Koroner Arter Ektazisinde İnflamasyon Parametrelerinin Obstrüksiyonla İlişkisi

Yıl 2021, Cilt: 18 Sayı: 1, 1 - 7, 28.04.2021

İdris Buğra Çerik , Ferhat Dindaş , Sefa Ömür , Mustafa Yenerçağ

https://doi.org/10.35440/hutfd.833532

Cited By: 1

Öz

Amaç: Koroner arter ektazisi (CAE), asemptomatik vakalardan, stabil anjina pectoris ve hatta akut koroner sendroma kadar geniş bir klinik spektrumda karşımıza çıkabilen bir koroner arter hastalığıdır. CAE, tıkayıcı bir lezyon olmaksızın akut koroner sendromla ortaya çıkabilir. İzole CAE’yi normal koroner arterler ve koroner arter hastalığı ile kıyaslayan birçok çalışma olmasına ragmen obstrüktif tipte lezyonu olan CAE hastaları (obstruktif CAE) daha önce hiç değerlendirmeye alınmamıştır. Biz bu çalışmada obstrüktif CAE hastaları ile izole CAE hastalarını çeşitli inflamatuvar parametreler açısından kıyaslamayı amaçladık.
Materyal ve Metod: Çalışmaya 95 obstrüktif CAE hastası ve 95 yaş ve cinsiyet uyumlu izole CAE hastası dahil olmak üzere toplam 190 hasta dahil edildi. Çalışmada tüm katılımcılar acil servise başvuran ve NSTE-AKS tanısı alan hastalardan oluşturuldu. İki grup arasında Platelet/lenfosit oranı (PLR), Nötrofil/lenfosit oranı (NLR), Monosit / HDL oranı, CRP ve sedimantasyon gibi sistemik inflamatuar parametreler karşılaştırıldı.
Bulgular: CRP değeri, obstrüktif CAE'de izole CAE'ye göre anlamlı olarak yüksek bulundu [sırasıyla, 5.5 (3.0-9.0) mg/L, 4.0 (3.0-6.0) mg/L (p=0.003)]. İzole CAE’ye göre obstrüktif CAE'de PLR değeri anlamlı olarak daha yüksek bulundu [sırasıyla, 120±45, 143±76 (p=0.015)]. Çok değişkenli lojistik regresyon analizinde, yalnızca CRP, CAE'deki tıkanıklığın bağımsız bir öngörücüsü olarak saptandı [OR:1.075 (1.011-1.142), p=0.021].
Sonuç: Bildiğimiz kadarıyla bu çalışma, akut koroner sendromla başvuran CAE hastalarında obstruktif tipte lezyonların inflamatuvar parametrelere etkisini değerlendiren ilk çalışmadır. Bu çalışmada CAE hastalarında obstrüktif koroner arter hastalığı varlığında sistemik inflamasyonun arttığını gösterdik.

Anahtar Kelimeler

koroner arter ektazisi, miyokard infarktüsü, inflamasyon, CRP

The Relationship of Inflammation Parameters with Obstruction in Coronary Artery Ectasia

Öz

Background: Coronary artery ectasia (CAE) is a coronary artery disease that can progress in a wide clinical spectrum, from asymptomatic cases to stable angina pectoris or acute coronary syndrome. CAE can present with an acute coronary syndrome without an obstructive lesion. Although many studies comparing isolated CAE with normal coronary arteries and coronary artery disease, CAE patients with obstructive type lesions (obstructive CAE) have never been evaluated. In this study, we aimed to compare obstructive CAE patients and isolated CAE patients in terms of various inflammatory parameters.
Materials and Methods: A total of 190 patients were enrolled, including 95 obstructive CAE patients and 95 age and sex-matched isolated CAE patients. All participants were evaluated in the study consisted of patients admitted to the emergency department and diagnosed with NSTE-ACS. Systemic inflammatory parameters such as Platelet/lymphocyte ratio (PLR), Neutrophil/lymphocyte ratio (NLR), Monocyte/HDL ratio, CRP and sedimentation of the patients, were compared between two groups.
Results: CRP value was found significantly higher in obstructive CAE, compared to isolated CAE [5.5 (3.0-9.0) mg/L, 4.0 (3.0-6.0) mg/L (P=0.003) respectively]. PLR value was found significantly higher in obstructive CAE compared to isolated CAE [143±76, 120±45 (p=0.015) respectively]. In multivariable logistic regression analysis, only CRP was an independent predictor of obstruction in CAE [OR:1.075 (1.011-1.142), p=0.021].
Conclusions: To the best of our knowledge, this study is the first to evaluate the effects of obstructive lesions on inflammatory parameters in patients with CAE presenting with acute coronary syndrome. We have shown that systemic inflammation is increased in the presence of obstructive coronary artery disease in CAE patients.

Anahtar Kelimeler

coronary artery ectasia, myocardial infarction, inflammation, CRP

Kaynakça

• 1. Falsetti HL, Carrol RJ. Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest. 1976;69(5):630-6 DOI: 10.1378/chest.69.5.630.
• 2. Pinar Bermúdez E, López Palop R, Lozano Martínez-Luengas I, Cortés Sánchez R, Carrillo Sáez P, Rodríguez Carreras R, et al. [Coronary ectasia: prevalence, and clinical and angiographic characteristics]. Rev Esp Cardiol. 2003;56(5):473-9 DOI: 10.1016/s0300-8932(03)76902-4.
• 3. Manginas A, Cokkinos DV. Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J. 2006;27(9):1026-31 DOI: 10.1093/eurheartj/ehi725.
• 4. Virmani R, Robinowitz M, Atkinson JB, Forman MB, Silver MD, McAllister HA. Acquired coronary arterial aneurysms: an autopsy study of 52 patients. Hum Pathol. 1986;17(6):575-83 DOI: 10.1016/s0046-8177(86)80129-0.
• 5. Rath S, Har-Zahav Y, Battler A, Agranat O, Rotstein Z, Rabinowitz B, et al. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J. 1985;109(4):785-91 DOI: 10.1016/0002-8703(85)90639-8.
• 6. Li JJ, Nie SP, Qian XW, Zeng HS, Zhang CY. Chronic inflammatory status in patients with coronary artery ectasia. Cytokine. 2009;46(1):61-4 DOI: 10.1016/j.cyto.2008.12.012.
• 7. Sarli B, Baktir AO, Saglam H, Arinc H, Kurtul S, Sivgin S, et al. Neutrophil-to-lymphocyte ratio is associated with severity of coronary artery ectasia. Angiology. 2014;65(2):147-51 DOI: 10.1177/0003319713488932.
• 8. Kundi H, Gök M, Çetin M, Kızıltunç E, Çiçekcioğlu H, Güven Çetin Z, et al. Relationship between platelet-to-lymphocyte ratio and the presence and severity of coronary artery ectasia. Anatol J Cardiol. 2016;16(11):857-62 DOI: 10.14744/AnatolJCardiol.2015.6639.
• 9. Savino M, Parisi Q, Biondi-Zoccai GG, Pristipino C, Cianflone D, Crea F. New insights into molecular mechanisms of diffuse coronary ectasiae: a possible role for VEGF. Int J Cardiol. 2006;106(3):307-12 DOI: 10.1016/j.ijcard.2005.01.025.
• 10. Aydin M, Tekin IO, Dogan SM, Yildirim N, Arasli M, Sayin MR, et al. The levels of tumor necrosis factor-alpha and interleukin-6 in patients with isolated coronary artery ectasia. Mediators Inflamm. 2009;2009:106145 DOI: 10.1155/2009/106145.
• 11. Turhan H, Erbay AR, Yasar AS, Aksoy Y, Bicer A, Yetkin G, et al. Plasma soluble adhesion molecules; intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and E-selectin levels in patients with isolated coronary artery ectasia. Coron Artery Dis. 2005;16(1):45-50 DOI: 10.1097/00019501-200502000-00009.
• 12. Turhan H, Erbay AR, Yasar AS, Balci M, Bicer A, Yetkin E. Comparison of C-reactive protein levels in patients with coronary artery ectasia versus patients with obstructive coronary artery disease. Am J Cardiol. 2004;94(10):1303-6 DOI: 10.1016/j.amjcard.2004.07.120.
• 13. Erayman A, Sen N. Neutrophil-lymphocyte ratio and C-reactive protein may be correlated in patients with coronary artery ectasia. Angiology. 2014;65(1):84-5 DOI: 10.1177/0003319713502719.
• 14. Azab B, Shah N, Akerman M, McGinn JT, Jr. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012;34(3):326-34 DOI: 10.1007/s11239-012-0718-6.
• 15. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315 DOI: 10.1093/eurheartj/ehv320.
• 16. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976;37(2):217-22 DOI: 10.1016/0002-9149(76)90315-5.
• 17. Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamopoulou E, et al. The natural history of aneurysmal coronary artery disease. Heart. 1997;78(2):136-41 DOI: 10.1136/hrt.78.2.136.
• 18. Ozturk S, Yetkin E, Waltenberger J. Molecular and cellular insights into the pathogenesis of coronary artery ectasia. Cardiovasc Pathol. 2018;35:37-47 DOI: 10.1016/j.carpath.2018.04.005.
• 19. Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, et al. Aneurysmal coronary artery disease. Circulation. 1983;67(1):134-8 DOI: 10.1161/01.cir.67.1.134.
• 20. Yetkin E, Waltenberger J. Novel insights into an old controversy: is coronary artery ectasia a variant of coronary atherosclerosis? Clin Res Cardiol. 2007;96(6):331-9 DOI: 10.1007/s00392-007-0521-0.
• 21. Huang QJ, Liu J, Chen MH, Li JJ. Relation of diabetes to coronary artery ectasia: A meta-analysis study. Anadolu Kardiyol Derg. 2014;14(4):322-7 DOI: 10.5152/akd.2014.5327.
• 22. Thaulow E, Erikssen J, Sandvik L, Stormorken H, Cohn PF. Blood platelet count and function are related to total and cardiovascular death in apparently healthy men. Circulation. 1991;84(2):613-7 DOI: 10.1161/01.cir.84.2.613.
• 23. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol. 1997;79(6):812-4 DOI: 10.1016/s0002-9149(96)00878-8.
• 24. Boles U, Zhao Y, Rakhit R, Shiu MF, Papachristidis A, David S, et al. Patterns of coronary artery ectasia and short-term outcome in acute myocardial infarction. Scand Cardiovasc J. 2014;48(3):161-6 DOI: 10.3109/14017431.2014.902495.
• 25. Huang QJ, Zhang Y, Li XL, Li S, Guo YL, Zhu CG, et al. Clinical features of coronary artery ectasia in the elderly. J Geriatr Cardiol. 2014;11(3):185-91 DOI: 10.11909/j.issn.1671-5411.2014.03.012.
• 26. Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial. J Am Coll Cardiol. 2000;35(6):1535-42 DOI: 10.1016/s0735-1097(00)00581-7.
• 27. Morrow DA, Rifai N, Antman EM, Weiner DL, McCabe CH, Cannon CP, et al. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1998;31(7):1460-5 DOI: 10.1016/s0735-1097(98)00136-3.