccd.27929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Prasad Gunasekaran
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Dusan Stanojevic
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Taylor Drees
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - John Fritzlen
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Megan Haghnegahdar
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Matthew McCullough
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Rajat Barua
- Division of Cardiology; Kansas City Veterans Affairs Medical Center; Kansas City Missouri
| | - Ashwani Mehta
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Eric Hockstad
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Mark Wiley
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Matthew Earnest
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Peter Tadros
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Randall Genton
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Kamal Gupta
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
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Dilating Vascular Diseases: Pathophysiology and Clinical Aspects. Int J Vasc Med 2018; 2018:9024278. [PMID: 30225143 PMCID: PMC6129317 DOI: 10.1155/2018/9024278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/29/2018] [Indexed: 01/22/2023] Open
Abstract
Atherosclerotic disease of the vessels is a significant problem affecting mortality and morbidity all over the world. However, dilatation of the vessels either in the arterial system or in the venous territory is another vessel disease. Varicocele, pelvic, and peripheral varicose veins and hemorrhoids are aneurysms of the venous vascular regions and have been defined as dilating venous disease, recently. Coronary artery ectasia, intracranial aneurysm, and abdominal aortic aneurysm are examples of arterial dilating vascular diseases. Mostly, they have been defined as variants of atherosclerosis. Although there are some similarities in terms of pathogenesis, they are distinct from atherosclerotic disease of the vessels. In addition, pathophysiological and histological similarities and clinical coexistence of these diseases have been demonstrated both in the arterial and in the venous system. This situation underlies the thought that dilatation of the vessels in any vascular territory should be considered as a systemic vessel wall disease rather than being a local disease of any vessel. These patients should be evaluated for other dilating vascular diseases in a systematic manner.
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Forte E, Aiello M, Inglese M, Infante T, Soricelli A, Tedeschi C, Salvatore M, Cavaliere C. Coronary artery aneurysms detected by computed tomography coronary angiography. Eur Heart J Cardiovasc Imaging 2018; 18:1229-1235. [PMID: 28025267 DOI: 10.1093/ehjci/jew218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/25/2016] [Indexed: 01/11/2023] Open
Abstract
Aims Coronary artery aneurysms (CAAs) are incidentally revealed by coronary angiography and consist in a localized dilation of a coronary artery. Although invasive coronary angiography (ICA) is the gold standard imaging technique, it can lead to the underestimation of CAAs diameter in presence of parietal thrombi. Computed tomography coronary angiography (CTCA) is a very sensitive tool in CAAs detection and provides a clear visualization of coronary lumen highlighting intraluminal thrombi. Methods and results We retrospectively reviewed 390 CTCA performed at our institution, 9 patients (6 men, 3 women) resulted affected by CAAs and represented the aneurysmal group (A group). Matched controls were identified among the non-aneurysmal patients with healthy coronaries to CTCA (NAH group). Clinical variables and imaging findings were compared and correlated. CAAs prevalence in our population was 2.31%. 15 CAAs were detected, mainly on the right coronary artery (RCA) (9 aneurysms) followed by the left anterior descending coronary artery (LAD) (three aneurysms) and the left circumflex coronary artery (CX) (three aneurysms). In six patients (66.7%) CTCA displayed an aneurysmal thrombosis and in 5 patients (55.5%) CAAs were associated to coronary artery stenoses. A statistically significant difference was found between the diameters of coronary vessels measured in healthy segments in A and NAH group. Conclusions CTCA has led to a non-invasive estimation of CAAs prevalence and characterization of aneurysmal features and coronary anatomy. Overcoming ICA limitations, CTCA has provided a fine analysis of the aneurysms, also in presence of intraluminal thrombi.
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Affiliation(s)
- Ernesto Forte
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | - Marco Aiello
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | | | | | | | - Carlo Tedeschi
- Unit of Cardiology, San Gennaro Hospital, ASL Napoli 1 Centro, Via San Gennaro 25, 80100 Naples, Italy
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Gök M, Kundi H, Kiziltunç E, Topçuoğlu C, Örnek E. The relationship between serum endocan levels and the presence/severity of isolated coronary artery ectasia. Cardiovasc Endocrinol Metab 2018; 7:42-46. [PMID: 31646279 DOI: 10.1097/xce.0000000000000143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to investigate the relationship between serum endocan levels and the presence and severity of isolated coronary artery ectasia (CAE). Patients and methods A total of 52 patients with CAE without obstructive coronary artery disease and 33 participants with a normal coronary artery were included in this study. The severity of CAE was graded according to Markis classification. Serum endocan levels were measured by enzyme-linked immunosorbent assay method. Results In multivariate regression analysis, high sensitivity C-reactive protein and endocan levels were found to be significantly associated with the presence of isolated CAE. However, there was no relationship between serum endocan levels and the severity of CAE according to Markis classification. Conclusion Plasma endocan levels may reflect the presence of isolated CAE, suggesting that endocan may be involved in the pathogenesis of isolated CAE.
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Affiliation(s)
| | | | | | - Canan Topçuoğlu
- Biochemistry, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Ozturk S, Yetkin E, Waltenberger J. Molecular and cellular insights into the pathogenesis of coronary artery ectasia. Cardiovasc Pathol 2018; 35:37-47. [PMID: 29772448 DOI: 10.1016/j.carpath.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/17/2018] [Accepted: 04/12/2018] [Indexed: 01/17/2023] Open
Abstract
Coronary artery ectasia describes a local or diffuse dilatation of the epicardial coronary arteries. This review summarizes the molecular and cellular mechanisms involved in the pathogenesis of coronary artery ectasia. Better identification of the pathophysiologic steps will shed light into the clinical significance and may have direct implications for the management strategies of this disease. Additionally, understanding the underlying etiology may help to improve treatment modalities specific to coronary artery ectasia.
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Affiliation(s)
- Selcuk Ozturk
- Ankara Education and Research Hospital, Department of Cardiology, Ankara 06230, Turkey.
| | - Ertan Yetkin
- Private Yenisehir Hospital, Department of Cardiology, Mersin, Turkey
| | - Johannes Waltenberger
- University of Münster, Faculty of Medicine, Münster, Germany; Cells-in-Motion Cluster of Excellence (EXC 1003-CiM), University of Münster, Münster, Germany
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Núñez-Gil IJ, Terol B, Feltes G, Nombela-Franco L, Salinas P, Escaned J, Jiménez-Quevedo P, Gonzalo N, Vivas D, Bautista D, Macaya C, Fernández-Ortiz A. Coronary aneurysms in the acute patient: Incidence, characterization and long-term management results. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:589-596. [PMID: 29276176 DOI: 10.1016/j.carrev.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms. METHODS Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS). RESULTS Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death. CONCLUSION The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain..
| | - Belén Terol
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - David Vivas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Daniel Bautista
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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Abstract
Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease.
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Affiliation(s)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Egypt.,Imperial College London, UK
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Is there any association between vitamin D levels and isolated coronary artery ectasia? ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2017; 1:e117-e122. [PMID: 28905032 PMCID: PMC5421538 DOI: 10.5114/amsad.2016.63183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
Introduction It has been postulated that low vitamin D levels are associated with coronary artery diseases. Coronary artery ectasia (CAE) is associated with atherosclerosis, congenital cardiac defects, immunological diseases and connective tissue diseases. In this study, we aimed to investigate whether there is an association between vitamin D and parathormone levels and isolated coronary artery ectasia and its extent. Material and methods The study included 93 participants: 47 patients (35 male, 12 female) with isolated CAE and 46 subjects (28 male, 18 female) with normal coronary arteries. Demographic characteristics of patients and controls were obtained from medical records, and Markis scores of patients were calculated. Serum vitamin D and parathormone levels were quantitatively measured by the paramagnetic particle chemiluminescence method. Results Serum vitamin D levels were found to be significantly lower in patients with isolated CAE than the control group (9.15 ±4.4 ng/ml, 13.35 ±5.9 ng/ml, p < 0.001). Parathormone levels were significantly higher in the CAE group than the control group (61.4 ±31.6, 48.7 ±25.5, p < 0.036). However, the study revealed no association between serum vitamin D levels and the extent of CAE according to the Markis classification (p = 0.23). Conclusions This study revealed that lower vitamin D levels and higher parathormone levels were associated with isolated CAE, but there was no association between vitamin D levels and the extent of CAE.
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Malviya A, Jha PK, Mishra A. Isolated coronary artery ectasia: Clinical, angiographic, and follow up characteristics. Indian Heart J 2017; 69:619-623. [PMID: 29054186 PMCID: PMC5650589 DOI: 10.1016/j.ihj.2016.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Isolated Coronary artery ectasia (CAE) is considered an uncommon angiographic finding with varying patterns of presentation and carries significant morbidity burden to the patient. Our objective was to evaluate the prevalence of this condition, to analyse its clinical, angiographic, and follow up characteristics. PATIENTS AND METHODS Coronary angiography was performed in 4950 patients from January 2009 to August 2014. The epidemiological, clinical, angiographic, and follow up characteristics of 52 patients with isolated CAE were examined. RESULTS Of the 4950 angiograms analysed, isolated CAE was found in 52 patients, a prevalence of 1.05 %. The mean age of patients was 53.4 years. A predominance of the male sex was observed (71.1%). Angina on exertion was the most common presenting symptom (61.5%). Single vessel was involved in 61.5%. Left anterior descending artery was the most commonly involved vessel followed by right coronary artery, left circumflex and left main coronary artery. Type IV CAE as per Markis classification was the most common involvement. The median follow-up was 28±20 months, during which 10 patients (19.2%) had recurrent chest pain, and four patients were re-hospitalised, three for unstable angina, one for myocardial infarction. CONCLUSION The prevalence of isolated coronary ectasia was 1.05%. The majority of patients had single vessel involvement, and left anterior descending branch was the most common involved vessel. This condition may not be considered completely benign, as it is associated with atherosclerotic risk factors and occurrence of coronary events including angina and myocardial infarction.
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Affiliation(s)
- Amit Malviya
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, Meghalaya, India
| | - Pravin K Jha
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, Meghalaya, India
| | - Animesh Mishra
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, Meghalaya, India.
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Ovalı C, Morrad B. Associations between coronary artery disease, aneurysm and ectasia. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:158-163. [PMID: 29181042 PMCID: PMC5701588 DOI: 10.5114/kitp.2017.70276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023]
Abstract
AIM Investigation the frequency and contribution of coronary artery aneurysm/ectasia in addition to their correlation with coronary artery disease (CAD). MATERIAL AND METHODS We retrospectively evaluated the coronary angiography records of 6500 adult consecutive patients, and 418 of them were met inclusion criteria and used in the present study. The CAD was defined as the presence of angiographic coronary stenosis of > 50% of the luminal diameter in no less than one of the epicardial coronary arteries. Moreover, the prevalence and features of the coronary artery aneurysm/ectasia among the cases with and without CAD were compared. RESULTS We observed coronary artery aneurysm (CAA) and ectasia (CAE) in 6.6% of the patients with significant CAD (+), and 6.1% of the patients with significant CAD (-) (p = 0.2). The percentage of coronary artery aneurysms was significantly higher in CAD (+) patients than in CAD (-) patients (0.8% vs. 0.4%, p = 0.015). The percentage of coronary artery ectasia showed no variation between CAD (+) patients and CAD (-) patients (5.8% vs. 5.7%, p = 0.47). The frequency of spotting aneurysm on a single coronary artery was higher than discerning aneurysm on two or three coronary arteries. CONCLUSIONS Presence of CAA or CAE cases is often encountered in those who have undergone angiography procedures. Furthermore, CAA and CAE should not be considered as simple dilations of vessels. Further studies are needed to determine the effective procedures for the treatment and prognostic evaluations of the patients with CAA or CAE.
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Affiliation(s)
- Cengiz Ovalı
- Cardiovascular Surgery Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Baktash Morrad
- Department of Cardiology, Parkhayat Akşehir Hospital, Afyonkarahisar, Turkey
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Núñez-Gil IJ, Nombela-Franco L, Bagur R, Bollati M, Cerrato E, Alfonso E, Liebetrau C, De la Torre Hernandez JM, Camacho B, Mila R, Amat-Santos IJ, Alfonso F, Rodríguez-Olivares R, Camacho Freire SJ, Lozano Í, Jiménez Díaz VA, Piraino D, Latini RA, Feltes G, Linares JA, Mancone M, Ielasi A, Sánchez-Grande Flecha A, Fernández Cisnal A, Ugo F, Jiménez Mazuecos JM, Omedè P, Pavani M, Villablanca PA, Louka BF, Fernández-Ortiz A. Rationale and design of a multicenter, international and collaborative Coronary Artery Aneurysm Registry (CAAR). Clin Cardiol 2017; 40:580-585. [PMID: 28337781 DOI: 10.1002/clc.22705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/22/2017] [Accepted: 02/15/2017] [Indexed: 11/09/2022] Open
Abstract
Coronary artery aneurysm is defined as a coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patient's largest normal coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right coronary artery. Although several causes have been described, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short- and long-term results in a large cohort of patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov. Unique identifier: NCT02563626.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Mario Bollati
- Department of Interventional Cardiology, SS Annanziata Hospital, Savigliano, Italy
| | - Enrico Cerrato
- Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi HOspital, Rivoli (Turin), Italy
| | - Emilio Alfonso
- Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | | | - Benjamín Camacho
- Department of Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Rafael Mila
- Department of Cardiology, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Ignacio J Amat-Santos
- Department of Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Íñigo Lozano
- Department of Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Hemodinámica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone,", Palermo, Italy
| | | | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | | | - Massimo Mancone
- Department of Interventional Cardiology, Hospital La Sapienza, Rome, Italy
| | | | | | | | - Fabrizio Ugo
- Department of Interventional Cardiology, Hospital San Giovanni Bosco, Turin, Italy
| | | | - Pierluigi Omedè
- Department of Cardiology, Città della Salute e della Scienza I, Turin, Italy
| | - Marco Pavani
- Department of Cardiology, Città della Salute e della Scienza II, Turin, Italy
| | - Pedro A Villablanca
- Department of Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
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Li Y, Wu C, Liu W. Coronary artery ectasia presenting with thrombus embolization and acute myocardial infarction: A case report. Medicine (Baltimore) 2017; 96:e5976. [PMID: 28121950 PMCID: PMC5287974 DOI: 10.1097/md.0000000000005976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. CAE is often associated with the presence of slow coronary flow and may lead to acute myocardial infarction (AMI), even without total occlusion. PATIENT CONCERNS AND DIAGNOSIS We report a case of a 24-year-old male patient with CAE suffering from AMI. INTERVENTIONS Percutaneous coronary intervention with aspiration thrombectomy failed to restore adequate blood flow. Heparin and antiplatelet treatment were provided for pharmacological management, but follow-up angiography 15 days later still revealed a poor result. This patient was ultimately treated with antiplatelet therapy in combination with warfarin treatment. OUTCOMES Follow-up coronary angiography 15 months later showed a restored normal Thrombolysis In Myocardial Infarction grade (TIMI) 3 flow. LESSONS CAE-related infarct is often associated with high-burden thrombus formation. Long-term warfarin in combination with antiplatelet therapy may be a good alternative intervention to decrease thrombus burden and enhance blood flow.
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Lee WC, Fang HY, Fang CY. Hybrid Strategy to Treat Life-Threatening Giant Coronary Artery Aneurysm With Severe In-Stent Restenosis. Int Heart J 2017; 58:283-285. [DOI: 10.1536/ihj.16-233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Devabhaktuni S, Mercedes A, Diep J, Ahsan C. Coronary Artery Ectasia-A Review of Current Literature. Curr Cardiol Rev 2016; 12:318-323. [PMID: 27142049 PMCID: PMC5304254 DOI: 10.2174/1573403x12666160504100159] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/28/2016] [Accepted: 03/04/2016] [Indexed: 12/29/2022] Open
Abstract
Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. Its incidence ranges from 1.2%-4.9%. Coronary artery ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth with atherosclerosis being the most common cause. Although, it has been described more than five decades ago, its management is still debated. We therefore reviewed the literature until date by searching PubMed and Google scholar using key words “coronary artery ectasia”, “coronary artery aneurysm”, “pathophysiology”, “diagnosis”, “management” either by itself or in combination. We reviewed the full articles and review articles and focused mainly on pathophysiology, diagnosis and management of CAE.
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40
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Meindl C, Achatz B, Huber D, Baessler A, Hubauer U, Meisinger C, Hengstenberg C, Erdmann J, Buchner S, Maier L, Schunkert H, Debl K, Fischer M. Coronary Artery Ectasia Are Frequently Observed in Patients With Bicuspid Aortic Valves With and Without Dilatation of the Ascending Aorta. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004092. [DOI: 10.1161/circinterventions.116.004092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
Abstract
Background—
The presence of coronary artery ectasia (CAE) is influenced by genetic factors and related to the presence of aneurysms in other vascular beds. Bicuspid aortic valve (BAV) disease is frequently accompanied by ascending aortic aneurysm. Because the aortic valve and the proximal parts of the coronary arteries share a common embryonic origin, we hypothesized that CAE is associated with BAV disease.
Methods and Results—
One hundred seventy-seven patients with suspected aortic valve disease (n=94 BAV, n=83 tricuspid aortic valve) underwent both cardiac magnetic resonance imaging and coronary angiography. To confirm the association of CAE with BAV, the frequency of CAE was evaluated in an in-house BAV registry (n=600, n=231 with available coronary angiogram) and compared with the frequency of CAE in the German Myocardial Infarction (MI) Family Study, in which the heritability of CAE was formerly established (n=899). Furthermore, the frequency of CAE was investigated in an observational registry of real-life patients undergoing coronary angiography for clinically indicated reasons (n=3.097) and in a subgroup of the KORA MI study (Cooperative Health Research in the Region of Augsburg), which is a population-based MI registry (n=403).
Compared with tricuspid aortic valve disease, CAE occurred more than twice as frequently in cardiac magnetic resonance–confirmed BAV disease (17% versus 44%;
P
<0.0001) and CAE was observed similarly often in subjects with BAV with (37%) and without (54%,
P
=0.11) ascending aortic pathology. The common appearance of CAE in patients with BAV could be independently confirmed in the BAV registry (frequency 37%), whereas CAE was found less frequently in family history of positive MI patients (21%), sporadic MI without familial disposition (10%), and rarely in unrelated real-life catheterization patients (6%).
Conclusions—
To our knowledge, our data show for the first time that ectatic coronary artery disease is a common appearance of BAV disease with and without ascending aortic ectasia.
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Affiliation(s)
- Christine Meindl
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Birgit Achatz
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Deborah Huber
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Andrea Baessler
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Ute Hubauer
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Christa Meisinger
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Christian Hengstenberg
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Jeanette Erdmann
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Stefan Buchner
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Lars Maier
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Heribert Schunkert
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Kurt Debl
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
| | - Marcus Fischer
- From the Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (C. Meindl, B.A., D.H., A.B., U.H., S.B., L.M., K.D., M.F.); Helmholtz Zentrum München, Institute of Epidemiology II, Technische Universität München, Germany (C. Meisinger); Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-und Kreislaufforschung (DZHK), Partner site Munich Heart Alliance, Munich, Germany (C.H., H.S.); and Institut für Integrative und Experimentelle
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Morrad B, Yazici HU, Aydar Y, Ovali C, Nadir A. Role of gender in types and frequency of coronary artery aneurysm and ectasia. Medicine (Baltimore) 2016; 95:e4395. [PMID: 27495054 PMCID: PMC4979808 DOI: 10.1097/md.0000000000004395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 01/27/2023] Open
Abstract
This study aimed to evaluate the role of gender in types and frequency of coronary artery aneurysm and ectasia.We assessed retrospectively the angiography records of 6100 patients. At first, we mainly reviewed angiographic movies for the presence of coronary ectasia and/or aneurysm. Consequently, based on the number of the coronary artery involvement, the coronary ectasia and aneurysm were graded as mild if 1 coronary artery was involved and severe if 2 or more coronary arteries were involved. The location of ectasia and aneurysm was analyzed with respect to their isolated or combined location on various coronary arteries. The patients included in the present study were divided into 2 groups based on their gender as male and female. Then, we evaluated the impact of gender on severity and the location of the ectasia and aneurysm.The incidence of the aneurysm and ectasia was 3.5%. Among the patients with aneurysm and ectasia, 6.9% were male and 4.5% were female. Aneurysm and ectasia were evaluated together; their frequency was significantly higher in the male than female patients (P < 0.01). However, when their incidence was evaluated separately, coronary artery ectasia was markedly greater in male patients with regard to female patients (P < 0.01). Incidence of CAE presence on the RCA was significantly greater in males than females (2.7% vs 1.9%, P < 0.05).This study showed that incidence of CAE is more common in males than females. Particularly, frequency for the involvement of CAE on RCA and concurrently on 3 vessels is greater in male patients than female patients.
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Affiliation(s)
- Baktash Morrad
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
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Turan T, Akyuz AR, Aykan AC, Kul S, Cirakoglu OF, Aslan AO, Gul I, Uçar U, Demir S, Celik S. Plasma Endocan Levels in Patients With Isolated Coronary Artery Ectasia. Angiology 2016; 67:932-936. [PMID: 26980772 DOI: 10.1177/0003319716637789] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endocan is a soluble proteoglycan, secreted by human vascular endothelial cells. Endocan is a marker for vascular pathologies and an important mediator of angiogenesis, strongly associated with inflammation, vascular endothelial dysfunction, and atherosclerosis. The relationship between coronary artery ectasia (CAE) and endocan has not been evaluated. We aimed to investigate this association. Fifty-four patients with isolated CAE without coronary stenosis and 30 controls with normal coronary angiogram were included in this study. Endocan plasma concentrations were measured using an enzyme-linked immunosorbent assay. Patients with isolated CAE had significantly higher levels of endocan compared to the controls (18.9 ± 7.3 vs 15.6 ± 3.6 ng/mL; P = .007). There was a significant correlation between endocan levels and severity of isolated CAE according to the Markis classification ( r = -.593, P < .001). Plasma endocan levels may reflect the presence and severity of isolated CAE, suggesting that endocan may be involved in pathogenesis of isolated CAE.
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Affiliation(s)
- Turhan Turan
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Ali Riza Akyuz
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Ahmet Cagri Aykan
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Selim Kul
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Omer Faruk Cirakoglu
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Ahmet Oguz Aslan
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Ilker Gul
- 2 Department of Cardiology, Izmir Sifa University Hospital, Trabzon, Turkey
| | - Utku Uçar
- 3 Department of Clinical Biochemistry, Ahi Evren Training and Research Hospital, Trabzon, Turkey
| | - Selim Demir
- 4 Department of Nutrition and Dietetics, Faculty of Health Science, Karadeniz Technical University Trabzon, Turkey
| | - Sukru Celik
- 1 Department of Cardiology, Ahi Evren Training and Research Hospital, Trabzon, Turkey
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Abstract
Objective: Serum levels of nitric oxide (NO) are decreased in patients with atherosclerosis and also are a risk factor for the development of atherosclerosis. Endothelial dysfunction and diffuse atherosclerosis have been proposed for the etiology of coronary artery ectasia (CAE). The purpose of this clinical trial was to determine the relationship between CAE and serum NO levels. Methods: This prospective controlled study was conducted between January 2008 and March 2012. Serum levels of NO were compared in 40 patients with CAE (mean age 60.1±7.3 years) and 40 patients with normal coronary arteries (mean age 57.6±5 years) as a control group. CAE was diagnosed when a segment of coronary artery was more than 1.5 times the diameter of the adjacent healthy segment. Patients with stenotic atherosclerotic plaques, slow coronary flow, previous history of revascularization, acute coronary syndromes, left ventricular dysfunction, valvular heart disease, and systemic diseases were not included in the study. The effect of NO on the outcome was studied by constructing a receiver operating characteristic (ROC) curve with CAE as the primary variable. Effects of different variables on CAE were calculated using binary logistics regression analysis. Results: Serum NO concentrations were significantly lower in patients with CAE than in the control group (42.1±20.1 µmol/L vs. 77.3±15.7 µmol/L, p<0.001). According to the results of the multivariate regression analysis, LDL and NO levels were identified as independent factors associated with CAE (OR=1.02, 95% CI 1–1.04, p=0.02 and OR=0.88, 95% CI 0.83–0.93, p=0.001, respectively). ROC analysis revealed that using a cut-off point of 63.3, NO level predicts CAE with a sensitivity of 87.5% and specificity of 90%. Conclusion: Our study indicates that decreased levels of NO are present in patients with CAE compared to patients with normal coronary arteries, supporting the hypothesis that decreased levels of NO might be associated with CAE development. (Anatol J Cardiol 2016; 16: 947-52)
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Pasha AK, Jokerst CE, Janardhanan R. Myocardial infarction related to a coronary artery aneurysm. Am J Med 2015; 128:e5-6. [PMID: 25448169 DOI: 10.1016/j.amjmed.2014.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/12/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Clinton E Jokerst
- Department of Medical Imaging, University of Arizona Medical Center, Tucson
| | - Rajesh Janardhanan
- Division of Cardiology, Sarver Heart Center, Department of Internal Medicine, University of Arizona Medical Center, Tucson.
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Joshi RK, Jyoti A, Aggarwal N, Aggarwal M, Joshi R. Contained Rupture of Mycotic Aneurysm of the Left Circumflex Coronary Artery in a Child. World J Pediatr Congenit Heart Surg 2014; 6:111-4. [DOI: 10.1177/2150135114551994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery segment to a diameter of more than 1.5-fold normal size. Rupture of CAA is a catastrophic event and may result in sudden death or myocardial infarction. We report this unusual case of contained rupture of the left circumflex CAA.
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Affiliation(s)
- Reena K. Joshi
- Pediatric Cardiac Anesthesia, Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Aman Jyoti
- Pediatric Cardiac Anesthesia, Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Aggarwal
- Pediatric Cardiology, Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Mridul Aggarwal
- Pediatric Cardiology, Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Raja Joshi
- Pediatric Cardiac Surgery, Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J 2014; 41:603-8. [PMID: 25593524 DOI: 10.14503/thij-13-3896] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms.
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries. World J Cardiol 2014; 6:1060-1066. [PMID: 25349650 PMCID: PMC4209432 DOI: 10.4330/wjc.v6.i10.1060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 08/11/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) allows the nonradiating assessment of coronary arteries; to achieve better image quality cardiorespiratory artefacts should be corrected. Coronary MRA (CMRA) at the moment is indicated only for the detection of abnormal coronary origin, coronary artery ectasia and/or aneurysms (class I indication) and coronary bypass grafts (class II indication). CMRA utilisation for coronary artery disease is not yet part of clinical routine. However, the lack of radiation is of special value for the coronary artery evaluation in children and women. CMRA can assess the proximal part of coronary arteries in almost all cases. The best results have been observed in the evaluation of the left anterior descending and the right coronary artery, while the left circumflex, which is located far away from the coil elements, is frequently imaged with reduced quality, compared to the other two. Different studies detected an increase in wall thickness of the coronaries in patients with type I diabetes and abnormal renal function. Additionally, the non-contrast enhanced T1-weighed images detected the presence of thrombus in acute myocardial infarction. New techniques using delayed gadolinium enhanced imaging promise the direct visualization of inflamed plaques in the coronary arteries. The major advantage of CMR is the potential of an integrated protocol offering assessment of coronary artery anatomy, cardiac function, inflammation and stress perfusion-fibrosis in the same study, providing an individualized clinical profile of patients with heart disease.
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Sen F, Yılmaz S, Kuyumcu MS, Ozeke O, Balcı MM, Aydoğdu S. The Presence of Fragmented QRS on 12-Lead Electrocardiography in Patients with Coronary Artery Ectasia. Korean Circ J 2014; 44:307-11. [PMID: 25278983 PMCID: PMC4180607 DOI: 10.4070/kcj.2014.44.5.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/15/2014] [Accepted: 08/04/2014] [Indexed: 01/14/2023] Open
Abstract
Background and Objectives Coronary artery ectasia (CAE) is an angiographic finding characterized by dilation of an arterial segment with a diameter at least 1.5 times that of its adjacent normal coronary artery. Fragmented QRS (fQRS) complexes are electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar and/or ischaemia. In the present study, we aimed to evaluate the presence of fQRS in patients with CAE. Subjects and Methods The study population included 100 patients with isolated CAE without coronary artery disease (CAD) and 80 angiographically normal controls. fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory. Results The two groups were similar in terms of age, sex, hypertension, dyslipidemia, and family history of CAD. The presence of fQRS was significantly (p<0.05) higher in the CAE group than that in the normal coronary artery group (29% vs. 6.2%, p=0.008). Isolated CAE were detected most commonly in the right coronary artery (61%), followed by left anterior descending artery (52%), left circumflex artery (36%), and left main artery (9%). Multivariate stepwise logistic regression analysis showed that CAE {odds ratio (OR) 1.412; 95% confidence interval (CI) 1.085-1.541; p=0.003} and diabetes (OR 1.310; 95% CI 1.025-1.482; p=0.041) were independently associated with fQRS. Conclusion The presence of fragmented QRS associated with increased risk for arrhythmias and cardiovascular mortality was significantly higher in patients with CAE than in patient with normal coronary artery. Further studies are needed to determine whether the presence of fragmented QRS is a possible new risk factor for patients with CAE.
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Affiliation(s)
- Fatih Sen
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Samet Yılmaz
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mevlüt Serdar Kuyumcu
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ozcan Ozeke
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mustafa Mücahit Balcı
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sinan Aydoğdu
- Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
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Hsu PC, Su HM, Lee HC, Juo SH, Lin TH, Voon WC, Lai WT, Sheu SH. Coronary collateral circulation in patients of coronary ectasia with significant coronary artery disease. PLoS One 2014; 9:e87001. [PMID: 24475209 PMCID: PMC3903606 DOI: 10.1371/journal.pone.0087001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/15/2013] [Indexed: 11/29/2022] Open
Abstract
Objectives Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. Methods We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. Results 73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027) and poorer coronary collateral (58.2% vs 71.2%, p = 0.040). Patients with poor collateral (n = 331) had a higher incidence of CE (15.7% vs 9.5%, p = 0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p = 0.026), CE (OR = 0.544, p = 0.048), and number of diseased vessels (OR = 2.488, p<0.001) were significant predictors of coronary collaterals development. Conclusion The presence of CE was associated with poorer coronary collateral development in patients with SCAD.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Suh-Hang Juo
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Yalcin AA, Topuz M, Akturk IF, Celik O, Erturk M, Uzun F, Duran M, Karadeniz M, Sarikamis C, Oner E. Is there a correlation between coronary artery ectasia and neutrophil-lymphocyte ratio? Clin Appl Thromb Hemost 2014; 21:229-34. [PMID: 24463600 DOI: 10.1177/1076029613520488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We aimed to investigate the association between the neutrophil-lymphocyte ratio (NLR) and coronary artery ectasia (CAE). The study included 198 patients who had undergone coronary angiography for suspected coronary artery disease (CAD). The patients were divided into the following 4 groups: group 1, 44 patients with normal coronary arteries; group 2, 61 patients with CAD; group 3, 40 patients with isolated CAE; and group 4, 53 patients with CAE coexisting with CAD. Neutrophil-lymphocyte ratio was significantly lower in group 1 than the other groups and significantly higher in group 4. Patients in group 1 had significantly lower neutrophil counts and significantly higher lymphocyte counts than the patients in group 4. The isolated CAE and CAD groups were similar in terms of NLR, neutrophil count, and lymphocyte count. In addition, we found significant positive correlations between presence of ectasia, number of ectatic vessels, and NLR. Our findings provide additional evidence for the role of NLR in CAE.
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Affiliation(s)
- Ahmet Arif Yalcin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Topuz
- Department of Cardiology, Turhal State Hospital, Turhal, Tokat, Turkey
| | - Ibrahim Faruk Akturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Muhammed Karadeniz
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Cetin Sarikamis
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Ender Oner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
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