Características clínicas y angiográficas de pacientes con ectasia coronaria en un hospital de referencia

David Alejandro Rodríguez Falla; Eliana Alejandra Rafael-Horna; José Quiroz Burgos; Gerald Lévano-Pachas; Giovanni Meneses

doi:10.47487/apcyccv.v3i3.229

Authors

David Alejandro Rodríguez Falla Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. https://orcid.org/0000-0002-9056-9342
Eliana Alejandra Rafael-Horna Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. https://orcid.org/0000-0002-3670-0776
Jose Quiroz Burgos Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. https://orcid.org/0000-0002-6978-0979
Gerald Lévano-Pachas Departamento de Cardiología, Hospital Nacional Guillermo Almenara. Lima, Perú. https://orcid.org/0000-0002-4136-5802
Giovanni Meneses Departamento Académico de Me- dicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. https://orcid.org/0000-0003-1677-3457

DOI:

https://doi.org/10.47487/apcyccv.v3i3.229

Keywords:

Ectasia, Coronary Angiography, Coronary Disease

Abstract

Objective: To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography. Materials and methods: 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. Results: 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). Conclusions: 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.

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References

Jarcho S. Bougon on coronary aneurysm (1812). Am J Cardiol. 1969;24(4):551- 553. doi: 10.1016/0002-9149(69)90500-1.

Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS, Alkhouli M. Management of Coronary Artery Aneurysms. JACC Cardiovasc Interv. 2018;11(13):1211-1223. doi: 10.1016/j.jcin.2018.02.041.

Packard M, Wechsler HF. Aneurysm of coronary arteries. Arch Intern Med. 1929;43:1-14.

Bjork L. Ectasia of the coronary arteries. Radiology. 1966;87(1):33-4. doi: 10.1148/87.1.33.

Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J. 1985;54(4):392-5. doi: 10.1136/hrt.54.4.392.

Befeler B, Aranda MJ, Embi A, Mullin FL, El-Sherif N, Lazzara R. Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis. Am J Med. 1977;62(4):597-607. doi: 10.1016/0002-9343(77)90423-5.

Alford WC Jr, Stoney WS, Burrus GR, Frist RA, Thomas CS Jr. Recognition and operative management of patients with arteriosclerotic coronary artery aneurysms. Ann Thorac Surg. 1976;22(4):317-21. doi: 10.1016/ s0003-4975(10)64961-2.

Swanton RH, Thomas ML, Coltart DJ, Jenkins BS, Webb-Peploe MM, Williams BT. Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis. Br Heart J. 1978;40(4):393-400. doi: 10.1136/hrt.40.4.393.

Daoud AS, Pankin D, Tulgan H, Florentin RA. Aneurysms of the coronary artery. Report of ten cases and review of literature. Am J Cardiol. 1963;11:228- 37. doi: 10.1016/0002-9149(63)90064-x.

Al-Harthi SS, Nouh MS, Arafa M, al-Nozha M. Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance. Int J Cardiol. 1991;30(2):191-4. doi: 10.1016/0167-5273(91)90094-6.

Markis JE, Joffe CD, Cohn PF, Feen DJ, Herinan MV, Gorlin R. Clinical significance of coronary artery ectasia. Am J Cardiol. 1976;37(2):217-22. doi: 10.1016/0002-9149(76)90315-5.

Bermúdez E, Palop R, Martínez-Luengas I, Sanchez R, Sáez P, Carreras R. Ectasia coronária: prevalencia, características clínicas y angiográficas. Rev Esp Cardiol. 2003;56(5);473-9. doi: 10.1157/13047012.

Sharma SN, Kaul U, Sharma S, Wasiv HS, Manchanda SC, Bahl VK, et al. Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. Indian Heart J. 1990;42(5):365-9.

Falsetti HL, Carrol RJ. Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest. 1976;69(5):630-6. doi: 10.1378/ chest.69.5.630.

Gulec S, Atmaca Y, Kilickap M, Akyürek O, Aras O, Oral D. Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol. 2003;91(8):996-9, A7. doi: 10.1016/s0002- 9149(03)00123-1.

Bove AA, Vlietstra RE. Spasm in ectatic coronary arteries. Mayo Clin Proc. 1985;60(12):822-6. doi: 10.1016/s0025-6196(12)64787-9.

Sorrell V, Davis M, Bove A. 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(3):157-60. doi: 10.1002/clc.4960210304.

Devabhaktuni S, Mercedes A, Diep J, Chowdhury A. Coronary Artery Ectasia – A review of current literature. Curr Cardiol Rev. 2016;12(4):318- 323. doi: 10.2174/1573403x12666160504100159.

Chatzizisis YS, Jonas M, Coskun AU, Beigel R, Stone BV, Maynard C, et al. Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress: an intravascular ultrasound and histopathology natural history study. Circulation. 2008;117(8):993- 1002. doi: 10.1161/CIRCULATIONAHA.107.695254.

Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316(22):1371-5. doi: 10.1056/NEJM198705283162204.

Bentzon JF, Pasterkamp G, Falk E. Expansive remodeling is a response of the plaque-related vessel wall in aortic roots of apoE-deficent mice: an experiment of nature. Arterioscler Thromb Vasc Biol. 2003;23(2):257-62. doi: 10.1161/01.atv.0000051387.70962.79.

Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone PH. Role of the endothelial shear stress in the natural history of coronary atherosclerotic and vascular remodeling: molecular, cellular and vascular behavior. Am Coll Cardiol. 2007;49(25):2379-93. doi: 10.1016/j. jacc.2007.02.059.

Vanhoutte PM. Endothelium and control of vascular function. Hypertension. 1989;13(6 Pt 2):658-67. doi: 10.1161/01.hyp.13.6.658.

Marginas A, Cokkinos D. Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J. 2006;27(9):1026-31. doi: 10.1093/eurheartj/ehi725.

Thygesen K, Alpert J, Jaffe A, Chaitman B, Bax J, Morrow DA, et al. Fourth universal definition of myocardial infarction. Eur Heart J. 2019;40(3):237- 269. doi: 10.1093/eurheartj/ehy462.

Wagner G, Macfarlane P, Wellens H, Josephson M, Gorgles A, Mirvis D, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part VI: Acute Ischemia/ Infarction. Circulation. 2009; 119(10): e262-e270. Doi:z 10.1161/ CIRCULATIONAHA.108.191095.

TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932-6. doi: 10.1056/ NEJM198504043121437.

Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88. doi: 10.1161/01.cir.93.5.879.

Malviya A, Jha PK., Mishra A. Isolated coronary artery ectasia: Clinical, angiographic, and follow up characteristics. Indian Heart J. 2017;69(5):619- 623. doi: 10.1016/j.ihj.2016.12.017.

Gunes Y, Boztosun B , Yildiz A , Metin Esen A , Saglam M , Bulut M, et al. Clinical profile and outcome of coronary artery ectasia. Heart. 2006;92(8):1159-60. doi: 10.1136/hrt.2005.069633.

Harikrishnan S, Sunder KR, Tharakan J, Titus T, Bhat A, Sivasankaran S, et al. Coronary artery ectasia: angiographic, clinical profile and follow-up. Indian Heart J. 2000;52(5):547-53.

Lam CSP, Ho KT. Coronary artery ectasia: a ten-year experience in a tertiary hospital in Singapore. Ann Acad Med Singap. 2004;33(4):419-22.

Awanleh P, Casado R, Mata R. Ectasia coronaria y lesiones trombóticas como causa de síndrome coronário agudo. Rev Colomb Cardiol. 2017;24(2):131.e1-e131.