Prevalence and Predictors of Coronary Artery Ectasia among Delta Population

Background: Localized or widespread non-obstructive lesions of the epicardial coronary arteries, with a luminal dilatation 1.5 times that of the neighbouring normal segments or vessel diameter, have been identified as CAE. This research was performed to determine prevalence and predictors of CAE among Delta population in Egypt. Methods: This cross-sectional research was conducted on 2850 cases over the age of 18 who came for coronary angiography with positive non-invasive diagnostic tests, acute coronary syndrome and stable CAD. Cases were divided into two groups Group I: CAE cases (n =108) and Group II Non-ectasia cases (n =2742). All cases were subjected to history taking, clinical examination, laboratory investigations, standard 12-leads ECG, resting transthoracic echocardiography (TTE) and coronary angiography. Results: CAE occurred in 108 (3.79%) of the studied cases. Total cholesterol level, serum creatinine, were insignificantly different between both groups. CRP, NLR, MPV, and PLR, were significantly higher in CAE cases versus non-Ectasia cases CRP, NLR, PLR, and MPV is a good predicator for CAE, LVESD and LVEDD, were significantly higher in CAE group. Conclusions: The RCA was the most often affected coronary artery. The existence of CAE can be predicted using easily accessible clinical laboratory values such as CRP, Neutrophil to lymphocyte ratio, mean platelet volume, and platelet to lymphocyte ratio.

Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results: Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.

Recent research on platelet-leukocyte aggregates and their role in the pathogenesis of Kawasaki disease / 中国当代儿科杂志

Activated platelets may interact with various types of leukocytes such as monocytes, neutrophils, dendritic cells, and lymphocytes, trigger intercellular signal transduction, and thus lead to thrombosis and synthesis of massive inflammatory mediators. Elevated levels of circulating platelet-leukocyte aggregates have been found in patients with thrombotic or inflammatory diseases. This article reviews the latest research on the formation, function, and detection methods of platelet-leukocyte aggregates and their role in the onset of Kawasaki disease, so as to provide new ideas for studying the pathogenesis of Kawasaki disease.

A Case Report of Successful Fibrinolysis in a Multiple Coronary Ectasia ST-segment Elevation Myocardial Infarction Validated by Coronary Angiography

Coronary artery ectasia (CAE) often presents in the form of an acute coronary syndrome (ACS) caused by slow blood flow leading to thrombus formation in ectatic coronary arteries. The usual approach is thrombectomy with intracoronary thrombolysis but often does not guarantee immediate blood flow. A 45-year-old male presented with anginal chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI), managed Immediately with tissue plasminogen activator(t-PA) followed later with coronary angiography revealing diffused Multiple coronary ectasia MCEA with no identified culprit lesions afterward. The patient was followed up periodically, with favorable outcomes on daily aspirin, direct oral anticoagulant (DOAC), and guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) and reduced ejection fraction heart failure (HF-rEF). This case management strategy was dictated by available resources at the time of presentation; however, it signifies the importance and favorable outcome of thrombolysis in CEA/STEMI patients. Future large-scale studies are required toward defining the duration as well as the choice of long-term anticoagulation.

Ectasia coronaria y miocardiopatía hipertrófica: una entidad infrecuente / Coronary artery ectasia and hypertrophic cardiomyopathy: case report

Resumen Se presenta el caso de un paciente de 54 años que consulta por angina de esfuerzo de 2 años de evolución en quien se identifica una dilatación ectásica del árbol coronario con lesiones ateroscleróticas críticas y miocardiopatía hipertrófica septal obstructiva. Una revisión bibliográfica revela que es una asociación infrecuente de la cual solo existen reportes de casos aislados.

Abstract We present the case of a 54-year-old patient who presented with a history of 2 years with angina. Invasive studies revealed critical coronary artery stenosis coexisting with obstructive hypertrophic miopathy. This is a rare association with only isolated case reports.

Enfermedad aneurismática coronaria / Coronary aneurysm disease

Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.

Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.

Comparison of mean platelet volume levels in coronary artery ectasia and healthy people: systematic review and meta-analysis

Coronary artery ectasia (CAE) is defined as the dilation of a segment of a coronary vessel to at least 1.5 times the diameter of its normal adjacent segment. Mean platelet volume (MPV) plays a role in acute coronary syndromes, with high MPV correlating to poor prognosis for acute thrombotic events and CAE. Several studies investigated the relationship between MPV and CAE, resulting in conflicting results. These results led us to systematically review all studies investigating the relationship between MPV and ectatic heart diseases by performing a meta-analysis study in order to report a unified result. This meta-analysis study investigated all case-control articles examining the relationship between MPV and CAE. All studies in the following databases published until January 31, 2018, were investigated: Science Direct, Scopus, PubMed, Google Scholar, and Web of Science. Following a quality control evaluation, 14 articles, all of which were published following studies performed in Turkey from 2007 to 2016, met the criteria for study inclusion. After pooling the results from all of the articles, a total standardized mean difference (SMD) value of 0.584 (95% CI, 0.219, 0.95) was obtained using the D+L pooled SMD, indicating a significant difference (P=0.002) between the two groups, with higher MPV values in ectatic patients when comparing to healthy individuals. Therefore, increased MPV levels were significantly related to CAE, suggesting that platelets, with their inflammatory and thrombotic activities, play a role in this disease. Therefore, anti-platelet and anti-inflammatory therapies may be effective in treating CAE.

The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level

BACKGROUND AND OBJECTIVES: Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process. SUBJECTS AND METHODS: This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared. RESULTS: There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863). CONCLUSION: We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.

ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis / 대한중환자의학회지

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

Severe Coronary Artery Ectasia with ST Elevation MI: A Challenging Situation.

Aim: To report a case of huge coronary artery ectasia presenting with acute myocardial infarction; a relatively rare finding encountered during coronary angiography. Presentation of Case: A young male presented with chest pain and profuse sweating at a local hospital. Electrocardiogram showed Infero-posterior STEMI. Patient received streptokinase. His symptoms settled however the electrocardiogram changes did not resolve. He presented at our hospital after 24 hours with chest discomfort. He was vitally stable and a murmur of MR was audible. His Troponin-I was raised and electrocardiogram showed ST elevations with Q waves. Coronary angiogram showed giant ectasia and occluded right coronary artery (RCA). Percutaneous coronary intervention of RCA was done; with TIMI II flow but still had some residual thrombus. The patient was kept on Tirofiban infusion. His CRP and homocysteine levels were raised. Dual antiplatelet, statin, ACE Inhibitor, beta blocker with vitamin B12 and folic acid supplement were continued. Discussion: Coronary artery ectasia is a form of atherosclerosis seen in 0.3–4.9% of coronary angiography procedures. It is described as dilation of the coronary arteries >1.5 times compared to adjacent normal vessel. An excessive expansive remodeling with enzymatic degradation of the extracellular matrix is considered to be the major pathophysiologic process. Clinical importance inclines on its association with acute coronary syndrome. Conclusion: A case of huge coronary artery ectasia presenting with acute myocardial infarction and successfully treated with PCI.

ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis / 대한구급학회지

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

Relationship Between Plasma Level of Asymmetric Dimethylarginine and Coronary Artery Ectasia in Relevant Patients / 中国循环杂志

Objective: To investigate the relationship between plasma level of asymmetric dimethylarginine (ADMA) and coronary artery ectasia in relevant patients. Methods: A total of 72 patients received coronary angiography (CAG) in our hospital were studied and the patients were divided into 3 groups: Coronary ectasia group, Coronary stenosis group and Normal coronary group.n=24 in each group. Plasma levels of ADMA, symmetric dimethylarginine (SDMA) and L-arginine (Arg) were measured by HPLC-MS/MS methods. The relationship between ADMA and CAD was examined by Logistic regression analysis. Results: Plasma level of ADMA in Coronary ectasia group (0.437 ± 0.098) μmol/L and Coronary stenosis group (0.456 ± 0.088) μmol/L were higher than that in Normal coronary group (0.381 ± 0.057) μmol/L,P<0.05. The ratio of Arg/ADMA in Coronary ectasia group (208.54 ± 61.52) and Coronary stenosis group (220.00 ± 104.82) were lower than that in Normal coronary group (254.26 ± 76.22),P<0.05. Logistic regression analysis presented that with adjusted age, gender, smoking, family history of CAD and LDL-C level, and plasma ADMA was still related with CAD (Partial regression coefifcient 9.469, P=0.011). Conclusion: Plasma levels of ADMA were higher in patients with coronary artery ectasia/stenosis than those with normal coronary artery; while ADMA levels were similar between the patients with coronary ectasia and stenosis. Plasma ADMA level was the independent risk factor of CAD.

Clinical features of coronary artery ectasia in the elderly / 老年心脏病学杂志（英文版）

Objective To investigate the incidence, imaging and clinical characteristics in elderly patients with coronary artery ectasia (CAE). Methods A retrospective analysis was conducted on patients with CAE who underwent coronary angiography between January 2006 and December 2012. According to age, the enrolled patients were divided into two groups (elderly group, age≥ 65 years; non-elderly group, age < 65 years). The clinical feature, imaging characteristics and the 5-year survival rate of the two groups were compared.Results The preva-lence of CAE in elderly patients was 0.33%. Patients in elderly group were found to have significantly higher proportion of female (30.1%vs. 10.1%,P< 0.001), three-vessel disease (60.5%vs. 45.2%,P = 0.003) and localized ectasia (55.0%vs. 40.2%,P = 0.003). In addition, body mass index (20.90 ± 2.71 kg/m2vs. 22.31 ± 2.98 kg/m2,P < 0.001) and percentage of current smokers (45.0%vs. 64.6%,P < 0.001) were significantly lower in elderly group. Cumulative survival curves demonstrated reduced 5-year cumulative survival at the follow-up in the elderly group compared with the non-elderly group (88.0%vs. 96.0%,P = 0.002). But the 5-year event free survival rate failed to show a significant difference between the two groups (31.0%vs. 35.0%,P= 0.311).ConclusionThe prevalence of CAE in elderly patients was 0.33%, which was about 1/3 of the entire numbers of CAE patients. There were significant differences between the elderly and the non-elderly patients with CAE in terms of coronary artery disease risk factors and coronary artery ectatic characteristics. CAE might be asso-ciated with increased mortality risk in the elderly.

Ectasia de vías coronarias en lactante de 3 meses con diagnóstico de enfermedad de Kawasaki

La Enfermedad de Kawasaki (EK) es una de las causas principales de enfermedad cardiaca adquirida durante la niñez. Para una subpoblación de pacientes en especial los menores de 1 año; los síntomas y los signos que forman parte de los criterios actuales para llegar al diagnóstico clínico de la enfermedad pueden aparecer luego de un período prolongado de tiempo haciendo que la identificación de la enfermedad sea más difícil e impidiendo el diagnóstico. Estudios recientes resaltan la importancia del diagnóstico oportuno; reportando que la identificación de la Enfermedad de Kawasaki luego del décimo día de ebre esta asociado con un incremento en la frecuencia de aneurismas de las arterias coronarias. El caso que reportamos es de un lactante masculino de 3 meses quien desarrolla las manifestaciones características de la Enfermedad de Kawasaki a los 20 días de fiebre persistente y además presentó la complicación más temida de dicha enfermedad. Este caso destaca la dificultad para hacer el diagnóstico en los menores de un año, quienes son la población de mayor riesgo para el desarrollo aneurismas coronarios.

Kawasaki disease (KD) is one of the leading causes of acquired heart disease in childhood.For a subpopulation of patients especially those under 1 year; the symptoms and signs that are part of the current criteria for the diagnosis of clinical disease may occur after a prolonged period of time making the identi cation of the disease more di cult and hindering the diagnosis. Recent studies highlight the importance of early diagnosis, reporting that the identi cation of Kawasaki disease after the tenth day of fever is associated with an increased frequency of coronary artery aneurysms. This case report is about a male infant of three months who develops the characteristic manifestations of Kawasaki disease at 20 days of persistent fever and also presented the most feared complication of this disease. This case highlights the di culty in making a diagnosis in children under one year of age, who are those most at risk for developing coronary aneurysms.

Alteration of NO,ET-1,MMP-9 and TIMP-1 plasma levels in coronary artery stenosis and ectasia / 基础医学与临床

Objective To explore the mechanisms responsible for different coronary artery lesions with involvement of nitric oxide(NO),endothelin-1(ET-1),matrix metalloproteinases-9(MMP-9) and the matrix metalloproteinase inhibitor-1(TIMP-1).Methods The cases undergone coronary anography were collected and divided into three groups:group A,30 patients with the coronary artery ectasia(7 cases of simple coronary artery ectasia;18 cases of the coronary artery ectasia coexisting a small amount of plaque);group B,38 patients with coronary atherosclerosis;group C,32 patients with with normal angiograph(14 cases of coronary artery completely normal;18 cases with a small amount of coronary plaque only).Plasma NO,ET-1,MMP-9 and TIMP-1 level were measured by ELISA method.Results There are significant differences among three groups on NO level,MMP-9 levels,NO/ET-1 and MMP-9/TIMP-1(P

A Case of diffuse dilatated coronary artery ectasia on Marfan's Syndrome / 대한내과학회지

Marfan's syndrome is a an autosomal dominant disorder of connective tissue that is characterized by ocular, skeletal, and cardiovascular manifestation. It is estimated to have a prevalence of 4-6 per 10,000 people, and at least 25 percent of the cases occur in the absence of a family history. Coronary artery ectasia is a diffuse abnormality of the vessel wall, which has been reported in associated with coronary atherosclerosis, infectious process, congenital heart lesion, syphilis, Ehlers-Danlos syndrome. We reported a case of 25-year-old male who presented with Marfan's syndrome associated with dissecting ascending arotic aneurysm and diffuse dilatated coronary artery ectasia. Coronary angiographic study demonstrated the diffusely dilatated coronary artery ectasia.