Pure coronary ectasia differs from atherosclerosis: Morphological and risk factors analysis

Abstract

Coronary artery ectasia (CAE) is defined as localized coronary dilatation that exceeds the diameter of the normal adjacent segments or the diameter of the patients' largest coronary artery by 1.5 times [ [1] Syed M. Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis. 1997; 40: 77-84 Google Scholar ]. The prevalence of the disease varies between 1.5 and 5% with an occurrence rate of 10% among Indians, and with male predominance [ 2 Giannoglou G.D. Antoniadis A.P. Chatzizisis Y.S. Damvopoulou E. Parcharidis G.E. Louridas G.E. Prevalence of ectasia in human coronary arteries in patients in northern Greece referred for coronary angiography. Am J Cardiol. 2006; 98: 314-318 Google Scholar , 3 Sharma S.N. Kaul U. Sharma S. et al. Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. Indian Heart J. 1990; 42: 365-369 Google Scholar ]. Such variation in disease prevalence is related to other associated conditions e.g. Kawasaki disease [ [4] Newburger J.W. Burns J.C. Kawasaki disease. Vasc Med. 1999; 4: 187-202 Google Scholar ] and connective tissue disorders, e.g. particularly polyarteritis nodosa [ [5] Pick R.A. Glover M.U. Vieweg W.V. Myocardial infarction in a young woman with isolated coronary arteritis. Chest. 1982; 82: 378-380 Google Scholar ] and Takayasu arteritis [ [6] Suzuki H. Daida H. Tanaka M. et al. Giant aneurysm of the left main coronary artery in Takayasu aortitis. Heart. 1999; 81: 214-217 Google Scholar ]. Despite the documented etiological role of atherosclerois [ [7] Antoniadis A.P. Chatzizisis Y.S. Giannoglou G.D. Pathogenetic mechanisms of coronary ectasia. Int J Cardiol. 2008; 130: 335-343 Google Scholar ], it fails to explain the paradoxically low prevalence of CAE among diabetics [ [8] Androulakis A.E. Andrikopoulos G.K. Kartalis A.N. et al. Relation of coronary artery ectasia to diabetes mellitus. Am J Cardiol. 2004; 93: 1165-1167 Google Scholar ], the anatomical predominance of the right coronary artery (RCA) [ [9] Farto e Abreu P. Mesquita A. Silva J.A. Seabra-Gomes R. Coronary artery ectasia: clinical and angiographic characteristics and prognosis. Rev Port Cardiol. 1993; 12: 305-310 Google Scholar ], the histological loss of the musculo-elastic component of the arterial wall [ [10] Markis J.E. Joffe C.D. Cohn P.F. Feen D.J. Herman M.V. Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976; 37: 217-222 Google Scholar ] and the potential genetic polymorphisms found in the promoter regions of MMP-2, MMP-3, MMP-9 and MMP-12 [ [11] Lamblin N. Bauters C. Hermant X. Lablanche J.M. Helbecque N. Amouyel P. Polymorphisms in the promoter regions of MMP-2, MMP-3, MMP-9 and MMP-12 genes as determinants of aneurysmal coronary artery disease. J Am Coll Cardiol. 2002; 40: 43-48 Google Scholar ]. We hypothesized that CAE has different nature from that of atherosclerotic coronary artery disease (CAD). We therefore examined consecutive coronary angiograms performed at the Umeå Heart Centre, Sweden and Letterkenny General Hospital, Ireland, between 2003 and 2009, with the objective of identifying all patients diagnosed as having CAE (Fig. 1), described the exact angiographic findings and analyzed the cardiovascular risk factors. Patients were classified as having pure or mixed lesions according to the following criteria. Pure CAE (Fig. 2A and C) when there was no evidence for atherosclerosis and mixed CAE (Fig. 2B and D) when, in addition to the dilated segments, there was classical evidence for atherosclerotic changes (plaque formation or minor atheromata ≤10% of lumen narrowing). We also recorded the anatomical sites of ectatic arteries and any ectatic lesion exceeding 20 mm in length. Patients with evidence for prior coronary intervention or other cardiac conditions were excluded. Clinical and angiographic variables of patients with CAE were later compared with 37 age-matched controls (65±8 years, 13 male) who were found to have normal angiograms. Conventional statistics including unpaired Student t test, chi-square test, univariate and multiple logistic regression analyses were used with p<0.05 as significance. Fig. 2Image showing the quantitative angiographic diferences between Pure (A, C) and mixed CAE (B, D). View Large Image Figure Viewer Download Hi-res image