Causation or Coincidence? A Case of Coexisting Spontaneous Coronary Artery Dissection and Coronary Thrombosis in a Patient with Kounis Syndrome

Kounis syndrome (KS) is a hypersensitive coronary disorder leading to acute coronary syndrome triggered by drugs, food, and environmental factors. Herein, we report a 39-year-old patient who was admitted to our clinic due to type 2 KS after oral diclofenac use. Interestingly, spontaneous coronary artery dissection was detected simultaneously on coronary angiography. Up to now, no case has been defined including the combination of these two different conditions

Assessment of arterial stiffness with cardio-ankle vascular index in patients with mitral annular calcification

Objective: Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascular events. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI) is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC. Materials and Methods: The study was cross-sectional and observational and included 98 patients with MAC confirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38 controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. Results: The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index was significantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, left arm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P = .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) was measured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P = .017 and P = .005, respectively). Conclusion: CAVI increased in all patients with MAC and associated with increasing grade of calcification

Porównanie stosunku liczby neutrofilów do limfocytów u pacjentów z tętniakiem tętnicy wieńcowej i chorych z istotnym zwężeniem tętnicy wieńcowej

Background: Previous studies have demonstrated that inflammation, neurohormonal process and cardiovascular risk factors are associated with the development of coronary artery ectasia (CAE). However, the underlying mechanisms responsible for ectasia formation are not fully understood. The neutrophil to lymphocyte (N/L) ratio has recently emerged as a new inflammation marker for cardiovascular disease.Aim: In this study, we hypothesised that CAE could be associated with more severe inflammation compared to obstructive coronary artery disease (O-CAD) with regard to N/L ratio values.Methods: A total of 405 patients with isolated CAE, O-CAD and insignificant CAD (controls) were enrolled. Severity of isolatedCAE was determined according to the Markis classification. N/L ratio values were compared between the three groups.Results: We determined that the patients with isolated CAE had significantly elevated N/L ratio values compared to O-CADand control groups (2.5 vs. 1.9, p &lt; 0.001 and vs. 1.6, p &lt; 0.001, respectively). In multivariate analysis adjusted for age, sex, diabetes meliteis (DM) and hypertension, N/L ratio was independently associated with the presence (N/L ratio, OR = 2.48, 95% CI 2.03–3.02, p &lt; 0. 001) and severity (DM, OR = 2.90, 95% CI 1.02–8.18, p = 0.044, N/L ratio, OR = 1.88, 95% CI 1.47–2.41, p = 0.004) of isolated CAE. ROC curve analysis revealed that a N/L ratio value of &gt; 2.06 identified the patients with isolated CAE.Conclusions: We showed that patients with isolated CAE had a significantly higher N/L ratio than patients with O-CAD and control groups. This finding suggests that a more severe inflammatory process could be involved in the development of CAE.Wstęp: Wcześniejsze badania wykazały, że zapalenie, proces neurohormonalny i czynniki ryzyka sercowo-naczyniowego wiążą się z rozwojem tętniaka tętnicy wieńcowej (CAE). Jednak mechanizmy prowadzące do powstania tętniaka nie zostały w pełni poznane. Ostatnio uznano stosunek liczby neutrofili do limfocytów (N/L) za nowy wskaźnik zapalenia w chorobach układu sercowo-naczyniowego.Cel: W niniejszym badaniu autorzy postawili hipotezę, że CAE może się wiązać z bardziej nasilonym procesem zapalnym niż istotne zwężenie tętnicy wieńcowej (O-CAD), czego miarą są wartości współczynnika N/L.Metody: Do badania włączono 405 osób z izolowanym CAE, O-CAD i nieistotną klinicznie CAD (grupa kontrolna). Ciężkość izolowanego CAE określono na podstawie klasyfikacji Markisa. Wartości współczynnika N/L porównano między grupami.Wyniki: Autorzy ustalili, że u chorych z CAE wartości współczynnika N/L były istotnie podwyższone w porównaniu z pacjentami z O-CAD i osobami z grupy kontrolnej (odpowiednio 2,5 vs. 1,9; p &lt; 0,001 i 1,6; p &lt; 0,001). W analizie wieloczynnikowej skorygowanej względem wieku, płci, cukrzycy i nadciśnienia tętniczego współczynnik N/L był niezależnie związanyz obecnością (współczynnik N/L, OR = 2,48; 95% CI 2,03–3,02; p &lt; 0,001) i ciężkością (cukrzyca, OR = 2,90; 95% CI 1,02–8,18; p = 0,044; współczynnik N/L, OR = 1,88; 95% CI 1,47–2,41; p = 0,004) izolowanego CAE. Analiza krzywychROC wykazała, że wartość współczynnika N/L wynosząca ponad 2,06 pozwala zidentyfikować pacjentów z izolowanym CAE.Wnioski: Autorzy wykazali, że u chorych z izolowanym CAE współczynnik N/L jest istotnie wyższy niż u pacjentów z O-CAD i u osób z grupy kontrolnej. Te obserwacje sugerują, że bardziej nasilony proces zapalny może wpływać na rozwój CAE