Effectiveness of an antiplatelet agent for coronary artery ectasia associated with silent myocardial ischemia

Coronary Ectasia with Slow Flow Related to Apical Hypertrophic Cardiomyopathy

Coronary ectasia (CE) has been reported to be associated with a high risk of coronary events and caused by several etiologies. The authors present a patient with CE who was noted to have an ECG abnormality in routine health check. Coronary angiography revealed diffuse ectasia in all 3 coronary arteries. The flow of contrast medium was slow and focal squeezing signs were observed in the left coronary artery. Echocardiography indicated mild apical hypertrophy and significant reduction of coronary flow reserve. Exercise thallium scintigraphy exhibited a transient perfusion defect in the inferior region. This is the first case report that a mild apical hypertrophy induced severe CE with slow coronary flow. The authors recommend a long-term prophylaxis of thrombotic complications with antiplatelet agents in patients with CE.

The Presence of Fragmented QRS on 12-Lead Electrocardiography in Patients with Coronary Artery Ectasia

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.

Mean platelet volume has a prognostic value in patients with coronary artery ectasia

The aim of this study was to investigate the prognostic role of mean platelet volume (MPV) in patients with coronary artery ectasia (CAE). The baseline MPV values of 258 patients with CAE were screened. The mean time of follow-up was 49 ± 21 months for major adverse cardiac events (MACEs) defined as the combination of cardiac death, nonfatal myocardial infarction (MI), rehospitalization due to cardiac disorders, and readmission due to chest pain. During follow-up period, 63 (24%) MACEs developed. There were 4 (2%) cardiovascular deaths, 0 nonfatal MI, 14 (5%) rehospitalization, and 45 (17%) readmission. Mean platelet volume values were significantly higher in patients with CAE with MACEs than in patients with CAE without MACEs (9.5 ± 1.2 fL vs 8.9 ± 1.1 fL, respectively, P = .002). The rate of MACE was higher in CAE patients with MPV of >9 fL than those with MVP of ≤9 fL (33% vs. 15%, P = .001). Mean platelet volume has a prognostic value for MACEs in patients with CAE.

The levels of tumor necrosis factor-alpha and interleukin-6 in patients with isolated coronary artery ectasia

Background/Aim. Coronary artery ectasia (CAE) is considered as a variant of atherosclerosis. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) are among the sensitive markers of systemic inflammation. The aim of this study was to evaluate the plasma levels of the cytokines; TNF-α and IL-6 in CAE patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 36 patients with CAE (28 males, mean age: 58.2 ± 12 years), and results were compared with age and sex-matched controls (n = 32) without coronary artery ectasia. TNF-α and IL-6 concentrations in blood were assesed by enzyme-linked immunosorbent assay (ELISA). Results. Baseline characteristics of the two groups were similar. TNF-α and IL-6 levels were significantly higher in CAE group than controls (15.6 ± 11.2 pg/mL versus 7.8 ± 3.7 pg/mL, P < .001, and 17.2 ± 12.6 versus 7.6 ± 2.1 P < .0001, resp.). Conclusion. CAE patients showed increases in TNF-α and IL-6 levels compared to the controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of CAE. Further placebo-controlled studies are needed to evaluate the clinical significance of this increase in TNF-α and IL-6 levels.

Assessment of left ventricular functions in patients with isolated coronary artery ectasia by conventional and tissue Doppler imaging

The authors sought to determine left ventricular functions by conventional and tissue Doppler imaging in patients with isolated coronary artery ectasia and controls. Peak early (E) and late (A) mitral inflow velocity, E/A ratio, E deceleration time, and isovolumetric relaxation time were obtained. Peak systolic velocity (Sm), diastolic early (Em), and late (Am) velocities were measured by tissue Doppler imaging. Interventricular septum velocities, including peak systolic (Ss), diastolic early (Es), and late (As) velocities, were recorded. Peak early (E) velocity, E/A ratio, and E deceleration time were different in both groups. Isovolumetric relaxation time was prolonged in patients with coronary artery ectasia than controls. Em and Em/Am ratio were lower in patients with coronary artery ectasia than controls. Diastolic early and Es/As velocities were lower in patients with coronary artery ectasia compared with controls. The authors showed that mitral inflow-lateral annulus and interventricular septum velocities were lower in patients with coronary artery ectasia than controls indicating left ventricular diastolic dysfunction.

Assessment of P-wave duration and dispersion in patients with isolated coronary artery ectasia

INTRODUCTION

Coronary artery ectasia (CAE) is defined as localized or diffuse dilatation of the epicardial coronary arteries. We sought to determine whether isolated CAE may alter P-wave duration and dispersion (PD).

METHODS

The study population consisted of 26 patients (mean age: 61.6+/-11.0 years) with isolated CAE (group 1) and sex- and age-matched 26 control subjects (group 2). Both groups underwent a standard 12-lead surface electrocardiogram recorded at 50 mm/s. Maximal (P(max)) and minimal P-wave durations (P(min)) are measured. PD was defined as the difference between P(max) and P(min).

RESULTS

In group 1, P(max) (114.2+/-10.4 ms vs 104.8+/-10.6 ms, p<0.002) and PD (34.0+/-12.7 ms vs 24+/-10.6, p<0.004) were significantly higher than those of group 2. Moreover a significant correlation was found between P(max) and PD with ectatic segment number (r=0.625, r=0.626, respectively; p=<0.001); and P(max) and PD with ectatic vessel number (r=0.698, r=0.704 respectively; p=<0.0001).

CONCLUSION

Isolated CAE and the degree of the ectasia were found to be associated with prolonged P(max) and PD.

Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity

Isolated coronary ectatic but otherwise normal epicardial coronary arteries are an infrequent angiographic finding. We sought to determine whether coronary artery ectasia (CAE) may alter QT-interval duration and dispersion. The study population consisted of 24 patients with isolated CAE and otherwise normal epicardial coronary arteries (group 1) and sex- and age-matched subjects with atypical chest pain and otherwise normal coronary flow (group 2). Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distribution of sex, age, body mass index, and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 +/- 10 vs 70 +/- 7, P > .05). In group 1, QTd, QTcd, and QTc were significantly higher than those of group 2 (QTd, 40 +/- 17 vs 29 +/- 10 milliseconds [P < .05]; QTcd, 43 +/- 19 vs 30 +/- 10 milliseconds [P < .05]; QTc, 410 +/- 21 vs 397 +/- 19 milliseconds [P < .05]). In conclusion, CAE was found to be associated with prolonged QT interval and increased QTd. Microvascular dysfunction and/or ischemia may be responsible mechanisms.