Koroner Arter Hastalığı Olmayan Hastalarda Kadın Cinsiyet ve İleri Yaş Koroner Arter Tortuozitesi İçin Bir Göstergedir

Yıl 2025, Cilt: 9 Sayı: 3, 169 - 177, 30.12.2025

Onur Argan , Buğra Nalinci , Yavuz Selim Akgün , Tarık Yıldırım , Özgen Şafak , Mehmet Tolga Hekim , Seda Elçim Yıldırım , Didar Elif Akgün , Eyüp Avcı , Halil Lütfi Kısacık

https://doi.org/10.33716/bmedj.1828954

https://izlik.org/JA95EC33RJ

Öz

Amaç: Koroner arter tortuozitesi (KAT), invaziv koroner anjiyografide sıkça gözlenmekle birlikte etiyolojisi ve klinik önemi halen belirsizdir. Çalışmamızın amacı, koroner arter hastalığı (KAH) bulunmayan hastalarda KAT'ı etkileyen parametreleri incelemektir.
Gereç ve Yöntem: KAH'ı olmayan 110 KAT izlenen hasta ile KAH ve KAT’ı olmayan 140 hasta retrospektif olarak değerlendirildi. KAT, en az bir koroner arterin ana gövdesi boyunca hem sistol hem de diyastolde izlenen, damar yönünde ≥45° değişiklik gösteren ≥3 kıvrım olarak tanımlandı. Demografik, biyokimyasal, ekokardiyografik ve anjiyografik parametreler gruplar arasında karşılaştırıldı.
Bulgular: KAT'ı olan hastalar daha yaşlıydı ve çoğunlukla kadın cinsiyetteydi. KAT'lı hastaların 24'ü (%21.8) erkek, 86'sı (%78.2) kadındı. KAT'lı hastaların yaş ortalaması 61.4±10.6 yıl iken kontrol grubunun 55.9±10.9 yıl idi. KAT'lı hastaların %62.7'sinde hipertansiyon, %27.3'ünde diabetes mellitus ve %30'unda sigara kullanımı mevcuttu. Ancak gruplar arasında anlamlı bir fark yoktu (p=0.469, p=0.446, p=0.242, sırasıyla). KAT en sık izlenen koroner arter sol ön inen koroner arter (LAD) idi (%86.4). Çok değişkenli regreyon analizi yaş (p=0.019), kadın cinsiyet (p<0.001) ve KAT arasında anlamlı ilişki olduğunu gösterdi.
Sonuç: Kadın cinsiyet ve ileri yaşın, koroner arter hastalığı bulunmayan hastalarda KAT'ın ana öngörücüsü olduğunu saptadık. Çalışmamızda diabetes mellitus, hipertansiyon ve sigara kullanımı gibi geleneksel risk faktörleri ile KAT gelişimi arasında anlamlı bir ilişki yoktu. KAT en sık izlenen koroner arter LAD idi. KAT’a neden olabilecek damar duvarındaki cinsiyet ve yaşa bağlı değişikliklerin altında yatan mekanizmaları anlamak için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

Koroner arter tortuozitesi , Yaşlanma , Cinsiyet

Etik Beyan

Balıkesir Üniversitesi Sağlık Bilimleri Araştırmalar Etik Kurulu'ndan Karar no: 2025/2 Tarih: 07.01.2025 ile etik kurul onayı alınmıştır.

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Female Gender and Older Age Are a Predictor Of Coronary Artery Tortuosity In Patients With No Coronary Artery Disease

https://izlik.org/JA95EC33RJ

Öz

Objective: Coronary artery tortuosity (CAT) is frequently observed in invasive angiography, though its aetiology and clinical significance remain ambiguous. The aim of our study was to investigate the parameters affecting CAT in patients without normal coronary artery disease (CAD).
Materials and Methods: 110 patients with CAT and no CAD and and 140 patients with no CAT and CAD were evaluated retrospectively. CAT was defined by ≥3 bends with a change in vessel direction of ≥45° present in both systole and diastole along the main trunk of at the least one coronary artery. Demographic, biochemical, echocardiogrphic and angiographic parameters were compared between groups.
Results: Patients with CAT were older and more often female gender. 24 (21.8%) were males and 86 (78.2%) were females in patients with CAT. The mean age of the patients with CAT were 61.4±10.6 years and the control group was 55.9±10.9 years. Among the patients with CAT, 62.7% had hypertension, 27.3% had diabetes mellitus and 30% were smokers. But, there was not significant difference between groups (p=0.469, p=0.446, p=0.242, respectively) . Left anterior descending artery (LAD) was the most commonly affected tortuous coronary artery (86.4%). Multivariate analysis showed significant relationship between age (p=0.019), female gender (p<0.001) and CAT.
Conclusion: We found that female gender and older age were a major predictor of CAT in patients with no CAD. Other traditional risk factors such as diabetes mellitus, hypertension and smoking were thought not to influence the development of CAT. LAD was the most commonly affected tortuous coronary artery. Further researches are required to understand the mechanisms underlying sex and age related changes in the arterial wall related with CAT.

Anahtar Kelimeler

Coronary artery tortuosity , Aging , Gender

Etik Beyan

This retrospective study was approved by the Balikesir University Clinical Research Ethics Commitee according to the Declaration of Helsinki (Decision No: 2025/2 Date: 07.01.2025)

Destekleyen Kurum

None

Proje Numarası

Yok

Teşekkür

None

Kaynakça

• Chiha, J., Mitchell, P., Gopinath, B., Burlutsky, G., Kovoor, P., & Thiagalingam, A. (2016). Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease. International journal of cardiology. Heart & vasculature, 14, 23–27. https://doi.org/10.1016/j.ijcha.2016.11.005
• Özyaşar, M., Doğduş, M., Yılmaz, A., Altıntaş, M. S., & Yetkin, E. (2024). Clinical Significance of Coronary Artery Tortuosity in Chronic Coronary Syndrome and Stable Angina: Insights from Gensini Scores. Kronik Koroner Sendrom ve Stabil Angina'da Koroner Arter Kıvrımlılığının Klinik Önemi: Gensini Skorlarından Elde Edilen Görüşler. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir, 52(8), 553–560. https://doi.org/10.5543/tkda.2024.87425
• Helisch, A., & Schaper, W. (2003). Arteriogenesis: the development and growth of collateral arteries. Microcirculation (New York, N.Y. : 1994), 10(1), 83–97. https://doi.org/10.1038/sj.mn.7800173
• Gaibazzi, N., Rigo, F., & Reverberi, C. (2011). Severe coronary tortuosity or myocardial bridging in patients with chest pain, normal coronary arteries, and reversible myocardial perfusion defects. The American journal of cardiology, 108(7), 973–978. https://doi.org/10.1016/j.amjcard.2011.05.030
• Zegers, E. S., Meursing, B. T., Zegers, E. B., & Oude Ophuis, A. J. (2007). Coronary tortuosity: a long and winding road. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 15(5), 191–195. https://doi.org/10.1007/BF03085979
• Hassanin Hanboly, N., Ghany, M.M.A., El-Kaffas, S.M.H., & Ahmed, T.U. (2021). Prevalence, risk factors, and coronary angiographic profile in patients with tortuous coronary artery. Cor et Vasa, 63(5), 547-554. doi: 10.33678/cor.2021.057
• Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S. E., Kreutz, R., Laurent, S., Lip, G. Y. H., … Authors/Task Force Members: (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of hypertension, 36(10), 1953–2041. https://doi.org/10.1097/HJH.0000000000001940
• American Diabetes Association (2010). Diagnosis and classification of diabetes mellitus. Diabetes care, 33 Suppl 1(Suppl 1), S62–S69. https://doi.org/10.2337/dc10-S062
• Yang, H. P., Brinton, L. A., Platz, E. A., Lissowska, J., Lacey, J. V., Jr, Sherman, M. E., Peplonska, B., & Garcia-Closas, M. (2010). Active and passive cigarette smoking and the risk of endometrial cancer in Poland. European journal of cancer (Oxford, England : 1990), 46(4), 690–696. https://doi.org/10.1016/j.ejca.2009.11.015
• Aydın Rodi Tosu, Mustafa Yurtdaş, Mahmut Özdemir, Murat Selçuk, Nesim Aladağ, Yemlihan Ceylan, Tayyar Akbulut, Yüksel Kaya (2014). İzole Koroner Arter Ektazilerinde Serum Ürik Asit ve C-reaktif Protein Düzeylerinin Değerlendirilmesi. Koşuyolu Heart Journal, 17(2), 105-109. doi:10.4274/khj.36036
• Zaacks, S. M., Allen, J. E., Calvin, J. E., Schaer, G. L., Palvas, B. W., Parrillo, J. E., & Klein, L. W. (1998). Value of the American College of Cardiology/American Heart Association stenosis morphology classification for coronary interventions in the late 1990s. The American journal of cardiology, 82(1), 43–49. https://doi.org/10.1016/s0002-9149(98)00239-2
• Turgut, O., Yilmaz, A., Yalta, K., Yilmaz, B. M., Ozyol, A., Kendirlioglu, O., Karadas, F., & Tandogan, I. (2007). Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?. The international journal of cardiovascular imaging, 23(6), 671–677. https://doi.org/10.1007/s10554-006-9186-4
• El Tahlawi, M., Sakrana, A., Elmurr, A., Gouda, M. & Tharwat, M. (2016) The relation between coronary tortuosity and calcium score in patients with chronic stable angina and normal coronaries by CT angiography. Atherosclerosis, 246(2016), 334–337. https://doi.org/10.1016/j.atherosclerosis.2016.01.029
• Jakob, M., Spasojevic, D., Krogmann, O.N., Wiher, H., Hug, R. & Hess, O.M. (1996) Tortuosity of coronary arteries in chronic pressure and volume overload. Catheterization and Cardiovascular Diagnosis, 38(1), 25–31. https://doi.org/10.1002/(SICI)1097-0304(199605)38:1<25::AID-CCD7>3.0.CO;2-5
• Li, Y., Shen, C., Ji, Y., Feng, Y., Ma, G. & Liu, N. (2011) Clinical implication of coronary tortuosity in patients with coronary artery disease. PLoS One, 6(8), e24232. https://doi.org/10.1371/journal.pone.0024232
• Groves, S. S., Jain, A. C., Warden, B. E., Gharib, W., & Beto, R. J., 2nd (2009). Severe coronary tortuosity and the relationship to significant coronary artery disease. The West Virginia medical journal, 105(4), 14–17
• Sharfo, A., Wandall-Holm, M. F., Linde, J. J., Hæsum, I., Laursen, G. P., Kofoed, K. F., & Hove, J. D. (2024). Tortuosity of the left anterior descending artery is associated with hypertension and is not independently related to physical performance: A cardiac computed tomography study. Clinical physiology and functional imaging, 44(6), 463–470. https://doi.org/10.1111/cpf.12900
• Yurdam, F. S., Kış, M., Demir, Y., Bakır, E. O., Akhan, O., & Güzel, T. (2023). Predictors of coronary tortuosity in patients with chronic coronary syndrome. Kardiologiia, 63(8), 56–61. https://doi.org/10.18087/cardio.2023.8.n2485
• Estrada, A., Sousa, A. S., Mesquita, C. T., & Villacorta, H. (2022). Coronary Tortuosity as a New Phenotype for Ischemia without Coronary Artery Disease. Tortuosidade das Artérias Coronárias como um Novo Fenótipo para Isquemia sem Doença Arterial Coronariana. Arquivos brasileiros de cardiologia, 119(6), 883–890. https://doi.org/10.36660/abc.20210787
• Lee, A. Y., Han, B., Lamm, S. D., Fierro, C. A., & Han, H. C. (2012). Effects of elastin degradation and surrounding matrix support on artery stability. American journal of physiology. Heart and circulatory physiology, 302(4), H873–H884. https://doi.org/10.1152/ajpheart.00463.2011
• McLean, E., Cogswell, M., Egli, I., Wojdyla, D., & de Benoist, B. (2009). Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public health nutrition, 12(4), 444–454. https://doi.org/10.1017/S1368980008002401
• Teng, Y., Teng, Z., Xu, S., Zhang, X., Liu, J., Yue, Q., Zhu, Y., & Zeng, Y. (2020). The Analysis for Anemia Increasing Fracture Risk. Medical science monitor : international medical journal of experimental and clinical research, 26, e925707. https://doi.org/10.12659/MSM.925707