Coronary Ectasia Research Articles

Cardiovascular Magnetic Resonance in Children with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: Institutional Protocol-Based Medium-Term Follow-up Study.

Multisystem inflammatory syndrome in children (MIS-C) secondary to COVID-19 infection in previously healthy children often results in subtle but persistent echocardiographic abnormalities despite complete clinical recovery. This study was done to investigate medium-term cardiovascular outcomes of patients with MIS-C using cardiovascular magnetic resonance imaging (CMR). This is a single-center retrospective study of patients aged less than 21 years, diagnosed with MIS-C who received an outpatient CMR, around 6 months after discharge. CMR was done in patients with significant troponin leak or depressed LVEF. CMR performed on a GE Signa HDxt 1.5 Tesla magnet with a myocarditis protocol. Diagnosis of myocarditis was determined by the original Lake Louise Criteria. There were 21 patients with a median age of 11 years, (IQR 8–13 years), who underwent CMR at median follow-up duration of 6 months (IQR 5–7 months). At the peak of illness during admission, there were 95.2% patients with abnormal Troponin I and BNP. By echocardiogram, 76.2% had left ventricular systolic dysfunction and 9.5% had coronary ectasia, which all resolved by 6 months. By CMR, there were five patients (23.8%) with abnormal left atrial volume, one patient (4.8%) with an abnormal indexed left ventricular end-diastolic volume, and three patients (15%) with abnormal LVEF. There was no evidence of myocardial edema in T2-weighted image sequence. There were three patients with persistent late gadolinium enhancement (14.3%). Follow-up CMR is a useful tool in diagnosing subtle myocardial abnormalities and guide necessity for future follow-up.

Congenital Coronary Ectasia and Bicuspid Aortic Valve: A Case Report with Review of the Literature

Coronary ectasia is a rare clinical condition whose etiology is dominated by atherosclerosis. In a small percentage of patients, it may be of congenital origin. Its mechanisms are still poorly understood and its management is still non standardized due to its rarity. We report a case of congenital coronary ectasia discovered in a patient with aortic valve stenosis caused by congenital bicuspid aortic valve; this association being frequent in congenital coronary ectasia. The aim of this report is also to review the clinical features of coronary ectasia, its diagnosis and treatment.

Evaluation of Serum Levels of Interlukine-17A (IL-17A), Fibrinogen, and Red Distribution Width (RDW) in Patients with Coronary Artery Ectasia, Candidate for Coronary Angiography: A Cross-Sectional Study

Background: Coronary stenosis and ectasia are cardiovascular diseases characterized by dysfunction of endothelial cells. Studies have shown that impaired blood flow due to inflammation and deposition in the endothelial cell wall can be effective in disease occurrence and progression. Although the etiologies of these diseases have not been identified accurately, it has been shown that inflammation and coagulation can be the main causes in these patients. Objectives: The aim of this study was to evaluate the levels of fibrinogen, Interlukine-17A (IL-17A), and red distribution width (RDW) in patients with coronary artery disease (CAD) and ectasia. Methods: In this study, 140 patients with CAD admitted to Shariati Hospital of Tehran University of Medical Sciences, Iran, were included from from Jun 2020 to October 2021. Based on the severity of CAD, the participants were divided into two equal groups (n = 70 in each) of mild CAD (patients with CAD less than 50%) and multi-vessels CAD (patients with more than 50% stenosis in coronary arteries) according to the number of involved vessels (one, two, or three). Then, 5 cc of peripheral blood was collected from each patient in ethylenediaminetetraacetic acid (EDTA) containing tubes. IL-17A and fibrinogen were measured using enzyme-linked immunosorbent assay (ELISA) kit, and RDW was calculated by cell counter. Results: The mean age of participants was 63.0 ± 11.0 years in the mild group (35% males vs. 65% females) and 60.1 ± 12.1 years in the multi-vessels group (28% males vs. 72% females). The results showed that IL-17A, fibrinogen, and RDW levels in patients with ectasia and multi-vessels group were significantly higher than those in patients without coronary ectasia and mild CAD, respectively (P-value = 0.01 for fibrinogen; P-value = 0.05 for IL-17A; and P-value = 0.03 for RDW). Conclusions: According to our results, identification and evaluation of fibrinogen and IL-17A, along with laboratory indices including RDW can be helpful in diagnosing high-risk individuals. Ectasia can be prevented, and it is possible to increase the patients’ survival through using some preventive and therapeutic strategies.

Long term non-invasive endothelial function assessment in patients with paediatric inflammatory multisystem syndrome temporarily associated with Covid 19 (PIMS TS)

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with PIMS-TS present with features of vasculitis (bright coronary arteries and diffuse coronary ectasia on transthoracic echocardiography) and prothrombotic features (e.g. elevated D Dimers) indicating involvement of the endothelial layer in the inflammatory process. Impairment in endothelial function may contribute to the acute but also to possible long-term consequences in patients with PIMS-TS. The aim of this pilot study is to assess non-invasively the endothelial (dys)function using reactive hyperemic peripheral arterial tonometry (RH-PAT) 6 months after the acute inflammatory phase. Methods Ten patients with previous diagnosis of PIMS-TS were compared to age-matched controls. The endothelial function was assessed using the EndoPAT device which provides the reactive hyperemic index (RHI) of endothelial function in a 15-min test. Cardiac function indices by means of LV fractional shortening (FS) was also assessed. Results There were no significant differences regarding age (11.2 ± 3.0 vs 13.6 ± 2.4, p = 0.063), height, weight and body surface area, (BSA: 1.49 ± 0.36 vs 1.52 ± 0.25, p = 0.856) in patients with previous diagnosis of PIMS-TS and controls respectively. The two groups also had similar LV systolic function assessed by FS (36.3 ± 9.1% vs 36.7 ± 7.1%, p = 0.922). The RHI in the PIMS TS group was similar to the control group (1.65 ± 0.43 vs 1.81 ± 0.60, p = 0.533 respectively). Conclusions. Patients with PIMS-TS who may present with features of vasculitis during the acute phase, do not show evidence of endothelial dysfunction during the long term follow-up, suggesting resolution. Further studies are required to accurately determine the endothelial (dys)function during the acute phase of the inflammatory syndrome and course.

Clinical and angiographic characteristics of patients with coronary ectasia in a reference hospital

To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography. : Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined. 7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000). coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.

Effect of matrix metalloproteinase-9 on angiographic criteria of coronary ectasia

Effect of matrix metalloproteinase-9 on angiographic criteria of coronary ectasia

The relationship between red blood cell distribution width and isolated coronary ectasia

Aim: Isolated coronary artery ectasia (CAE) is an abnormal dilatation of the coronary artery which cause ischemia. RDW has been investigated in several cardiovascular disorders and has also been recently proposed as a predictive biomarker of adverse outcomes in patients with these conditions. We hypothesized that increased RDW would be associated with isolated CAE because both are associated with inflammation.
 Material and Methods: We studied 140 subjects, including 69 patients with isolated CAE, 71 patients with angiographically normal controls. Baseline clinical characteristics and laboratory findings, including RDW, were compared among two groups.
 Results: The level of RDW was significantly higher in isolated CAE than normal controls (14,36±1,61vs 13,59±1.57, p=0.005). In addition, the levels of glomerular filtration rate and creatinin, high density lipoprotein and low density lipoprotein were significantly lower in isolated CAE than normal controls (76,43±19,64 vs 100,36±18,3 and 0,9±0,28 vs 0,74±0,25, 43,39±10,09 vs 48,4±13,67, 121,36±32,05 vs 143,70±55,33 p=0,001, p=0,001, p=0,01, p=0,004 respectively). In a ROC curve analysis, a RDW value of 13,5 was identified as an effective cut off point for the discrimination of the presence or absence of isolated CAE (Area Under curve [AUC]: 0.71, CI 95%, 0.62-0.80, p

623 Coronary ectasia in different clinical subsets: stable and acute coronary syndromes

Abstract Aims Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis. Methods and results A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients. Conclusions CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.

Is Coronary Artery Ectasia a Progressive Disease? A Self-Controlled Retrospective Cohort Study.

Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress.Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time.Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis.Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.

Prevalence and Angiographic Characteristics of Coronary Ectasia in Adults: A Retrospective Study in a Tertiary Cardiac Centre of Nepal

Background and Aims: Coronary artery Ectasia is a relatively uncommon problem encountered during coronary angiography with the prevalence ranging from 1.2% to 4.9%. Coronary artery Ectasia and aneurysm both denote an arterial segment the dimension of which is larger than normal arterial segment, both have diameter greater than 1.5 times of normal. The length of dilate segment is greater than its width in Ectasia while less in aneurysm. There is an overlap between risk factors of coronary artery Ectasia and atherosclerosis. The clinical relevance in general, and the appropriate medical management of coronary artery Ectasia specifically, is ill defined, as no randomised prospective studies exists. The study was conducted with an aim to estimate the prevalence of coronary artery Ectasia and aneurysm as well as to study the angiographic characteristics of coronary artery Ectasia and aneurysm undergoing in adult patients’ coronary angiography in tertiary cardiac centre of Nepal.
 Methods: A retrospective study was conducted in Shahid Gangalal national heart centre, Nepal analysing the angiographic records from cardiac catheterization lab. A total of 447 patients who underwent coronary angiography and meet the inclusion criteria from July, 2019 to December, 2019 were included in the study. Any angiographic evidence of coronary Ectasia and aneurysm, coronary artery involved and it’s extent were analysed and recorded in the proforma. In addition, any associated evidence of coronary artery disease was analysed and recorded in the proforma.
 Results: The findings of our study revealed the overall prevalence of coronary artery Ectasia (CAE) and Coronary artery Aneurysm as 2.6%. Coronary ectasia was most prevalent in left anterior descending (LAD) artery (83.3%), followed by RCA and left main in 66.7% and 16.7% respectively. In contrast, Coronary aneurysm was mostly seen in RCA (66.7%) followed by LCX (33.3%). In addition, the study also showed the frequency of localised Ectasia as 50 % and the association of significant coronary artery disease with coronary artery Ectasia in 66.67%.
 Conclusion: CAE and aneurysm are rare phenomenon encountered in routine coronary angiography, with LAD and RCA being most commonly involved in CAE and coronary aneurysm respectively. CAE and aneurysm have significant association with the coronary artery disease.

Evaluation of management strategies in patients with coronary ectasia: a retrospective cohort study

Abstract Background/Introduction Since patients with coronary ectasia have an increased risk of developing myocardial infarction and cardiovascular death, these patients could benefit from a more intensive treatment. Unfortunately, the evidence regarding outcomes with different management strategies is limited, especially with direct oral anticoagulants (DOAC). Purpose To compare clinical outcomes in patients with coronary ectasia based on the selected/chosen treatment strategy. Methods We conducted a retrospective cohort study in patients diagnosed with coronary artery ectasia. They were divided into 3 different groups based on the treatment they received at discharge and we evaluated the main cardiovascular outcomes at one-year follow-up. Results Between 2016 and 2019, 7,579 angiographies were performed, in which 510 patients with coronary ectasia were found (prevalence of 6.72%). Of these patients, 43.9% (n=224) had the diagnosis of STEMI, 21% NSTEMI (n=107), 5.1% unstable angina (n=26), 18.6% chronic stable angina (n=95) and other 11.4% (n=58). The angiographic distribution of the lesions was as follows: left main coronary artery 25.1%, Left descending coronary artery 62.7%, circumflex artery 52.1%, right coronary artery 79.2%. It was possible to obtain the follow-up of 363 patients (71.2%) because 25 died during their hospitalization and data of 122 were not available at the time of analysis. Three groups were formed based on the treatment: (1) Dual Antiplatelet Therapy (DAPT) in 47% (n=174); (2) DAPT + Vitamin K Antagonist (VKA) in 8.5% (n=31); (3) DAPT + DOAC in 6.6% (n=24). The overall MACE rate at 1-year of follow-up was 6.6% (n=15): 11 patients in the DAPT group (6.3%), 1 patient in the DAPT + VKA group (3.2%), and 3 patients in the DAPT + DOAC group (12.5%). During this period, 3 patients died from cardiovascular causes, all of them in the DAPT group. Myocardial infarction occurred in 12 patients, 8 in the DAPT group (4.2%), 1 in the DAPT + VKA group (3.2%) and 3 in the DAPT + DOAC group (12.5%). Stroke occurred in 2 patients: 1 patient in the DAPT group (0.5%) and 1 patient in the DAPT + DOAC group, 4.1% None of these findings were statistically significant. One-year occurrence of bleeding events was also evaluated: 23 patients presented a bleeding event, 14 in the DAPT group (8%), 7 in the DAPT + VKA group (22.5%) and 2 in the DAPT + DOAC group (8.3%); p=0.010. Conclusion(s) Our findings suggest that there is no statistically significant difference in the incidence of thrombotic complications, when comparing the treatment options. Patients using the combination of DAPT+VKA have a higher incidence of bleeding. Funding Acknowledgement Type of funding sources: None.

Coronary lesions suggestive of kawasaki disease in young patients presenting with acute myocardial infarction

Abstract Background Approximately 25% of patients with untreated Kawasaki disease (KD) in childhood develop coronary aneurysms, which represent a higher likelihood for the occurrence of acute myocardial infarction (AMI) in young adults. Although the clinical characteristics of young adults with KD and suspected ischemia have been studied, the available data about suggestive lesions of KD in AMI is scarce. Purpose To describe the prevalence, clinical characteristics and in-hospital mortality of young adults with AMI and coronary artery lesions suggestive of KD. Methods We conducted a retrospective study of consecutive ≤40-year old patients hospitalized with AMI and coronary angiography in a coronary care unit of a Mexican teaching hospital between 2006–2020. Patients were classified according to the presence or absence of suggestive lesions of KD sequelae such as proximal aneurysms, larger size and normal distal segments Results There were included 488 patients of 40 years of age and younger, diagnosed with AMI, in whom a coronary angiography was performed. Among them, 44 patients (9%) showed coronary aneurysm or ectasia, within this group, 16 patients (36.3%) had angiographic lesions compatible with KD. The patients were classified according to the type of coronary lesions: Angiographic lesions compatible with KD, 3.3% (n=16); Diffuse coronary artery ectasia (CAE), 5.7% (n=28); and Obstructive coronary disease (OCD), 91% (n=444). The prevalence of smoking, dyslipidemia, and hypertension were similar between the groups, whereas a history of diabetes was absent in KD patients (0%, 10.7%, and 22.1% for KD, CAE and OCD, respectively; P=0.04). At admission, ST-elevation myocardial infarction was more frequent in patients with KD (81.3%, 75%, and 67.1% for KD, CAE and OCD, respectively; P=0.35). More than half of patients with KD had coronary aneurysms in two or more vessels. The right coronary artery was the most commonly affected artery followed by the left anterior descending artery and left circumflex coronary artery (87.5%, 56.3% and 56.3%, respectively). The presence of intracoronary thrombus identified at the time of angiography was more frequent in patients with KD (62.5%, 60.7% and 44.1% for KD, CAE and OCD, respectively; P=0.09). Overall, unadjusted in-hospital mortality was 3.9% and there were no deaths in the KD group (0%, 0% and 4.3% for KD, CAE, and OCD, respectively; P=0.37). Conclusion In young patients with AMI, the sequelae of KD should be considered as a possible etiology, based on their angiographic characteristics. To bear in mind the nature of the pathogenesis is crucial to assess medical and interventional management strategies, which are not well defined yet, in order to evaluate cardiovascular risk and optimize a patient-tailored treatment, which could differ from the treatment of atherosclerotic coronary artery disease Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

BackgroundWhile cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C.MethodsWe included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan.ResultsOf the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted.TreatmentAll patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins.ConclusionSinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation.Funding AcknowledgementType of funding sources: None. Kid, MIS-C. Bradycardia/Atrial Rhythm

Clinical profile of Kawasaki disease in children admitted at a tertiary care hospital of North India and their short-term follow-up.

Aim:The aim of this study was to evaluate presenting symptoms, clinical features, and laboratory tests for the diagnosis of Kawasaki disease (KD) in children and their short-term follow-up at a tertiary care hospital of North India from April 2017 to March 2020.Materials and Methods:A total of 31 children (23 boys and 8 girls) up to 10 years of age were included in this study. The diagnosis of KD was made as per the American Heart Association 2017 guidelines. Clinical features, laboratory parameters, and coronary involvement were compared between the complete and incomplete KD groups.Results:The incidence of complete versus incomplete KD was 19 (61.2%) versus 12 (38.7%) children, respectively. Change in extremities and oral mucosal changes were more encountered in the complete KD group as compared to the incomplete KD group (100% vs. 58.3%, P = 0.004, and 78.9% vs. 33.3%, P = 0.002, respectively). Coronary artery aneurysm was seen in 54% of the patients on echocardiography which was greater in the incomplete KD group (83.3%) as compared to the complete KD group (36.8%). The median time from the onset of symptoms to intravenous immunoglobulin infusion was <10 days in 84.2% of the patients with complete KD versus 41.7% with incomplete KD which was statistically significant. Fifty percent of the children with coronary ectasia and small aneurysm had normal coronaries at follow-up of 6 months.Conclusion:KD is probably underdiagnosed in most developing countries, like that of ours, and requires a high index of suspicion.

Echocardiographic Findings and Correlation with Laboratory Values in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19.

Cardiac involvement is a common and serious problem in multisystem inflammatory syndrome in children (MIS-C). Echocardiographic evaluation of systolic and diastolic function by traditional, tissue Doppler and three-dimensional (3D) echocardiography was performed in consecutive 50 MIS-C patients during hospitalization and age-matched 40 healthy controls. On the day of worst left ventricular (LV) systolic function (echo-1), all left and right ventricular systolic function parameters were significantly lower (p < 0.001), E/A ratio was significantly lower, and averaged E/e′ ratio was significantly higher (median 1.5 vs. 1.8, p < 0.05; 8.9 vs. 6.3, p < 0.001 respectively) in patients compared to control. Patients were divided into 2 groups according to 3D LV ejection fraction (LVEF) on the echo-1: Group 1; LVEF < 55%, 26 patients, and group 2; LVEF ≥ 55%, 24 patients. E/e′ ratio was significantly higher in group 1 than group 2 and control at discharge (median 7.4 vs. 6.9, p = 0.005; 7.4 vs. 6.3, p < 0.001 respectively). Coronary ectasia was detected in 2 patients (z score: 2.53, 2.6 in the right coronary artery), and resolved at discharge. Compared with group 2, group 1 had significantly higher troponin-I (median 658 vs. 65 ng/L; p < 0.001), NT-pro BNP (median 14,233 vs. 1824 ng/L; p = 0.001), procalcitonin (median 10.9 vs. 2.1 µg/L; p = 0.009), ferritin (median 1234 vs. 308 µg/L; p = 0.003). The most common findings were ventricular systolic dysfunction recovering during hospitalization, and persisting LV diastolic dysfunction in the reduced LVEF group at discharge. Coronary artery involvement was rare in the acute phase of the disease. Also, in MIS-C patients, the correlation between LV systolic dysfunction and markers of inflammation and cardiac biomarkers should be considered.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00246-021-02738-3.

Evaluation of OxPL Levels in Patients Undergoing Coronary Angiography: A Cross-Sectional Study

Background and Aim: Coronary ectasia is one of the prevalent cardiovascular diseases worldwide. It causes many deaths annually ranged between 9% to 10% which is dependent on related risk factors. The main pathogenesis has not been determined yet; however, it has been shown, that increased lipid profiles and their oxidation in patients can cause endothelial cell dysfunction and thrombosis. Therefore, here we investigated the oxidized phospholipids (OxPLs) role in the pathogenesis of coronary artery disease. Methods: This cross-sectional study was performed in Shariati Hospital, Tehran. Accordingly, patients with coronary artery angiography indications (n=360) were included and classified into one of the following three groups, based on the angiographic results: 1) normal coronary artery (not dysfunction in vessels) or mild CAD (only intimal irregularity or less than 3% narrowing without ectasia); 2) vessel dilation more than 1.5 times compared to the normal part of the vessel or compared to the normal size according to age and gender in one or more coronary vessels; and 3) patients with more than 50% stenosis in one of the coronary arteries. The peripheral blood was collected from patients in EDTA anticoagulants container tubes and the OxPL level was measured using an ELISA kit. Results: The results showed that the amount of OxPL in the third and second groups was higher than in the first group. It was also found that hyperlipidemia, diabetes, hypertension, and smoking were higher in the third and second groups; all mentioned findings were statistically significant (p-value <0.05). Conclusion: According to the findings of this study, it was shown that an increase in OxPL in patients with coronary ectasia can be considered as a risk factor for disease progression; OxPL measurement can be used to identify high-risk individuals. *Corresponding Author: Seyed Abdolhussein Tabatabaei; Email: tabatabaeiseyedah@gmailcom; ORCID iD: 0000-0001-5091-6066 Please cite this article as: Nikdoust F, Lashkari Zadeh F, Tabatabaei SA. Evaluation of OxPL Levels in Patients Undergoing Coronary Angiography: A Cross-Sectional Study. Arch Med Lab Sci. 2021;7:1-6 (e12). https://doi.org/10.22037/amls.v7.34602

Cardiac implications of multisystem inflammatory syndrome associated with COVID-19 in children under the age of 5 years.

Coronavirus disease 2019 (COVID-19) is responsible for significant lung disease in adults. Despite mild manifestations in most children, multisystem inflammatory syndrome (MIS-C) associated with COVID-19 is well described in older children with cardiac manifestations. However, MIS-C-related cardiac manifestations are not as well described in younger children. The study is a retrospective analysis of MIS-C patients under the age of 5 years admitted between May and November 2020 to a single centre. Included cases fulfilled the case definition of MIS-C according to Royal College of Pediatrics and Child Health criteria with laboratory, electrocardiogram, or echocardiographic evidence of cardiac disease. Collected data included patients' demographics, laboratory results, echocardiographic findings, management, and outcomes. Out of 16 MIS-C cases under 5 years of age, 10 (62.5%) had cardiac manifestations with a median age of 12 months, 9 (90%) were previously healthy. Cardiac manifestations included coronary arterial aneurysms or ectasia in five (50%) cases, two (20%) with isolated myopericarditis, coronary ectasia with myocarditis in two (20%), and supraventricular tachycardia in one (10%). Intravenous immunoglobulins were given in all cases with coronary involvement or myocarditis. The median duration of hospitalisation was 7 (6-14) days; two (20%) cases with cardiac disease were mechanically ventilated and mortality in MIS-C cases below 5years was 12.5%. Normalisation of systolic function occurred in half of the affected cases within 1 week and reached 100% by 30days of follow-up. MIS-C associated with SARS-CoV-2 has a high possibility of serious associated cardiac manifestations in children under the age of 5years with mortality and/or long-term morbidities such as coronary aneurysms even in previously healthy children.

Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).

Febrile Illness in 3 Adolescent Patients.

Febrile Illness in 3 Adolescent Patients.

Post-PCI outcomes in STEMI patients with coronary ectasia: meta-analysis

ABSTRACT Background Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate. Methods Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0–1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Results Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06–1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44–3.32;p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42–6.84;p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48–0.86;p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39–1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities. Conclusion Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.