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Eyuboglu M, Eyuboglu C. Coronary Artery Ectasia in the Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Arteries. Am J Cardiol 2022; 171:28-31. [PMID: 35287947 DOI: 10.1016/j.amjcard.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/01/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022]
Abstract
Coronary artery ectasia (CAE) is associated with an increased risk for acute myocardial infarction (AMI). A significant proportion of patients with AMI have no obstructive coronary artery disease (CAD), however, the underlying mechanism of myocardial infarction with nonobstructive coronary arteries (MINOCA) is poorly understood. Therefore, the present study aimed to investigate whether CAE has a role in the pathogenesis of MINOCA. A total of 1,284 patients who were admitted with a diagnosis of non-ST-segment elevation myocardial infarction were included in the study. Patients were divided into 2 groups according to the presence or absence of obstructive CAD (≥50% stenosis). Patients without obstructive CAD (MINOCA group) and patients with obstructive CAD (no-MINOCA group) were compared regarding the frequency of CAE. Additionally, the association between CAE and MINOCA was investigated. In the study participants, 101 patients (7.9%) were diagnosed with MINOCA, whereas 1,183 (92.1%) had AMI with obstructive CAD. Importantly, the frequency of patients with CAE was significantly higher in patients with MINOCA compared with those with obstructive CAD (22.8% vs 3.5%, p <0.001). Moreover, CAE was observed in 64 patients (4.9%). The frequency of MINOCA was found to be significantly higher in patients with CAE compared with patients without CAE (35.9% vs 6.4%, p <0.001). Furthermore, multivariate analysis demonstrated that the presence of CAE was an independent predictor of MINOCA in patients presented with a diagnosis of non-ST-segment elevation myocardial infarction (odds ratio 1.812, 95% confidence interval 1.376 to 2.581, p <0.001). In conclusion, CAE may be considered as a risk factor for MINOCA and may have a role in the pathophysiology of MINOCA.
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Affiliation(s)
| | - Canan Eyuboglu
- Department of Anatomy, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Dogdus M, Kucukosmanoglu M, Kilic S. Assessment of the impact of isolated coronary artery ectasia on left ventricular functions with 3D speckle-tracking echocardiography. Echocardiography 2019; 36:2209-2215. [PMID: 31742786 DOI: 10.1111/echo.14533] [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: 07/15/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D-STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D-STE in the present study. METHODS Ninety-one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D-STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography. RESULTS The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >-16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >-20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE. CONCLUSION Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D-strain parameters, and 3D-STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Usak University, Training and Research Hospital, Usak, Turkey
| | - Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, Turkey
| | - Salih Kilic
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, 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: 1.6] [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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Liang S, Zhang Y, Gao X, Zhao H, Di B, Sheng Q, Liu R. Is Coronary Artery Ectasia a Thrombotic Disease? Angiology 2018; 70:62-68. [PMID: 29929375 DOI: 10.1177/0003319718782807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Coronary artery ectasia (CAE) is a rare disease and a substantial portion of patients with CAE are first diagnosed with acute myocardial infarction (AMI). The question was raised if CAE was a kind of thrombotic disease. We assessed a consecutive series of 119 patients with CAE including 32 patients with AMI (CAE + AMI group) and 87 patients without AMI (CAE group). During the same period, 90 patients with coronary heart disease, 90 patients with normal coronary arteries (control), and 120 AMI patients without CAE (AMI group) were randomly selected and evaluated. Both current and previous AMI prevalence rates in the CAE population were higher than the AMI rate for the other patients undergoing coronary angiograms; the mean platelet volume and fibrinogen were increased in the CAE + AMI and CAE groups. For patients with CAE with AMI, most of the thrombotic lesions were in the ectasia site. After dividing the patients with CAE into with and without antiplatelet treatment groups before admission, the AMI rate was lower in the antiplatelet group. Platelets may participate in the thrombotic process in CAE. Antiplatelet treatment may decrease the AMI rate of patients with CAE.
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Affiliation(s)
- Siwen Liang
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yue Zhang
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Gao
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huiqiang Zhao
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Beibing Di
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qianqian Sheng
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruifeng Liu
- 1 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Abstract
Ectasias and coronary aneurysms are uncommon coronary artery diseases, can coexist and are poorly known. Their principal etiology in adults is coronary atherosclerosis. It has been suggested that these abnormalities would have poor prognosis and that slow flow could lead to in situ thrombosis and distal embolisation. However, ectasias and aneurysms are most often associated with coronary stenosis. We report a series of 47 cases of ectasias and coronary aneurysms with evaluation of the clinical and angiographic characteristics, the therapeutic choices and we review the literature concerning these lesions. In situ thrombosis does not seem to be the usual pathophysiological mechanism. We retain that this is a particular form of coronary atherosclerosis in this population and present technical problems in case of revascularization with an predominant indication of medical treatment (57.4 % of the cases), but rarely the introduction of anticoagulants (4.25 % of the cases), except in acute coronary syndromes where revascularization is most common (70.6 % of cases) as is usually expected in the general population. The complex angiographic presentation of these lesions is probably an explanation for the low numbers of revascularizations performed.
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Affiliation(s)
- M A Bouzid
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Hôpital européen de Paris-la-Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - H Benamer
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Hôpital européen de Paris-la-Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Institut cardiovasculaire Paris-Sud, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France.
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Aghajani H, Faal M, Hosseinsabet A. Evaluation of longitudinal left ventricular function in patients with coronary artery ectasia and vitamin D deficiency by 2D speckle tracking echocardiography. Echocardiography 2017; 34:397-406. [PMID: 28150401 DOI: 10.1111/echo.13467] [Citation(s) in RCA: 4] [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
OBJECTIVES Coronary artery ectasia (CAE) is defined as the dilation of at least one segment of the coronary arteries that reaches at least 1.5 times the size of a normal neighboring segment. It has been shown that left ventricular (LV) diastolic function is impaired in patients with CAE. Also, it has been shown that LV function is impaired in vitamin D-deficient subjects compared with vitamin D-sufficient subjects and vitamin D deficiency is prevalent in CAE patients. We hypothesized that LV function is impaired in patients with CAE so we evaluated longitudinal LV myocardial function by 2D speckle tracking echocardiography (2DSTE) in patients with CAE and vitamin D deficiency without significant coronary artery stenosis and compared the results with those of subjects with vitamin D deficiency and near-normal coronary arteries. METHODS Our study population comprised 21 consecutive patients with CAE and without significant coronary artery stenosis (<50%) and 31 control subjects with near-normal coronary arteries. All subjects had vitamin D deficiency. RESULTS All 2DSTE-derived indices of longitudinal LV function, comprised of the absolute values of systolic strain (14.0±2.7% vs 15.4±2.3%, P=.039), systolic strain rate (1.2±0.2/s vs 1.3±0.2/s, P=.015), early diastolic strain rate (1.1±0.3/s vs 1.3±0.3 s-1 , P=.030), and late diastolic strain rate (0.8±0.2/s vs 1±0.2/s, P=.005), were reduced in the patients with CAE and vitamin D deficiency. CONCLUSIONS The systolic and diastolic functions of the LV in the patients with CAE and vitamin D deficiency were impaired as evaluated by 2DSTE.
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Affiliation(s)
- Hasan Aghajani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Faal
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Dogan A, Arslan A, Yucel H, Aksoy F, Icli A, Ozaydin M, Varol E, Erdogan D. Gamma glutamyltransferase, inflammation and cardiovascular risk factors in isolated coronary artery ectasia. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dogan A, Arslan A, Yucel H, Aksoy F, Icli A, Ozaydin M, Varol E, Erdogan D. Gamma glutamyltransferase, inflammation and cardiovascular risk factors in isolated coronary artery ectasia. Rev Port Cardiol 2015; 35:33-9. [PMID: 26711537 DOI: 10.1016/j.repc.2015.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE There are conflicting data on the prevalence of cardiovascular risk factors in coronary artery ectasia (CAE). It is unclear whether CAE is associated with high-sensitivity C-reactive protein (hs-CRP) and gamma glutamyltransferase (GGT). We therefore investigated major cardiovascular risk factors, serum GGT and hs-CRP levels in a large population of patients with CAE. METHODS A total of 167 patients with isolated CAE and 150 controls with normal coronary arteries were selected from 10505 patients undergoing coronary angiography. Serum GGT and hs-CRP levels were evaluated in addition to cardiovascular risk factors including family history, obesity, smoking, diabetes, hypertension and hyperlipidemia. RESULTS Hypertension and obesity were slightly more prevalent in CAE patients than in controls, whereas diabetes was slightly less frequent in CAE patients. Other risk factors were similar. Serum GGT (22 [17-42] vs. 16 [13-21] U/l, p=0.001) and hs-CRP (2.9 [1.9-3.6] vs. 1.4 [1.1-1.8] mg/l, p=0.001) levels were higher in CAE patients than in controls. The presence of CAE was independently associated with diabetes (OR: 0.44, 95% CI: 0.20-0.95, p=0.04), obesity (OR: 2.84, 95% CI: 1.07-7.56, p=0.04), GGT (OR: 1.08, 95% CI: 1.03-1.12, p=0.001) and hs-CRP levels (OR: 3.1, 95% CI: 2.1-4.6, p=0.001). In addition, GGT and hs-CRP levels were higher in diffuse and multivessel ectasia subgroups than focal and single-vessel ectasia subgroups (each p<0.05). CONCLUSIONS Our findings show that CAE can be independently and positively associated with obesity, GGT and hs-CRP levels, but inversely with diabetes. Moreover, its severity may be related to GGT and hs-CRP levels.
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Affiliation(s)
- Abdullah Dogan
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Akif Arslan
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey.
| | - Habil Yucel
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Fatih Aksoy
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Atilla Icli
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Ozaydin
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Ercan Varol
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Dogan Erdogan
- Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
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Ozcan OU, Atmaca Y, Goksuluk H, Akbulut IM, Ozyuncu N, Ersoy N, Erol C. Effect of Diltiazem on Coronary Artery Flow and Myocardial Perfusion in Patients With Isolated Coronary Artery Ectasia and Either Stable Angina Pectoris or Positive Myocardial Ischemic Stress Test. Am J Cardiol 2015; 116:1199-203. [PMID: 26277295 DOI: 10.1016/j.amjcard.2015.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 12/27/2022]
Abstract
Isolated coronary artery ectasia (CAE) may be associated with stable or unstable coronary events despite the absence of epicardial coronary stenosis. Impaired coronary flow dynamics and myocardial perfusion have been demonstrated in stable patients with ectatic coronary arteries. We aimed to assess whether epicardial flow and tissue-level perfusion would be improved by diltiazem in myocardial regions subtended by the ectatic coronary arteries in patients with isolated CAE. A total of 60 patients with isolated CAE were identified of 9,780 patients who underwent elective coronary angiography. Patients were randomized to 5 mg of intracoronary diltiazem or saline. Coronary blood flow of the microvascular network was assessed using myocardial blush grade (MBG) technique. The thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (TFC) were used to assess epicardial coronary flow. MBG (from 2.4 to 2.6, p = 0.02), TIMI flow grades (from 2.4 to 2.8, p <0.001), and TFC (from 35 to 26, p <0.001) were significantly improved after diltiazem, whereas no significant change was noticed after saline (from 2.4 to 2.4, p = 0.86 for MBG; from 2.3 to 2.3, p = 0.71 for TIMI flow grade; and from 35 to 33, p = 0.43 for TFC). Diltiazem provided amelioration of the altered coronary flow dynamics, which was suggested as the pathophysiological influence of CAE. In conclusion, the favorable effects of the diltiazem on myocardial perfusion were observed at both epicardial and tissue levels.
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Affiliation(s)
| | - Yusuf Atmaca
- Department of Cardiology, Ankara University, Ankara, Turkey
| | | | | | - Nil Ozyuncu
- Department of Cardiology, Ankara University, Ankara, Turkey
| | - Nedret Ersoy
- Department of Cardiology, Ankara University, Ankara, Turkey
| | - Cetin Erol
- Department of Cardiology, Ankara University, Ankara, Turkey
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Farrag A, Faramawy AE, Salem MA, Wahab RA, Ghareeb S. Coronary artery ectasia diagnosed using multidetector computed tomography: morphology and relation to coronary artery calcification. Int J Cardiovasc Imaging 2012; 29:427-33. [PMID: 22718361 DOI: 10.1007/s10554-012-0079-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/04/2012] [Indexed: 01/07/2023]
Abstract
Coronary artery ectasia (CAE) is usually considered a variant of coronary artery atherosclerosis; however, a definite link has not yet been confirmed. As not all patients with CAE are symptomatic, the real incidence is unknown. The aim of this study was to evaluate the prevalence of CAE and its clinical and angiographic characteristics as well as its relation to coronary artery calcification and any associated vascular abnormality by using multidetector computed tomography (MDCT). We prospectively enrolled 2,600 patients (mean age 55 ± 10 years) who were scheduled for computed tomography coronary angiography (CTCA). CTCA was performed using 64-MDCT with dedicated software for calcium measurement. CAE was defined as an arterial segment with a diameter of >1.5 times the diameter of the adjacent normal segment. The presence of ≥70 % diameter stenosis of any major epicardial vessel was considered an obstructive lesion. CAE was encountered in 192 (7.4 %) patients and showed gender predominance in men (88 %). Patients with CAE were more hypertensive but less diabetic. Left anterior descending artery was the most commonly affected vessel. Only 16 % of CAE patients had no atherosclerotic lesion. Coronary artery calcium score (CACS) and prevalence of ascending aorta aneurysm were shown to be significantly higher in CAE patients compared to patients having no ectasia. A significant negative correlation was noted between CACS and Markis classification. CTCA is a feasible technique to identify and evaluate morphology of CAE. The link between CACS and CAE may favor the consideration that ectasia is an advanced form of atherosclerosis.
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Affiliation(s)
- Azza Farrag
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Musiałek P, Tekieli Ł, Pieniazek P, Undas A, Miszalski-Jamka T, Zajdel W, Klimeczek P, Laskowicz B, Banyś RP, Pasowicz M, Podolec P. How should I treat a very large thrombus burden in the infarct-related artery in a young patient with an unexplained lower GI tract bleeding? EUROINTERVENTION 2012; 7:754-5; discussion 756-63. [PMID: 21986333 DOI: 10.4244/eijv7i6a119] [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: 11/23/2022]
Affiliation(s)
- Piotr Musiałek
- Jagiellonian University Institute of Cardiology, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland.
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The relationship between acute coronary syndrome and inflammation: a case of acute myocardial infarction associated with coronary involvement of Sweet's syndrome. Blood Coagul Fibrinolysis 2011; 21:703-6. [PMID: 20729720 DOI: 10.1097/mbc.0b013e32833e4781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sweet's syndrome is characterized by skin lesions and fever. One of the rare extracutaneous manifestations of Sweet's syndrome is cardiovascular involvement including coronary artery occlusion. In this article, we present a case of acute myocardial infarction associated with exacerbation of Sweet's syndrome. Coronary angiography has demonstrated normal left coronary arterial system and the occlusion of distal right coronary artery. The patient underwent successful balloon angioplasty and subsequent coronary artery stenting. The presence of coronary ectasia, aneurysm and coronary occlusion of right coronary artery caused us to hypothesize that the coronary involvement including ectasia, aneurysm and occlusion might be associated with hyperreactive inflammatory response secondary to exacerbations of Sweet's syndrome.
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Dahi S, Karliner JS, Sarkar R, Lovett DH. Transgenic expression of matrix metalloproteinase-2 induces coronary artery ectasia. Int J Exp Pathol 2011; 92:50-6. [PMID: 21039989 PMCID: PMC3052756 DOI: 10.1111/j.1365-2613.2010.00744.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/26/2010] [Indexed: 01/23/2023] Open
Abstract
Coronary artery ectasia (CAE) is generally diagnosed in patients undergoing arteriography for presumptive atherosclerotic coronary artery disease. CAE is commonly considered as a variant of atherosclerotic disease; however, recent studies suggest that CAE is the result of a systemic vascular disorder. There is increasing evidence that aneurysmal vascular disease is a systemic disorder characterized by enhanced expression of pro-inflammatory cytokines and increased synthesis of enzymes capable of degrading elastin and other components of the vascular wall. Matrix metalloproteinase-2 degrades a number of extracellular substrates, including elastin and has been shown to play a critical role in the development of abdominal aortic aneurysms. This study characterizes the development of CAE in a unique murine transgenic model with cardiac-specific expression of active MMP-2. Transgenic mice were engineered to express an active form of MMP-2 under control of the α-myosin heavy chain promoter. Coronary artery diameters were quantified, along with studies of arterial structure, elastin integrity and vascular expression of the MMP-2 transgene. Latex casts quantified total coronary artery volumes and arterial branching. Mid-ventricular coronary luminal areas were increased in the MMP-2 transgenics, coupled with foci of aneurysmal dilation, ectasia and perivascular fibrosis. There was no evidence for atherogenesis. Coronary vascular elastin integrity was compromised and coupled with inflammatory cell infiltration. Latex casts of the coronary arteries displayed ectasia with fusiform dilatation. The MMP-2 transgenic closely replicates human CAE and supports a critical and initiating role for this enzyme in the pathogenesis of this disorder.
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Affiliation(s)
- Sia Dahi
- The Department of Surgery, San Francisco Department of Veterans Affairs Medical Center/University of California San Francisco and Northern California Institute for Research and Education, San Francisco, CA 94121, USA
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Leschka S, Stolzmann P, Scheffel H, Wildermuth S, Plass A, Genoni M, Marincek B, Alkadhi H. Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography. Eur Radiol 2008; 18:2776-84. [PMID: 18641995 DOI: 10.1007/s00330-008-1087-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/30/2008] [Accepted: 05/05/2008] [Indexed: 11/25/2022]
Abstract
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 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement > or = 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 +/- 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 +/- 4.9 mm), but had higher diameters (levels of agreement: -1.0 to 3.4 mm). 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 CCA.
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Affiliation(s)
- Sebastian Leschka
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Bibliography--editors' selection of current world literature. Coron Artery Dis 2007; 18:589-94. [PMID: 17925615 DOI: 10.1097/01.mca.0000267547.16160.f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harikrishnan S, Krishnakumar N, Jaganmohan T. Coronary Artery Ectasia-Is it Time for Reappraisal? Clin Cardiol 2007; 30:536. [PMID: 17929287 PMCID: PMC6653085 DOI: 10.1002/clc.20216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/10/2022] Open
Affiliation(s)
- S. Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences Trivandrum, India
| | - Nair Krishnakumar
- Sree Chitra Tirunal Institute for Medical Sciences Trivandrum, India
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