Coronary Collateral Circulation in Patients of Coronary Ectasia with Significant Coronary Artery Disease
Background:Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development.
Methods: We evaluated 838 consecutive patients undergoing coronary angiography and 251 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group.
Results: 130 patients (51.7%) had CE lesions which were most located in the right coronary artery (58.4%). Patients with CE had a lower incidence of diabetes (33.0% vs 41.3%, p= 0.03), lower incidence of smoking (13.8% vs 27.2%, p=0.021), higher incidence of dyslipidaemia (32.3% vs 13.2%, 0.010) and poorer coronary collateral (85.0% vs 25.6%, p<0.0001). Patients with poor collateral (n= 142) had a higher incidence of CE (78% vs 17.4%, p<0.0001) and fewer diseased vessels numbers (1.76 vs 2.00, p,0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p= 0.026), CE (OR= 2.44, p= 0.001), and number of diseased vessels (OR= 2.488, p=0.001) were significant predictors of coronary collaterals development.
Conclusion: The presence of CE was associated with poorer coronary collateral development in patients with SCAD.
2. Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, et al. (1983) Aneurysmal coronary artery disease. Circulation 67: 134–138.
3. Hartnell GG, Parnell BM, Pridie RB (1985) Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J 54(4): 392–5.
4. Yilmaz H, Sayar N, Yilmaz M, Tangu¨rek B, Cakmak N, et al. (2008) Coronary artery ectasia: clinical and angiographical evaluation. Turk Kardiyol Dern Ars 36: 530–535.
5. Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, et al. (1990) Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. Indian Heart J 42(5): 365–9.
6. Swanton RH, Thomas ML, Coltart DJ, Jenkins BS, Webb-Peploe MM, et al. (1978) Coronary artery ectasia—a variant of occlusive coronary arteriosclerosis. Br Heart J 40(4): 393–400.
7. Rodbars S, Ikeda K, Montes M (1967) An analysis of mechanisms of poststenotic dilatation. Angiology 18: 349–353.
8. Fujita M, Sasayama S, Ohno A, Nakajima H, Asanoi H (1987) Importance of angina for development of collateral circulation. Br Heart J 57: 139.
9. Tayebjee MH, Lip GY, MacFadyen RJ (2004) Collateralization and the response to obstruction of epicardial coronary arteries. QJM 97: 259.
10. Levin DC (1974) Pathways and functional significance of the coronary collateral circulation. Circulation 50: 831–7. 11. Cohen M, Rentrop KP (1986) Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation 74(3): 469–76.
12. Meier P, Gloekler S, Zbinden R, Beckh S, de Marchi SF, et al. (2007) Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation 116(9): 975–83.
13. Regieli JJ, Jukema JW, Nathoe HM, Zwinderman AH, Ng S, et al. (2009) Coronary collaterals improve prognosis in patients with ischemic heart disease. Int J Cardiol 132(2): 257–62.
14. Markis JE, Joffe CD, Cohn PF, Fen DJ, Herman MV, et al. (1976) Clinical significance of coronary artery ectasia. Am J Cardiol 37: 217–222.
15. Rentrop KP, Cohen M, Blanke H, Phillips RA (1985) Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 5(3): 587–92.
16. Werner GS, Ferrari M, Heinke S, Kuethe F, Surber R, et al. (2003) Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation 107: 1972–7.
17. Brown G, Rockstroh J (2002) Coronary collateral size, flow capacity, and growth estimates from the angiogram in patients with obstructive coronary disease. Circulation 105: 168–73.
18. Befeler B, Aranda JM, Embi A, Mullin F, Ei-Sherif N, et al. (1977) Coronary artery aneurysms: Study of their etiology, clinical course and effect on left ventricular function and prognosis. Am J Cardiol 62: 597–607.
19. Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, et al. (1997) The natural history of aneurysmal coronary artery disease. Heart 78:136–141.
20. Manginas A, Cokkinos DV (2006) Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J 27(9): 1026–31.
21. Mavrogeni S (2010) Coronary artery ectasia: from diagnosis to treatment. Hellenic J Cardiol 51(2): 158–63.
22. Daoud AS, Pankin D, Tulgan H, Florentin RA (1963) Aneurysms of the coronary artery. Report of ten cases and review of literature. Am J Cardiol 11: 228–237.
23. al-Harthi SS, Nouh MS, Arafa M, al-Nozha M (1991) Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance. Int J Cardiol 30: 191–194.
24. Onouchi Z, Hamaoka K, Kamiya Y, Hayashi S, Ohmochi Y, et al. (1993) Transformation of coronary artery aneurysm to obstructive lesion and the role of collateral vessels in myocardial perfusion in patients with Kawasaki disease. J Am Coll Cardiol 21(1): 158–62.
25. Tatara K, Kusakawa S, Itoh K, Honma S, Hashimoto K, et al. (1991) Collateral circulation in Kawasaki disease with coronary occlusion or severe stenosis. Am Heart J 121: 797–802.
26. Ozbay Y, Akbulut M, Balin M, Kayancicek H, Baydas A, et al. (2007) The level of hs-CRP in coronary artery ectasia and its response to statin and angiotensin-converting enzyme inhibitor treatment. Mediators Inflamm 89649.
27. Li JJ, Nie SP, Qian XW, Zeng HS, Zhang CY (2009) Chronic inflammatory status in patients with coronary artery ectasia. Cytokine 46(1): 61–4.
28. Sezen Y, Bas M, Polat M, Yildiz A, Buyukhatipoglu H, et al. (2010) The relationship between oxidative stress and coronary artery ectasia. Cardiol J 17(5): 488–94.
29. Abaci A, Og˘uzhan A, Kahraman S, Eryol NK, Unal S, et al. (1999) Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation 99(17): 2239–2242.
30. Helfant RH, Kemp HG, Gorlin R (1970) Coronary atherosclerosis, coronary collaterals, and their relation to cardiac function. Ann Intern Med 73: 189–193.
31. Sezer M, Ozcan M, Okcular I, Elitok A, Umman S, et al. (2007) A potential evidence to explain the reason behind the devastating prognosis of coronary artery disease in uraemic patients: renal insufficiency is associated with poor coronary collateral vessel development. Int J Cardiol 115(3): 366–372.
32. Gulec S, Ozdemir AO, Maradit-Kremers H, Dincer I, Atmaca Y, et al. (2006) Elevated levels of C-reactive protein are associated with impaired coronary collateral development. Eur J Clin Invest 36(6): 369–75.
33. Resar JR, Roguin A, Voner J, Nasir K, Hennebry TA, et al. (2005) Hypoxia-inducible factor 1alpha polymorphism and coronary collaterals in patients with ischemic heart disease. Chest 128(2): 787-91
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