Antiendothelial cell antibodies in patients with coronary artery ectasia

Prevalence of Antinuclear Antibodies in Patients With Coronary Artery Disease: A Scoping Review

Coronary artery disease (CAD) is one of the most common causes of death worldwide. CAD is characterized by atherosclerosis and inflammation of the intima layer in blood vessels. Autoimmune diseases have a well-established association with CAD, which is accredited to the role immune modulators play in atherogenesis and autoimmune disease. Antinuclear-antibody (ANA) is an immunoglobulin that attacks nuclear and cytoplasmic components within cells, serving as a biomarker for many autoimmune conditions. This study evaluates whether ANA titers serve as an independent risk factor for CAD and its clinical manifestations. A scoping review was conducted using the following databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, ProQuest, OVID Medline, and PubMed. The search terms "Coronary artery disease" OR "Coronary disease" OR "Coronary aneurysm" AND "Antibodies, Antinuclear" were used to search for articles from 2000 to 2024. The initial search identified 442 articles and a total of 13 articles were included in the final results for data extraction. After analysis, 329 patients with CAD were found to have positive ANA titers, where a titer greater than 1:40 was considered positive. Among these patients, the most prevalent titer was 1:160 (0.31, n=103). Confounding rheumatological factors were evaluated: anti-cardiolipin IgG and IgM were the second most common antibodies (0.39, n=130) (0.37. n=123). Furthermore, a strong positive association between ANA titers and the number of stenotic coronary vessels was seen in the coronary artery ectasia (CAE) population. Hypertension was the most frequently observed comorbidity. Although smoking and being a male individual is a common risk factor for CAD, it was found that ANA titers were most prevalent in female nonsmokers. Results indicate that positive ANA titers could be an independent risk factor for CAD in patients without established autoimmune disease. This is evidence, particularly among patients with CAE, that the severity of ectasia in the coronary vessels is correlated with the strength of ANA titers. This investigation suggests that patients with positive ANA titers should undergo preliminary cardiovascular screening. Further research is needed to isolate ANA from traditional risk factors of CAD and to explore the potential use of ANA titers as a screening tool for CAD.

Hypertension and coronary artery ectasia: a systematic review and meta-analysis study

BACKGROUND

Coronary artery ectasia (CAE) is characterized by the enlargement of a coronary artery to 1.5 times or more than other non-ectasia parts of the vessel. It is important to investigate the association of different factors and CAE because there are controversial results between available studies. We perform this systematic review and meta-analysis to evaluate the effects of hypertension (HTN) on CAE.

METHODS

To find the potentially relevant records, the electronic databases, including Scopus, PubMed, and Science Direct were searched on 25 July 2019 by two of the authors independently. In the present study, the pooled odds ratio (OR) accompanied by 95 % confidence intervals (CIs) were calculated by a random-effects model. Heterogeneity presented with the I² index. Subgroup analysis and sensitivity analysis by the Jackknife approach was performed.

RESULTS

Forty studies with 3,263 cases and 7,784 controls that investigated the association between HTN and CAE were included. The pooled unadjusted OR of CAE in subjects with HTN in comparison by subjects without HTN was estimated 1.44 (95 % CI, 1.24 to 1.68) with moderate heterogeneity (I² = 41 %, Cochran's Q P = 0.004). There was no evidence of publication bias in the analysis of HTN and CAE with Egger's test (P = 0.171), Begg's test (P = 0.179). Nine articles reported the adjusted effect of HTN on CAE by 624 cases and 628 controls. The findings indicated the overall adjusted OR was 1.03 (95 % CI, 0.80 to 1.25) with high heterogeneity (I² = 58.5 %, Cochran's Q P = 0.013).

CONCLUSIONS

We found that when the vessel was in normal condition, HTN was not very effective in increasing the chance of CAE and only increased the CAE chance by 3 %. This is an important issue and a warning to people who have multiple risk factors together. More studies need to be performed to further establish these associations by reported adjusted effects.

Coronary artery ectasia in Crohn's disease

Coronary artery ectasia (CAE) can be ascribed, in the majority of cases, to coronary atherosclerosis. Nevertheless, the presence of isolated ectatic lesions without obstructive coronary artery disease and the association of CAE with several autoimmune diseases characterised by systemic vascular involvement suggest that the pathogenesis of CAE may extend beyond coronary atherosclerosis. We herein report the case of a 56-year-old male patient with Crohn's disease and isolated CAE, who has been found positive for IgM and IgA antiendothelial cell antibodies, and discuss a potential pathogenic mechanism.

Antiendothelial cells antibodies in patients with systemic sclerosis in relation to pulmonary hypertension and lung fibrosis

Although scleroderma is generally considered a fibrosing disease, it is now recognized that the underlying vascular pathology is playing a fundamental role in its pathogenesis. The present study was aimed at testing the prevalence of anti-endothelial cell antibodies (AECA) in systemic scleroderma (SSc) patients with and without pulmonary hypertension (PH) and in relation to the presence of pulmonary fibrosis. Fifty four SSc patients (50 females and 4 male, mean age 55.7 ± 16.3 years) were prospectively screened. All patients underwent transthoracic echocardiography with the estimation of pulmonary artery pressure (PAP) and tricuspid regurgitant peak gradient (TRPG). All patients suspected to have pulmonary hypertension were referred for right heart catheterization. Restrictive lung disease was confirmed by HRCT. A healthy control group included (n = 27; 7 men and 20 women, mean age 49.8 ± 12.1 years). The study of AECA was performed using the indirect immunofluorescence method on commercially available human umbilical vein endothelial cells. The HRCT scans in patients with suspected interstitial lung disease revealed signs of lung fibrosis in 15 (out of the 36 examined patients). TRPG at rest of 31 mmHg was demonstrated in 14 (21%) patients. During cardiac catheterization, arterial PH was found in two patients. Resting venous PH was found in one patient and an excessive post capillary PAP elevation at rest was demonstrated in 11 patients. At the baseline, 14/54 patients (26%) were positive for AECA. In the control group, the frequency of the antibodies was 3/27 (11%). No statistical correlation between antibody titter and the presentation of the disease existed. AECA were highly prevalent in a subgroup of patients suffering from interstitial pulmonary fibrosis. Out of the 15 patients suffering from lung fibrosis, 7 were AECA positive. The presence of AECA correlated very well with antinuclear antibodies (ANA), but was not related to the profile of ANA. Our findings support evidence that endothelial cell damage is involved in SSc, as there was increased prevalence of circulating AECA of the IgG isotype in SSc patients. AECA may also be related to the complications of SSc, like pulmonary fibrosis.