Among Ectasia Patients with Coexisting Coronary Artery Disease, TIMI Frame Count Correlates with Ectasia Size and Markis Type IV Is the Commonest

Background. Coronary artery ectasia (CAE) occurs in 0.3 to 5.3% of patients undergoing coronary angiography. TIMI frame count (TFC) is an index of coronary flow that correlates with flow velocity. In ectasia patients, there is delayed coronary flow with increased TFC. Methods. We evaluated angiograms of 789 patients for presence of CAE, coronary artery disease (CAD), and Markis type of CAE. We measured ectasia size and length and their correlation with TFC in ectatic right coronary arteries (RCA) of patients with CAE and CAD. Results. 30 patients had CAE (3.8%). Of these 16.7% had isolated CAE, while 83.87% had CAE and CAD. Among CAE and CAD patients, the RCA was most involved (70.4%), and Markis type IV CAE was the commonest (64%). In isolated CAE, the RCA, LAD, and LCx were equally involved (33.3%). Patients with CAE and CAD had significantly higher TFC compared to controls, P=0.035. There was a positive correlation of moderate strength, between ectasia size and TFC, r(17) = 0.598, P=0.007. Ectasia length was not significantly correlated with TFC, rho (17) = 0.334, P=0.163. Conclusion. Among patients undergoing angiography, CAE has a prevalence of 3.8% and Markis type IV is the commonest. Larger ectasias are associated with slower coronary flow

Cardiovascular involvement in Kawaski Disease

This article contains a case report of a 19 month old child with Kawasaki Disease who developed bilateral giant coronary artery aneurysms.peer-reviewe

Discrete atherosclerotic coronary artery aneurysms: A study of 20 patients

The incidence, angiographic features and natural history of discrete atherosclerotic coronary aneurysms were evaluated in 20 patients with 22 aneurysms (0.2% of 8,422 patients referred for coronary angiography). Fifteen aneurysms (68%) were in the left anterior descending, four (18%) in the circumflex, two (9%) in the right and one (5%) in the left main coronary artery. Aneurysm diameter ranged from 4 to 35 mm (mean 8); 95% of aneurysms were adjacent to a severe obstruction.Seventy-five percent of patients had severe triple vessel disease that included severe left main disease in 15%. Total obstruction of one or two arteries was present in 75%. In patients with wall motion abnormalities, 78% of the abnormalities were in the distribution of the aneurysm. Follow-up (range 1 to 90 months [mean 30]) was obtained in all 20 patients. There were two cardiac and two noncardiac deaths; 12 patients had coronary bypass surgery and of 16 survivors, 13 were angina-free.In conclusion, discrete coronary aneurysms are much less common than diffuse ectasia. Unlike ectasia, they are never found in arteries without severe stenosis, and are most common in the left anterior descending coronary artery. Associated coronary artery disease is more severe in patients with discrete aneurysms than in those with diffuse ectasia. Discrete coronary aneurysms do not appear to rupture, and their resection is not warranted

Coronary artery ectasia

AbstractCoronary artery ectasia (CAE) is defined as localized or diffuse dilatation of coronary artery lumen exceeding the largest diameter of an adjacent normal vessel more than 1.5 fold. The incidence of CAE is reported as 0.3–4.9% of patients undergoing coronary angiography. The rate of recognition may increase with the use of new non-invasive imaging methods like computed tomography (CT) and magnetic resonance (MR) coronary angiography. Atherosclerosis is considered as the main etiologic factor responsible for more than 50% of cases in adults while Kawasaki disease is the most common cause in children or young adults. Coronary ectasia is thought to be a result of exaggerated expansive remodeling, which is eventuated as a result of enzymatic degradation of the extracellular matrix and thinning of the vessel media. Patients with CAE without significant coronary narrowing may present with angina pectoris, positive stress tests or acute coronary syndromes. Ectatic vessel may be an origin of thrombus formation with distal embolization, vasospasm or vessel rupture. The prognosis of CAE depends directly on the severity of the concomitant coronary artery disease. Antiplatelet drugs underlie the therapy. Other management strategies in CAE involve both the prevention of thromboembolic complications and percutaneous or surgical revascularization

Evaluation of hemogram parameters in diabetic patients with coronary artery ectasia

Aim: To compare the importance of hemogram parameters in predicting the disease in diabetic patients with coronary artery ectasia (CAE) and normal coronary artery. Methods: The records of 7287 patients who underwent coronary angiography between January 2017 and October 2019 were reviewed. After appropriate exclusions, diabetic patients were divided into coronary artery ectasia and normal coronary artery groups. A total of 248 patients were included in the study and hemogram parameters of these two groups were compared. Results: Compared to control group white blood count (WBC) [8 (4-13) vs. 7 (5-12) u/mm3, p=0.023], hemoglobin [13 (10-16) vs. 14 (10-20) gr/dL, p=0.015], red cell distribution width (RDW) [16 (14-20) vs. 15 (12-19) %, p=0.026], neutrophil [4.5 (2.1-11.4) vs. 4.0 (0.2-7.5) u/mm3, p=0.003], platelet counts (Plt) [266 (196-450) vs. 236 (163-362) k/mm3 p<0.001], platelet distribution width (PDW) (17.9 (16.2-20.4) vs. 17.7 (15.9-19.7) % p=0.011), mean platelet volume (MPV) [8.4 (6.4-11.2) vs. 7.9 (6.6-10.1) Fl, p=0.015], plateletcrit (PCT) [0.20 (0.14-0.32) vs. 0.19 (0.13-0.26), p<0.001], and neutrophil lymphocyte ratio (NLR) [2.1 (1.0-9.7) vs. 1.6 (0.2-5.7), p=0.002] were significantly higher in CAE patients. Conclusion: The results of this study suggest that the increased some hemogram parameters may be useful in predicting disease in diabetic patients with CAE

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9mm), but had higher diameters (levels of agreement: −1.0 to 3.4mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CC

Effect of isolated coronary artery ectasia on left ventricular global longitudinal strain

Background: Coronary artery ectasia (CAE), known as a dilatation of coronary segment to at least 150% of the diameter of adjacent healthy segment. Despite the fact that coronary ectasia is under-treated angiographic finding, it has a tremendous impact on patients mortality and morbidity. The hypothesis that isolated CAE is a cause of subtle left ventricle (LV) systolic dysfunction needs intense and thorough research. Objective: To assess longitudinal LV functions in patients with isolated coronary ectasia using 2 dimensional (2D) speckle tracking echocardiography. Patients and Methods: This study is a case control study conducted on two groups of patients referred to our tertiary centre for elective coronary angiography. The first group included 30 consecutive symptomatic patients proved to have CAE without obstructive coronary artery disease. The second group included 30 patients with normal coronary angiography serving as a control group. Patients with any form of structural heart disease affecting LV systolic functions were excluded, echocardiographic evaluation was held for every patient targeting 2D assessment of systolic and diastolic functions, tissue Doppler measurements and finally offline 2D speckle tracking for assessment of global LV longitudinal strain. Results: Males were more dominant in CAE group. Hypertension and dyslipidemia were more prevalent in CAE group unlike diabetes that was more common among control subjects. LV volumes, dimensions, mass index, left atrium (LA) volume index and aortic root diameter were significantly higher among CAE group. Mean global longitudinal strain was significantly lower in CAE group with value of (-16.5%) versus (-19.5%) in control group. Conclusions: Global longitudinal strain is significantly reduced in patients with CAE even in the absence of obstructive coronary artery disease denoting subclinical LV systolic dysfunctio

Evaluation of OxPL Levels in Patients Undergoing Coronary Angiography: A Cross-Sectional Study

Background and Aim: Coronary ectasia is one of the prevalent cardiovascular diseases worldwide. It causes many deaths annually ranged between 9% to 10% which is dependent on related risk factors. The main pathogenesis has not been determined yet; however, it has been shown, that increased lipid profiles and their oxidation in patients can cause endothelial cell dysfunction and thrombosis. Therefore, here we investigated the oxidized phospholipids (OxPLs) role in the pathogenesis of coronary artery disease. Methods: This cross-sectional study was performed in Shariati Hospital, Tehran. Accordingly, patients with coronary artery angiography indications (n=360) were included and classified into one of the following three groups, based on the angiographic results: 1) normal coronary artery (not dysfunction in vessels) or mild CAD (only intimal irregularity or less than 3% narrowing without ectasia); 2) vessel dilation more than 1.5 times compared to the normal part of the vessel or compared to the normal size according to age and gender in one or more coronary vessels; and&nbsp; 3) patients with more than 50% stenosis in one of the coronary arteries. The peripheral blood was collected from patients in EDTA anticoagulants container tubes and the OxPL level was measured using an ELISA kit. Results: The results showed that the amount of OxPL in the third and second groups was higher than in the first group. It was also found that hyperlipidemia, diabetes, hypertension, and smoking were higher in the third and second groups; all mentioned findings were statistically significant (p-value &lt;0.05). Conclusion: According to the findings of this study, it was shown that an increase in OxPL in patients with coronary ectasia can be considered as a risk factor for disease progression; OxPL measurement can be used to identify high-risk individuals. *Corresponding Author: Seyed Abdolhussein Tabatabaei; Email: tabatabaeiseyedah@gmailcom; ORCID iD: 0000-0001-5091-6066 Please cite this article as: Nikdoust F, Lashkari Zadeh F, Tabatabaei SA. Evaluation of OxPL Levels in Patients Undergoing Coronary Angiography: A Cross-Sectional Study. Arch Med Lab Sci. 2021;7:1-6 (e12). https://doi.org/10.22037/amls.v7.3460

Chronic exposure to high altitude and the presence of coronary ectasia in patients with ST elevation myocardial infarction

Objective. To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru. Materials and methods. Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals. Results. Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236). Conclusions. In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia.Objective. To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru. Materials and methods. Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals. Results. Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236). Conclusions. In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia