Triglyceride-Glucose Index Could be Used to Predict Severity of Coronary Artery Ectasia

Yıl 2023, Cilt: 26 Sayı: 1, 34 - 39, 21.03.2023

Ersan Oflar İsmail Ünğan Cennet Yıldız Güngör İlayda Bostancı Alp Büşra Mavi Fatma Nihan Turhan Çağlar Alparslan Şahin Demet Erciyes

Öz

Introduction: Coronary artery ectasia (CAE) refers to a 1.5 fold increase in coronary artery diameter compared to the normal segment. Although the underlying pathophysiological mechanism is not fully elucidated, coronary atherosclerosis is thought to play a role in more than half of the cases. Triglyceride glucose (TyG) index is an indicator of insulin resistance. In the present study, aimed to evaluated TyG index values in CAE cases and find if a predictive value of TyG index existed.

Patients and Methods: Sixty-one patients with CAE (study group) and 64 patients with normal coronary arteries (control group) were included in the study. TyG index was calculated as ln (fasting triglyceride × fasting glucose/2).

Results: There were no differences between the two groups with respect to age, sex, diabetes mellitus prevalence, and biochemical parameters including, white blood cell, platelet, lymphocyte, monocyte counts, hemoglobin, hematocrit, urea, glucose, total cholesterol, high density lipoprotein-cholesterol, triglyceride levels and TyG index value. Twenty-five patients (41.0%) had one-vessel involvement, 24 (39.3%) patients had twovessel involvement and 12 (19.7%) patients had three-vessel involvement. Right coronary artery was the most commonly affected vessel (11, 44%), followed by left anterior descending artery (8, 35%), left main coronary artery (4, 16%) and circumflex artery (1, 4%). TyG index was statistically significantly higher in patients who had two/three vessel involvement (8.80 ± 0.48 vs 9.14 ± 0.62, p= 0.027). TyG index had statistically significant correlation with the number of ectatic vessels (r= 0.275, p= 0.032). ROC curve analysis showed that TyG index was useful for the prediction of ectasia severity (AUC= 0.653, 95% CI= 0.515-0.792, p= 0.043). TyG index value of 9.16 had 41.7% sensitivity and 84% specificity for prediction of CAE severity.

Conclusion: TyG index, which is easily calculated from biochemical parameters, might be used for the assessment of CAE severity.

Anahtar Kelimeler

Triglyceride, glucose, index, coronary arteries, ectasia

Kaynakça

• 1. Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia, its prevalence and clinical significance in 4993 patients. Br Heart J 1985;54:392-5.
• 2. Manginas A, Cokkinos DV. Coronary artery ectasias: Too large to miss? Eur Cardiovasc Dis 2006;2:1-6.
• 3. Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK, et al. Coronary arteriographic profile in young and old Indian patients with ischemic heart disease: A comparative study. Indian Heart J 1990;42:365-9.
• 4. Chaithiraphan S, Goldberg E, O’Reilly M. Multiple aneurysms of coronary artery in sclerodermal heart disease. Angiology 1973;24:86-93.
• 5. Shiro I, Bannerman RM, Graf CJ, Brennan JC. Ehlers-Danlos syndrome with multiple arterial lesions. Am J Med 1969;47:967-77.
• 6. Türkmen M, Bitigen A, Esen AM. Coronary artery ectasia. J Med Sci 2006;26:68-72.
• 7. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 1976;37:217-22.
• 8. Antoniadis AP, Chatzizisis YS, Giannoglou GD. Pathogenetic mechanisms of coronary ectasia. Int J Cardiol 2008;130:335-43.
• 9. Sorrell VL, Davis MJ, Bove AA. Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin Cardiol 1998;21:157-60.
• 10. Androulakis AE, Andrikopoulos GK, Kartalis AN, Stougiannos PN, Katsaros AA, Syrogiannidis DN, et al. Relation of coronary artery ectasia to diabetes mellitus. Am J Cardiol 2004;93:1165-7.
• 11. Johanning JM, Franklin DP, Han DC, Carey DJ, Elmore JR. Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion. J Vasc Surg 2001;33:579-86.
• 12. Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, et al.Aneurysmal coronary artery disease. Circulation 1983;67:134-8.
• 13. Sadr-Ameli M, Sharifi M. The natural history of ectatic coronary artery disease. Iranian Heart J 2001;2:12-6.
• 14. Mrdović I, Jozić T, Asanin M, Perunicić J, Ostojić M. Myocardial reinfarction in a patient with coronary ectasia. Cardiology 2004;102:32-4.
• 15. Kühl M, Varma C. A case of acute coronary thrombosis in diffuse coronary artery ectasia. J Invasive Cardiol 2008;20:23-5.
• 16. DeFronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: The missing links. The Claude Bernard Lecture. Diabetologia 2010;53:1270-87.
• 17. Bornfeldt KE, Tabas I. Insulin resistance, hyperglycemia, and atherosclerosis. Cell Metabol Rev 2011;14:575-85.
• 18. Zhang Y, Ding X, Hua B, Liu Q, Gao H, Chen H, et al. Predictive effect of triglyceride glucose index on clinical events in patients with type 2 diabetes mellitus and acute myocardial infarction: Results from an observational cohort study in China. Cardiovasc Diabetol 2021;20:43.
• 19. Chiu TH, Tsai HJ, Chiou HYC, Wu PY, Huang JC, Chen SC. A high triglyceride-glucose index is associated with left ventricular dysfunction and atherosclerosis. Int J Med Sci 2021;18:1051-7.
• 20. Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: A 9-year longitudinal population-based study. Lipids Health Dis 2017;16:175.
• 21. Srinivasan S, Singh P, Kulothungan V, Sharma T, Raman R. Relationship between triglyceride glucose index, retinopathy and nephropathy in type 2 diabetes. Endocrinol Diabetes Metab 2020;4:e00151.
• 22. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, MartínezAbundis E, Ramos-Zavala MG, Hernández-González SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3347-51.
• 23. Lin CT, Chen CW, Lin TK, Lin CL. Coronary artery ectasia. Tzu Chi Med J 2008;20:270-4.
• 24. Sultana R, Sultana N, Ishaq M, Samad A. The prevalence and clinical profile of angiographic coronary ectasia. J Pak Med Assoc 2011;61:372-5.
• 25. Malviya A, Jha PK, Mishra A. Isolated coronary artery ectasia; clinical, angiographic, and follow up characteristics. Indian Heart J 2017;69:619-23.
• 26. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJV, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: Data from the CHARM program and the Duke Databank. Am Coll Cardiol 2007;50:40-7.
• 27. Sezen Y, Bas M, Polat M, Yildiz A, Buyukhatipoglu H, Kucukdurmaz Z, et al. The relationship between oxidative stress and coronary artery ectasia. Cardiol J 2010;17:488-94.
• 28. Guo YL, Luo SH, Tang Y, Li JJ. Association of red cell distribution width with the presence of coronary artery ectasia. Clin Lab 2014;60:199-205.
• 29. Turkmen S, Yolcu M, Cagliyan CE, Sercelik A, Ipek E, Tekin K, et al. The relationship between microalbuminuria and isolated coronary artery ectasia. Eur Rev Med Pharmacol Sci 2014;18:1661-5.
• 30. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000;106:453-8.
• 31. Zhang X, Liu A, Guo M, Guan J, Cai S, Du Q, et al. Correlations among plasma insulin concentration, insulin sensitivity and coronary artery ectasia. Int J Clin Exp Med 2018;11:2325-30
• 32. Pino AD, DeFronzo RA. Insulin resistance and atherosclerosis: Implications for insulin-sensitizing agents. Endocr Rev 2019;40:1447-67.
• 33. Cao Y, Yin H, Yin H, Jiang Z, Wang T, Chen T. Associations of the insulin level and insulin resistance with the severity of coronary artery ectasia. Int J Clin Exp Med 2018;11:4937-42.
• 34. Devabhaktuni S, Mercedes A, Diep J, Ahsan C. Coronary artery ectasia-a review of current literature. Curr Cardiol Rev 2016;12:318-23.
• 35. Hong S, Han K, Park CY. The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: A population-based study. BMC Med 2020;18:361.