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Objective: Coronary artery ectasia (CAE) is a condition characterized by the localized or widespread dilation of one or more coronary arteries. The majority of CAE patients do not present with clinical symptoms, and the exact cause of CAE remains unclear. Therefore, a retrospective analysis was conducted to explore the potential causes of CAE., Methods: This study was a retrospective analysis of patients who underwent coronary angiography at Guangdong Provincial People's Hospital between January 2017 and July 2022, of whom 679 patients were ultimately enrolled in the study. Among them, 260 patients were diagnosed with CAE, whereas 419 patients with normal coronary results composed the control group. Remnant cholesterol (RC) was calculated as total cholesterol (TC) minus high-density lipoprotein cholesterol (HDL-C) minus low-density lipoprotein cholesterol (LDL-C). The association between RC levels and the risk of CAE was assessed via multivariable logistic models., Results: Out of the 679 patients who participated in this study, with an average age of 59.9 years, 38.3% were diagnosed with CAE. Patients with CAE had higher RC levels than did those without CAE (P = 0.001). A significant positive association was observed between RC levels and the risk of CAE, with a multivariable adjusted odds ratio (OR) of 1.950 (95% confidence interval [CI]: 1.163-3.270). There was a significant positive association between RC levels and the risk of CAE in both single-vessel and multivessel dilation cases, as well as in isolated CAE and dilation secondary to coronary atherosclerosis. According to the subgroup analyses, RC levels were positively associated with the risk of CAE in participants with hypertension (OR, 1.065; 95% CI, 1.034-1.098)., Conclusion: RC levels are positively correlated with CAE, implying that a focus on RC could be beneficial in CAE research., (© 2024. The Author(s).)

Purpose: The syndromes of myocardial infarction/myocardial ischemia with No Obstructive Coronary Artery Disease (MINOCA/INOCA) are seen more and more often. Endothelial dysfunction (ED) leading to ischemic events has been reported in many of these patients. We aimed to compare patients with MINOCA and INOCA regarding brachial artery flow-mediated endothelium-dependent vasodilation (flow-mediated dilation [FMD]) and plasma concentration of cardiotrophin-1 (CT-1)., Methods: We included 42 patients with MINOCA and 38 patients with INOCA. Endothelial function was assessed by measuring FMD% and nitroglycerin-mediated dilatation (NMD%) in the brachial artery. The plasma level of CT-1 was determined by solid-phase enzyme-linked immunosorbent assay., Results: FMD% was significantly lower in MINOCA than in INOCA patients (6.45 ± 2.65 vs 8.94 ± 3.32, P < .001), without significant difference in NMD% (10.69 ± 3.19 vs 12.16 ± 3.69, P = .06). Plasma CT-1 levels were not significantly different: 40.1 pg/mL (22.5-102.1) vs 37.2 pg/mL (23.5-67.2), P = .53., Conclusion: Our results suggest worse ED in MINOCA than in INOCA patients, but demonstrated no difference in CT-1 levels between patients with stable and unstable ischemic heart disease and normal coronary arteries., (© 2020 Wiley Periodicals LLC.)

Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). The relationship between total bilirubin (TBil) and carotid intima media thickness (cIMT) in patients with CAE has not been fully investigated. Hence, we evaluated the relationship between TBil levels and cIMT in 142 consecutive eligible patients with CAE, newly diagnosed coronary artery disease (CAD), and normal coronary arteries. There were no significant differences in TBil ( P = .772) and cIMT ( P = .791) between the CAE and CAD groups. Bilirubin levels were significantly lower in both CAE and CAD groups compared to the controls ( P < .01). The cIMT was significantly higher in both CAE and CAD groups compared to control participants ( P < .01). A negative correlation between cIMT and TBil was found in all the groups ( P < .01, r = .354). We show for the first time that patients with CAE and CAD have lower TBil and greater cIMT compared to controls with normal coronary angiograms.

Objective: Dilation of one or more coronary artery segments to a diameter at least 1.5 times that of a normal adjacent segment is referred to as coronary artery ectasia (CAE). Adropin is a protein involved in endothelial function and is shown to have a protective effect on the regulation of cardiac functions. Atherosclerosis and endothelial dysfunction play an important role in the development of CAE. The aim of this study was to investigate the association between serum adropin levels and isolated CAE., Methods: Patients with stable angina pectoris who underwent coronary angiography (CAG) between August 2017 and July 2018 were evaluated prospectively. A total of 92 subjects were included in the study-40 patients over 18 years old and diagnosed with isolated CAE based on CAG findings and a control group of 52 patients., Results: Serum adropin level was found to be significantly lower in the isolated CAE group compared to the control group (1019.57 pg/mL and 1151.10 pg/mL, respectively, p=0.010). The isolated CAE group also exhibited a significantly higher mean platelet volume than that in the control group (10.75 fL and 10.17 fL, respectively, p=0.011)., Conclusion: Our results show that there is an association between low serum adropin level and isolated CAE.

Marfan syndrome (MFS) is a rare genetic disease characterized by a matrix metalloproteases (MMPs) dysregulation that leads to extracellular matrix degradation. Consequently, MFS patients are prone to develop progressive thoracic aortic enlargement and detrimental aneurysm. Since MMPs are activated by the extracellular MMP inducer (EMMPRIN) protein, we determined whether its plasmatic soluble form (sEMMPRIN) may be considered a marker of thoracic aortic ectasia (AE). Methods : We compared plasma sEMMPRIN levels of 42 adult Caucasian MFS patients not previously subjected to aortic surgery with those of matched healthy controls (HC) by ELISA. In the MFS cohort we prospectively evaluated the relationship between plasma sEMMPRIN levels and the main MFS-related manifestations. Results : MFS patients had lower plasma sEMMPRIN levels (mean±SD: 2071±637 pg/ml) than HC (2441±642 pg/ml, p =0.009). Amongst all considered MFS-related clinical features, we found that only aortic root dilatation associated with circulating sEMMPRIN levels. Specifically, plasma sEMMPRIN levels negatively correlated with aortic Z-score (r=-0.431, p =0.004), and were significantly lower in patients with AE (Z-score≥2, 1788±510 pg/ml) compared to those without AE (Z-score<2, 2355±634 pg/ml; p =0.003). ROC curve analysis revealed that plasma sEMMPRIN levels discriminated patients with AE (AUC [95%CI]: 0.763 [0.610-0.916], p =0.003) with 85.7% sensitivity, 76.2% specificity, and 81% accuracy. We defined plasma sEMMPRIN levels ≤2246 pg/ml as the best threshold discriminating the presence of AE in MFS patients with an odds ratio [95%CI] of 19.2 [3.947-93.389] ( p <0.001). Conclusions : MFS patients are characterized by lower sEMMPRIN levels than HC. Notably, plasma sEMMPRIN levels are strongly associated with thoracic AE., Competing Interests: Competing Interests: The authors have declared that no competing interest exists.

Isolated biliary dilation, as an incidental diagnosis, is increasing owing to an increase in the use of noninvasive abdominal imaging and poses a diagnostic challenge to physicians especially when further noninvasive diagnostic testing fails to reveal an etiology. This article reviews available data describing the natural history of this clinical scenario and the impact of endoscopic ultrasound examination in the evaluation of unexplained dilation of the common bile duct., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Several studies have demonstrated the relationship between visfatin and increased risk of diseases caused by inflammation, however, the relationship between visfatin and coronary artery ectasia (CAE) is still unknown. The aim of our study is to investigate the association between serum visfatin with presence of coronary ectasia and its severity. We enrolled 85 individuals including 35 CAE patients (mean age: 58.40 ± 9.82 years) and 50 control persons (mean age: 53.24 ± 8.81 years). These participants underwent some biochemical tests including visfatin, fasting blood glucose and lipid profiles. In univariate analysis, the serum level of visfatin was significantly associated with ectasia in all patients with CAE and CAD coexisting with CAE groups, but a trend toward significance in isolated CAE group. In multivariate analysis, visfatin showed independently significant association with presence of ectasia in all patients with ectasia and in CAD coexisting with ectasia groups, but not significant in isolated CAE group. Visfatin was also independently associated with severity of ectasia according to MARKIS classification. We conclude that visfatin independently can be the useful predictor for the presence and severity of coronary ectasia., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Coronary artery ectasia (CAE) is identified as dilation of one or more segments of coronary arteries that reaches 1.5 times or more, compared with near segments that are normal. Several etiologies like atherosclerosis, autoimmune diseases and congenital anomalies have been proposed for this condition. Vitamin D deficiency activates the renin-angiotensin-aldosterone system, which affects the cardiovascular system. For these reasons, we investigated the serum level of vitamin D in patients with CAE compared with individuals with normal coronary arteries., Methods: The study group included 30 patients (20 males and 10 females, mean age: 57 ± 9 years) with isolated CAE without any stenotic lesions, and the control group consisted of 60 age/gender matched subjects who had normal coronary angiograms (CAG) (40 males and 20 females, mean age: 57 ± 8 years). All participants underwent CAG at Tehran Heart Center between December 2015 and March 2016. Along with routine lab tests, vitamin D, serum albumin, calcium, phosphorus and alkaline phosphatase levels were analyzed and the unadjusted and adjusted effects of vitamin D on CAE were evaluated using logistic regression model., Results: The median vitamin D level of the patients with CAE was lower than that of the control group (6.5 [3.0, 18.8] ng/mL vs. 17.7 [8.9, 27.1] ng/mL; P = 0.002). The logistic regression model showed that vitamin D deficiency was a predictor for the presence of CEA (P = 0.013). After adjustment for confounding variables, this association remained significant (P = 0.025)., Conclusion: An association between CAE and vitamin D deficiency was found in our study., (© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Low homoarginine is an independent marker of mortality in heart failure patients and incident cardiovascular events. Whether homoarginine is related with healthier cardiac structure and function is currently unclear. We used data of the population-based "Study of Health in Pomerania" (SHIP-Trend) to assess this relation. Homoarginine was measured in serum using liquid chromatography-tandem mass spectrometry. Linear regression models assessed the relation between homoarginine and several structural as well as functional parameters and N-terminal pro B-type natriuretic peptide (NTproBNP). All models were adjusted for age, sex, body mass index, and renal function. A total of 3113 subjects (median age 48 (25th percentile 37 to 75th percentile 60) years, 46% male) were included. A standard deviation decrease in homoarginine was associated with a larger left ventricular diastolic diameter (0.3; 95%-confidence interval (CI): 0.2 to 0.5 mm; p < 0.001), left ventricular systolic diameter (0.38; 95%-CI: -0.22 to 0.54 mm; p < 0.001) as well as a less relative wall thickness (⁻0.003 95%-CI: -0.006 to -0.0008; p = 0.01), left ventricular ejection fraction (⁻0.47; 95%-CI: ⁻0.79 to -0.15%; p < 0.01) and fractional shortening (-0.35; 95%-CI: -0.62 to 0.07%; p = 0.01). Low homoarginine was also related to higher NTproBNP (-0.02 95%-CI: -0.034 to -0.009 log pg/mL; p < 0.01). Lower serum homoarginine is associated with dilatation of the heart and decreased function. Prospective clinical studies should assess if homoarginine supplementation improves cardiac health in subjects with low serum concentrations.

Objective: We aimed to investigate whether soluble CD40 ligand (CD40L) levels are higher in patients with isolated coronary artery ectasia (CAE) compared to patients with angiographically normal coronary arteries and those with stable coronary artery disease (CAD)., Materials and Methods: In all, 55 patients with isolated CAE without stenosis, 55 with stable CAD, and 55 control participants with angiographically normal coronary arteries were included. The CAE severity was determined according to the Markis classification. Plasma levels of soluble CD40 ligand were measured by enzyme-linked immunosorbent assay., Results: The baseline characteristics of the 3 groups were similar. Plasma levels of soluble CD40 ligand were significantly higher in patients with CAE and CAD than in controls (2.6 ± 3.1 ng/mL and 2.0 ± 3.1 ng/mL vs 1.8 ± 2.1 ng/mL, P = .004). No difference was found between the CAE and CAD groups. Soluble CD40 ligand level was significantly higher in the type 1 Markis subgroup than that in the type 3 or type 4 subgroups ( P = .01). A receiver operating characteristic curve analysis revealed that soluble CD40 ligand level >1.2 ng/mL identified patients with isolated CAE., Conclusion: Significantly higher levels of soluble CD40 ligand were detected in patients with CAE than that in control participants with normal coronary arteries, suggesting that soluble CD40 ligand may be involved in the pathogenesis of CAE. The CD40-CD40 ligand system likely plays a role in the pathogenesis of CAE.

Objectives: The study aimed to examine the relationship of serum apolipoprotein B level with left ventricular (LV) structural and functional characteristics, in particular, LV remodeling parameters in peritoneal dialysis (PD) patients., Methods: A total of 182 patients with end-stage renal disease (ESRD) receiving PD were identified. Conventional echocardiography was performed for each patient, and echocardiographic characteristics were analyzed according to apo B quartile groups. Multivariate linear regression models were used to determine the associations between serum apo B and LV remodeling indices., Results: A high serum apo B level was significantly related to the reduction in left atrium dimension (r = - 0.20, P = 0.011), LV dimensions (end-diastolic: r = - 0.27, P = 0.001; end-systolic: r = - 0.24, P = 0.003), peak velocities of early filling divided by peak velocities of atrial filling (r = - 0.38, P < 0.001), and LV volumetric dimension (end-diastolic: r = - 0.27, P < 0.001; end-systolic: r = - 0.28, P < 0.001). After adjustment for clinical confounding factors, the effect of serum apo B on LV eccentric remodeling modestly weakened but remained statistically significant (P = 0.038), while other associations were not significant. In multivariate linear regression analysis, conventional lipid profiles were not significantly associated with LV eccentric remodeling, whereas serum apo B was an independent determinant of LV dilatation (β: - 42.10, 95% CI - 74.82 to - 9.38, P = 0.012)., Conclusions: Serum apo B was significantly and inversely associated with LV dilatation, independently of conventional lipids and other CV risk factors in our ESRD patients undergoing PD. It suggested that low serum apo B level could be a powerful risk marker for eccentric left ventricular geometry remodeling and could be potentially used to risk-stratify PD patients.

Context: Endothelin-1(ET-1) has been implicated in coronary artery disease (CAD) and may be associated with coronary artery ectasia (CAE)., Objective: To clarify the relationship between big ET-1 and isolated CAE., Methods: We measured big ET-1 with ELISA in 216 patients (CAE, n = 72; CAD, n = 72; normal, n = 72) and evaluated the link with isolated CAE., Results: The level of plasma big ET-1 was significantly higher in patients with isolated CAE (p < 0.001). Big ET-1 was strongly and independently associated with CAE by multivariate analysis (OR 95%CI: 1.026 (1.018-1.034), p = 0.000)., Conclusions: Big ET-1 may be a useful predictor for the presence of isolated CAE.

Background: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase., Aim: We aimed to determine plasma ADMA levels in patients with ascending aorta dilatation in comparison to those without aorta dilatation, and to evaluate the diagnostic, predictive, and prognostic value of serum ADMA level for aorta dilatation., Methods: This was a cross-sectional case-control study. A total of 104 consecutive patients (female/male, 35/69; mean age, 62.75 ± 13.11 years) diagnosed with ascending aorta dilatation (≥ 4.5 cm) on echocardiography (case group), and 52 age-and gender-matched patients (female/male, 17/35; mean age, 63.44 ± 7.56 years) with normal aorta dimensions (≤ 3.8 cm) (control group) were included. Routine biochemical and haematological analysis in addition to measurement of serum ADMA level were performed., Results: The mean diameter of ascending aorta measured on echocardiography was 4.95 ± 0.57 cm and 3.34 ± 0.36 cm in patients with aorta dilatation and those without aorta dilatation, respectively (p < 0.001). Serum ADMA level was significantly higher in patients with aorta dilatation than in the control group (1.70 ± 1.12 μmol/L vs. 0.79 ± 0.76 μmol/L, respectively, p < 0.001). There was significant positive correlation between ADMA level and aortic diameter in Spearman correlation analysis (r = 0.317, p < 0.001). In linear regression analysis, ADMA was found to be a significant independent predictor of aorta diameter (Beta = 0.26, p < 0.001). Receiver-operator characteristic curve analysis also revealed that serum ADMA cut-off level over 0.29 μmol/L predicts aorta dilatation (≥ 4.5 cm) with 94% sensitivity and 92% specificity and with high ac-curacy (area under curve: 0.786; 95% confidence interval: 0.709-0.863, p < 0.001)., Conclusions: Serum ADMA level is diagnostic for ascending aorta dilatation with high sensitivity and specificity, and should be considered for use in clinical diagnosis of aorta dilatation.

Background: Serglycin plays an important role in the inflammatory status, but the relationship between coronary artery ectasia (CAE) and serglycin is still unknown., Aim: In this study, we aimed to investigate the association of serglycin level with isolated CAE., Methods: Fifty-two patients with isolated CAE and 35 individuals with normal coronary angiography were included into the study. The Markis classification and number of ectatic coronary arteries were recorded. Plasma serglycin levels were measured., Results: Multivariate logistic regression analysis revealed that serglycin and high-sensitivity C-reactive protein were indepen-dently associated with the presence of CAE. In receiver operating characteristics curve analysis the cut of serglycin level for the prediction of isolated CAE was 13.5, with a sensitivity of 88.5% and a specificity of 84.8%. However, there was no association between serglycin levels and Markis classification., Conclusions: Serglycin levels are significantly and independently higher in patients with CAE.

Coronary artery ectasia (CAE) is associated with coronary artery disease (CAD). The underlying pathophysiology of CAE is not fully understood. α 1 -antitrypsin (A1AT) plays a role in the tissue protease system, and AAT-1 deficiency (A1ATD) has been shown to be related to CAD. We compared A1AT serum levels in patients with and without CAE to determine the association between A1AT levels and the extent of ectasia using the Markis score. We included 50 patients (38 males) with isolated CAE and 46 patients (28 males) with normal coronary arteries after coronary angiography. The levels of A1AT were measured by nephelometry. The median A1AT levels were lower in patients with isolated CAE than in the control group (1.27 ng/mL [range: 1.07-1.37 ng/mL] vs 1.43 ng/mL [range: 1.27-1.59 ng/mL]; P < .001). According to the Markis classification, the extent of CAE was not correlated with A1AT levels ( P = .41). Our results demonstrate an inverse relationship between serum A1AT levels and CAE. α 1 -antitrypsin is fundamental for the stability and integrity of the arterial wall. Lack of elastase inhibition in cases of A1ATD may contribute to ectasia formation by facilitating proteolysis and weakening the arterial wall.

Endocan is a soluble proteoglycan, secreted by human vascular endothelial cells. Endocan is a marker for vascular pathologies and an important mediator of angiogenesis, strongly associated with inflammation, vascular endothelial dysfunction, and atherosclerosis. The relationship between coronary artery ectasia (CAE) and endocan has not been evaluated. We aimed to investigate this association. Fifty-four patients with isolated CAE without coronary stenosis and 30 controls with normal coronary angiogram were included in this study. Endocan plasma concentrations were measured using an enzyme-linked immunosorbent assay. Patients with isolated CAE had significantly higher levels of endocan compared to the controls (18.9 ± 7.3 vs 15.6 ± 3.6 ng/mL; P = .007). There was a significant correlation between endocan levels and severity of isolated CAE according to the Markis classification ( r = -.593, P < .001). Plasma endocan levels may reflect the presence and severity of isolated CAE, suggesting that endocan may be involved in pathogenesis of isolated CAE.

Background and Aims: Thiol/disulfide homeostasis has an important role in the antioxidant defense system. Oxidative stress may contribute to the pathogenesis of coronary artery ectasia. The aim of this study was to evaluate plasma thiol levels and thiol/disulfide homeostasis in patients with isolated coronary artery ectasia., Methods: Forty-one patients with isolated coronary artery ectasia and 72 patients with normal coronary arteries were included in the study. Markis classification and number of ectatic coronary arteries were recorded. Plasma total thiol levels, native thiol levels and disulfide levels were measured. Thiol/disulfide homeostasis was appraised by calculating thiol/disulfide ratio., Results: Plasma native thiol levels were significantly lower (336.9 (252.9-374.1) vs. 353.1 (327.0-380.0), p = 0.041) and disulfide levels were significantly higher (18.9 ± 6.3 vs. 16.6 ± 3.4, p = 0.014) in patients with coronary artery ectasia than control patients. Both native thiol/disulfide and total thiol/disulfide ratio was significantly lower in the coronary artery ectasia group (p < 0.001). Multivariate logistic regression analysis revealed that native thiol levels, disulfide levels and native thiol/disulfide ratio were independently associated with the presence of coronary artery ectasia. Thiol/disulfide ratio was not different according to number of ectatic coronary arteries and there was no association between thiol/disulfide ratio and Markis classification., Conclusions: Plasma thiol/disulfide homeostasis is altered in patients with coronary artery ectasia., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: Proteolytic enzymes might contribute to coronary artery ectasia (CAE) through the destruction of extracellular matrix (ECM) vessel components. This study aimed to find out if peripheral blood mononuclear cells (PBMCs) served as a source of those proteinases and their regulators., Method: In this study, transcriptional expression profiles of the main proteinases and their regulators were detected in the PBMCs of CAE patients as follows: (1) matrix metalloproteinases (MMP) 1, 2, 3, 8, 9, 10, 12 and 13; (2) the serine proteinases elastase: cathepsin G and proteinases 3; (3) the cysteine proteinases: cathepsin L and cathepsin S; (4) the main endogenous inhibitors for the above proteinases: tissue inhibitors of metalloproteinase (TIMP) 1 and 2, α1-antitrypsin (α1-PI) and α2-macroglobulin (A2M); (5) twelve cytokines that could regulate the above proteinases., Result: The characteristic changes in CAE were: (1) MMP1 and MMP9 increased while the serine and cysteine families did not change; (2) the four proteinase inhibitors did not change in the CAE group; (3) among the 12 cytokines, interleukin-1 alpha (IL1A), platelet-derived growth factor (PDGF), interferon gamma (IFNγ) and growth differentiation factor 15 (GDF15) were elevated. Partial correlation analysis showed that MMP1 significantly correlated with IL1A and with IFNγ, and MMP9 correlated with IFNγ and with GDF 15., Conclusion: PBMCs might participate in the pathological process of CAE by the increased expression of MMP1, MMP9, IL1A, IFNγ and GDF15.

Thrombus formation and myocardial infarction are not uncommon in patients with coronary artery ectasia (CAE). In light of this, the present study aims to systemically evaluate the blood coagulation and fibrinolytic systems in CAE patients. In this study, we enrolled 30 patients with CAE, 30 patients with coronary atherosclerosis disease (CAD), and 29 subjects with normal coronary arteries (control). The coagulation system was evaluated using a routine coagulation function test performed in the hospital laboratory before coronary angiography, and measurements included prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen time, and thrombin time. The evaluation of the fibrinolytic system included measurements of D-dimer, euglobulin lysis time, plasminogen activator inhibitor 1, plasminogen, plasminogen activity assay, α1-antitrypsin (α1-AT), α2 plasmin inhibitor (α2-PI), and α2-macroglobulin (α2-MG). Alpha1-AT, α2-PI, and α2-MG also inhibit activities of 3 neutrophil serine proteases, namely human neutrophil elastase (HNE), cathepsin G (CG), and proteinase 3 (PR3); therefore, the plasma levels of these 3 proteinases were also evaluated.In CAE patients, the circulating coagulation system was normal. For the fibrinolytic system, a decrease of plasminogen activity was observed (P = 0.029) when compared with CAD patients, and the concentrations of α1-AT (both P < 0.001), α2-PI (P = 0.002 and P = 0.025), and α2-MG (P = 0.034 and P < 0.001) were significantly elevated when compared with CAD patients and normal controls. Moreover, the plasma levels of HNE (both P < 0.001) and CG (P = 0.027 and 0.016) in CAE patients were also significantly higher than those of the CAD and control groups. There was no difference in plasma PR3 concentration among these 3 groups.Disequilibrium of the coagulation/fibrinolytic system may contribute to thrombus formation and clinical coronary events in patients with CAE. The increased plasma concentrations of α1-AT, α2-PI, and α2-MG might provide beneficial effects by inhibiting the proteinases and restraining the ectatic process; on other hand, they led to unfavorable results by inhibiting plasmin and decreasing thrombus degradation in CAE patients.

Reasons for Performing Study: Studies on the use of atrial natriuretic peptide (ANP) as a biomarker for left atrial dilatation in horses have produced variable results. Few have been performed, and the results may have been influenced by ANP instability, differences in sampling protocol and changes in the assay over time. N-Terminal proANP (NT-proANP) is a more stable molecule and might be a good alternative for clinical use., Objectives: To compare ANP and NT-proANP in terms of the detection of left atrial dilatation and to determine the influence of sample storage at temperatures of -80 and -20°C., Study Design: Prospective clinical study., Methods: Atrial natriuretic peptide and NT-proANP concentrations were compared between healthy horses (Group 1, n = 20), horses with mitral valve regurgitation and a normal atrial size (Group 2, n = 11) and horses with mitral valve regurgitation associated with left atrial dilatation (Group 3, n = 16). The ANP concentration was measured with an equine enzyme-linked immunosorbent assay and the NT-proANP concentration with an enzyme-linked immunosorbent assay developed for use in human patients. Samples were stored at -20 and -80°C and analysed within 7 months., Results: The NT-proANP concentrations were not significantly different between the groups. Horses in Group 3 had a significantly higher ANP concentration (median 366 pg/ml; interquartile range [IQR] 74-2000 pg/ml) compared with horses in Group 1 (median 31 pg/ml; IQR 31-333 pg/ml) or Group 2 (median 31 pg/ml; IQR 31-1152 pg/ml; P = 0.02). The ANP cut-off value for detection of left atrial dilatation was 52 pg/ml (sensitivity 81%; specificity 84%) for sample storage at -80°C, and 44 pg/ml (sensitivity 69%; specificity 84%) for storage at -20°C. A larger decrease in ANP (45 ± 126 pg/ml) than in NT-proANP (10 ± 31 pg/ml) was found associated with sample storage at -20 instead of -80°C., Conclusions: Atrial natriuretic peptide, but not NT-proANP, can be used to detect left atrial dilatation in horses. Atrial natriuretic peptide is less stable than NT-proANP when samples are stored at -20°C. Atrial natriuretic peptide is a more suitable biomarker of left atrial dilatation in horses than NT-proANP., (© 2014 EVJ Ltd.)

Was investigated serum level of endothelial monocyte activating peptide II (EMAP-II) and endothelium-dependent dilatation in type 1 diabetes and possible relation between those. We found an increase serum level of EMAP-II and decrease of endothelium-dependent dilatation in type 1 diabetes. It was significant correlation between EMAP-II and HbAc1, blood glucose, total cholesterol, LDL, triglycerides and inverse correlation between EMAP-II and HDL, endotheliumdependent dilatation. The revealed change of EMAP-II serum level reflects an endothelial dysfunction in type 1 diabetes, alteration of carbohydrate and lipid metabolism could influence of this pathway.

Objective: Proteolytic enzymes possibly contribute to coronary artery ectasia (CAE). This study aimed to determine whether neutrophils, neutrophil serine proteases (NSPs), and their endogenous inhibitors participated in the pathological process of CAE., Methods: The study consisted of 30 patients with CAE, 30 patients with coronary artery disease (CAD), and 29 subjects with normal coronary arteries (Control). The following circulating items were measured: the main NSPs, including human neutrophil elastase (HNE), cathepsin G (CG), and proteinase 3 (PR3); soluble elastin (sElastin), which was a degradation product of elastin fibres; NSP inhibitors such as α1-protease inhibitor (α1-PI), α2-macroglobulin (α2-MG), secretory leucoprotease inhibitor (SLPI), and elafin; as well as two neutrophil activation markers (myeloperoxidase and lactoferrin) and three classic neutrophil activators [tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and bacterial endotoxin]., Results: The levels of HNE, CG, and sElastin were elevated in the CAE group. The levels of α1-PI and α2-MG were also significantly increased in the CAE group. The levels of myeloperoxidase and lactoferrin were higher in the CAE group. The levels of TNF-α, IL-8, and endotoxin were unchanged in the CAE group compared with those in the CAD group., Conclusion: Neutrophils may participate in the process of vessel extracellular matrix destruction and coronary ectasia by releasing NSPs in a non-classical manner.

We aimed to investigate the association between the neutrophil-lymphocyte ratio (NLR) and coronary artery ectasia (CAE). The study included 198 patients who had undergone coronary angiography for suspected coronary artery disease (CAD). The patients were divided into the following 4 groups: group 1, 44 patients with normal coronary arteries; group 2, 61 patients with CAD; group 3, 40 patients with isolated CAE; and group 4, 53 patients with CAE coexisting with CAD. Neutrophil-lymphocyte ratio was significantly lower in group 1 than the other groups and significantly higher in group 4. Patients in group 1 had significantly lower neutrophil counts and significantly higher lymphocyte counts than the patients in group 4. The isolated CAE and CAD groups were similar in terms of NLR, neutrophil count, and lymphocyte count. In addition, we found significant positive correlations between presence of ectasia, number of ectatic vessels, and NLR. Our findings provide additional evidence for the role of NLR in CAE., (© The Author(s) 2014.)

Objective: Irisin is a newly identified myokine that can promote energy expenditure and alleviate insulin-resistance in animal model. It has been established that insulin resistance is frequently associated with endothelial dysfunction. Therefore, we hypothesize that circulating irisin levels are associated with endothelial dysfunction in type 2 diabetes., Methods: One hundred and eighty eight patients with newly diagnosed type 2 diabetes and 40 healthy subjects were recruited. Serum irisin concentrations were measured by using enzyme-linked immunosorbent assay, and flow-mediated dilation (FMD) was evaluated by using high-resolution ultrasound., Results: The mean value of circulating irisin levels in newly diagnosed type 2 diabetes was 13.25 ng/ml, which was significantly lower than that in controls (25.98 ng/ml, p < 0.001). By dividing the distribution of FMD levels into quartiles, serum irisin levels were increased gradually with the increase of FMD levels (p < 0.001). Multivariate stepwise regression analysis demonstrated that serum irisin levels were independently associated with FMD (p = 0.009). By logistic regression analysis the odds ratio for lower FMD levels was reduced by 11.8% per 1 ng/ml increase in serum irisin concentration after adjustment for multivariate metabolic factors [OR (95% CI); 0.882 (0.709-0.969)]., Conclusion: These results demonstrated that circulating irisin levels were decreased in newly diagnosed Chinese type 2 diabetic patients without clinical angiopathy and positively associated with FMD levels., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Context: Biomarkers of lesion-specific drug induced liver toxicity are currently lacking., Objective: To develop a biomarker signature using routine clinical pathology parameters that predict hepatic sinusoidal dilation related to anti-DLL4 biotherapeutics., Methods: Random forest and factor analysis was used to construct a signature of routine laboratory tests to detect microscopically confirmed sinusoidal dilation of the liver., Results: A biomarker signature was developed comprising two scores (S1 and S2) with area under the curve (AUC) for sinusoidal dilation prediction of 0.81, 0.85 and 0.96 in three rat studies and 0.48 and 0.81 in two monkey studies., Conclusion: A unique, two-dimensional signature of liver parameters and red blood cell parameters could detect sinusoidal dilation in multiple preclinical species.

Background and Aims: The pathogenesis of coronary artery ectasia (CE) is poorly understood. An underlying inflammatory process is suspected; current therapy aims to prevent thrombotic events. Presently, there is no evidence to support an anti-inflammatory approach for CE patients. We undertook this study to determine the presence and levels of adhesion molecules as well as other inflammation-related markers and evaluate their invasive angiography findings to compare between patients with CE or atherosclerotic coronary artery disease (CAD)., Methods: We included 23 patients with CE alone and 23 patients with CAD alone reported by diagnostic angiography. The two groups were paired according to gender and age. Clinical variables, angiographic findings (STEMI, NSTEMI, previous coronary stenting and previous CABG), serum VCAM, ICAM, C-reactive protein (CRP), IL-6 and adiponectin were compared between groups., Results: In patients with CE, median for serum VCAM was 1700 ng/mL with a range from 900-4050 and for serum ICAM was 550 ng/mL (370-1530); in contrast to the obstructive lesions group where we found a median for VCAM of 1150 ng/mL (650-2000) and for ICAM of 370 ng/mL (150-480). Both measurements achieved statistical significance with a p value = 0.0001. There was no important variation between patients measured at different times from diagnosis., Conclusion: Plasma soluble adhesion molecules in CE are elevated in comparison to CAD. The presence of high levels of these molecules, along with not uncommon multivessel and extensive coronary affection suggest the participation of subclinical inflammation, which may have an important role in the development of CE., (Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.)

Background: Red cell distribution width (RDW) has been recognized as a novel marker for several cardiovascular diseases. The aim of this study was to evaluate the association between RDW levels and the presence of isolated coronary artery ectasia (CAE)., Methods: We studied 414 subjects including 113 patients with isolated CAE (Group A), 144 patients with coronary artery disease (CAD, group B) and 157 angiographically normal controls (group C). Baseline clinical characteristics and laboratory findings including RDW were compared among three groups., Results: The levels of RDW were significantly higher in group A and B compared with that in group C (12.97 ± 1.4 and 12.88 ± 1.0 vs 12.34 ± 0.9, p = 0.020) while no difference was found between CAE and CAD (p = 0.17). Additionally, the levels of CRP were also higher in patients with CAE and CAD compared with normal controls (0.26 ± 0.14 mg/L, 0.31 ± 0.27 mg/L vs 0.20 ± 0.06 mg/L, p = 0.04). The multivariate analysis indicated that RDW and CRP were the independent variables most strongly associated with the presence of isolated CAE and CAD. There was a positive correlation between levels of RDW and CRP in patients with isolated CAE (γ=0.532, p = 0.001)., Conclusions: Our data suggested that RDW may be a useful marker and independent predictor for the presence of isolated CAE.

Background: Red cell distribution width (RDW) has recently been considered as a strong predictor of a variety of acute and chronic cardiovascular diseases, while the association between RDW and coronary artery ectasia (CAE) has not been elucidated yet. The aim of the present study was to evaluate the association of RDW levels in the presence of the CAE., Methods: One hundred and sixty-four consecutive patients including 84 patients (69 male, mean age: 55 +/- 11 years) with isolated CAE and 60 angiographically normal controls (48 male, mean age: 52 +/- 13 years) were enrolled. Blood samples were drawn to measure RDW and C-reactive protein (CRP). Baseline clinical characteristics and laboratory findings were compared between the two groups., Results: The levels of RDW were significantly higher in patients with isolated CAE than that in normal controls (12.94 +/- 2.1 vs. 12.48 +/- 1.4, p = 0.021). In addition, the levels of CRP were also higher in patients with CAE compared with normal controls (0.28 +/- 0.14 mg/L vs. 0.21 +/- 0.11 mg/L, p = 0.047). The multivariate analysis indicated that RDW and CRP were the independent variables most strongly associated with the presence of isolated CAE. Finally, correlation analysis suggested that there was positive correlation between plasma levels of CRP and RDW levels in patients with CAE (n = 84, gamma = 0.358, p = 0.001)., Conclusions: The data demonstrated that RDW levels were significantly higher in patients with isolated CAE, suggesting that RDW may be a valuable marker for the patients with CAE.

Background: The true association between breast cancer and vitamin D is currently under investigation. We compared serum 25-hydroxy-vitamin D levels in women with benign and malignant breast masses and controls., Materials and Methods: Levels of vitamin D were measured by electrochemiluminescense. Serum levels >35 ng/ml, 25-35 ng/ml, 12.5-25 ng/ml and <12.5 ng/ml were considered as normal, mild, moderate and severe vitamin D deficiency, respectively., Results: Overall, 364 women were included in the control, 172 in the benign and 136 in the malignant groups. The median serum vitamin D level was significantly lower in breast cancers than controls. Levels were also lower in malignant than benign cases and in benign cases than controls although statistically non-significant., Conclusions: Multinomial logistic regression analysis showed that severe vitamin D deficiency causes a three-fold increase in the risk of breast cancer while this was not the case for moderate and mild deficiency.

Objective: The role of inflammation in coronary artery ectasia (CAE) remains controversial. We evaluated the hypothesis that CAE might be associated with a specific pattern of T helper (Th) lymphocyte activation by measuring the Th-1 cytokine, interleukin-2 (IL-2) and the Th-2 cytokines, interleukin-4 (IL-4) and interleukin-6 (IL-6) in patients with CAE, obstructive coronary artery disease (CAD) and controls., Methods: Serum levels of IL-2, IL-4 and IL-6 were measured in 74 patients undergoing an elective cardiac catheterization due to angina pectoris and positive or equivocal non-invasive screening for cardiac ischaemia: 34 had CAE and non-obstructive CAD (Group A), 22 had obstructive CAD (Group B) and 18 had normal coronaries (Group C)., Results: Group A had significantly higher IL-4 than Group B and Group C (p<0.001 and p=0.006, respectively). In contrast, Group A had markedly lower IL-2 than Group B and Group C (p<0.001 for both comparisons). Group C had higher IL-4 and lower IL-2 than Group B (p<0.001 for both comparisons). Interleukin-6 was significantly higher in Groups A and B compared to Group C (p<0.001 for both comparisons), whilst it was comparable between Group A and Group B. Multivariate logistic regression analysis showed that higher levels of IL-4 and lower levels of IL-2 were the strongest independent predictors associated with CAE (OR: 3.846, CI: 1.677-8.822, p=0.001 and OR: 0.567, CI: 0.387-0.831, p=0.004, respectively)., Conclusions: Our data demonstrates that Th-2 immune response, exhibited through increased IL-4 and low IL-2, constitutes a fundamental feature of CAE., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: In this study, we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma-glutamyltransferase (GGT) and uric acid and coronary artery ectasia (CAE) in a large patient population., Study Design: A total of 406 patients (245 male, 161 female; mean age: 55±9 years) were selected retrospectively as the study population from among 3265 individuals who underwent coronary angiography between August 2011 and December 2012. Information regarding blood tests of the patients obtained during hospitalization was extracted from the institute electronic database., Results: MPV, GGT and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with normal coronary arteries (NCA). There were no significant differences between the isolated CAE and NCA groups in terms of MPV (8.6±1.2 fL vs. 8.6±1.1, respectively, p=0.993), serum GGT (33±15 U/L vs. 30±15 U/L, respectively, p=0.723) and uric acid levels (5.4±1.6 mg/dl vs. 5.2±1.7 mg/dl, respectively, p=0.845)., Conclusion: Unlike previous studies, our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.

Objectives: It has been shown that the neutrophil to lymphocyte ratio (N/L ratio) is associated with cardiovascular events and mortality. In this study, we investigated the N/L ratio in patients with coronary artery ectasia (CAE)., Study Design: Fifty patients diagnosed with CAE using coronary angiography were included in the study (29 male, 21 female; mean age, 51.1±7.1 years). The control group consisted of 28 patients who had normal coronary arteries as determined by coronary angiography (16 male, 12 female; mean age, 49.5±9.4 years). Basal characteristics were recorded. The number of ectatic segments was noted. Hematologic parameters were measured and the N/L ratio was calculated., Results: The N/L ratio was significantly higher in the CAE group compared with control group (median [25-75% percentile] 2.2 [1.6-3.0] vs. 1.8 [1.4-2.0], p=0.014, respectively). The Spearman correlation analysis demonstrated that the N/L ratio positively correlated with number of ectatic segments (r=0.35; p<0.002). Multivariable logistic regression analysis showed an independent relationship between CAE and the N/L ratio (odds ratio 2.674, 95% confidence interval 1.184-6.039, p=0.018)., Conclusion: The N/L ratio is higher in patients with CAE. This ratio is related to presence and severity of CAE.

Objectives: Coronary artery ectasia (CAE) has been defined as a dilated artery luminal diameter that is at least 50% greater than the diameter of the normal portion of the artery. Isolated CAE is defined as CAE without significant coronary artery stenosis and isolated CAE has more pronounced inflammatory symptoms. Neutrophil to lymphocyte ratio (NLR) is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between NLR and the presence of isolated CAE., Study Design: In this study, 2345 patients who underwent coronary angiography for suspected or known ischemic heart disease were evaluated retrospectively. Following the application of exclusion criteria, our study population consisted of 81 CAE patients and 85 age- and gender-matched subjects who proved to have normal coronary angiograms. Baseline neutrophil, lymphocyte and other hematologic indices were measured routinely prior to the coronary angiography., Results: Patients with angiographic isolated CAE had significantly elevated NLR when compared to the patients with normal coronary artery pathology (3.39 ± 1.36 vs. 2.25 ± 0.58, p<0.001). A NLR level >= 2.37 measured on admission had a 77% sensitivity and 63% specificity in predicting isolated CAE at ROC curve analysis. In the multivariate analysis, hypercholesterolemia (OR=2.63, 95% CI 1.22-5.65, p=0.01), obesity (OR=3.76, 95% CI 1.43-9.87, p=0.007) and increased NLR (OR=6.03, 95% CI 2.61-13.94, p<0.001) were independent predictors for the presence of isolated CAE., Conclusion: Neutrophil to lymphocyte ratio is a readily available clinical laboratory value that is associated with the presence of isolated CAE.

Red cell distribution width (RDW) is an index that has been shown to be an independent correlate of adverse outcomes in some cardiac conditions. Isolated coronary artery ectasia (CAE) is an abnormality of the coronary anatomy and can cause ischemia. We hypothesized that increased RDW would be associated with isolated CAE because both are associated with inflammation. In this study, 2345 patients who received coronary angiography were retrospectively evaluated. After exclusion, 75 patients with isolated CAE and 96 consecutive patients with normal coronary were included in the study. The severity of isolated CAE was determined according to the Markis classification. Baseline RDW was measured as part of the automated complete blood count. Red cell distribution width was observed to be an independent predictor of both presence and severity of isolated CAE. In conclusion, RDW is associated with both the presence and severity of isolated CAE.

Objective: Intraventricular haemorrhage (IVH) is a major problem in premature infants. Our objective is to assess the early predictive value of vascular endothelial growth factor (VEGF) for development of IVH and management of its squeal in preterm neonates., Methods: We prospectively studied 150 preterm neonates (PT) less than 34 weeks gestation. Fifty of them completed the study. 30/50 developed IVH during follow up, and 20 did not. First 24 hours, and 3(rd) day serum samples were collected. Cerebrospinal fluid (CSF) samples were withdrawn for 10 IVH patients., Results: Serum VEGF; both samples were increased in IVH compared to non-IVH group (P=0.001). PHVD-group (n=10) had higher VEGF in both samples than resolved IVH (P=0.004), (P=0.005). While, VEGF increased in the IVH group 2(nd) sample compared to 1(st) (P=0.000), it decreased in non-IVH group, P=0.033). Each 1 unit increase in 1(ST) VEGF increased the risk of occurrence of IVH by 1.6%. 3(rd) day VEGF at a cut-off value of 135 pg/ml is 96% sensitive and 100% specific to predict PHVD. Serum VEGF inversely correlated with TLC, pH, PO(2) and HCO(3), and positively correlated with PCo(2) and FiO(2)., Conclusion: Serum VEGF predicts development of IVH and PHVD in PT neonates. Also, high CSF level of VEGF could predict the need for permanent shunt placement.

There are currently no acceptable treatments to limit progression of abdominal aortic aneurysm (AAA). Increased serum concentrations of high-density lipoprotein (HDL) are associated with reduced risk of developing an AAA. The present study aimed to assess the effects of fenofibrate on aortic dilatation in a mouse model of AAA. Male low-density lipoprotein receptor-deficient (Ldlr(-/-)) mice were maintained on a high-fat diet for 3 weeks followed by 6 weeks of oral administration of vehicle or fenofibrate. From 14 to 18 weeks of age, all mice were infused with angiotensin II (AngII). At 18 weeks of age, blood and aortas were collected for assessment of serum lipoproteins, aortic pathology, aortic Akt1 and endothelial nitric oxide synthase (eNOS) activities, immune cell infiltration, eNOS and inducible NOS (iNOS) expression, sphingosine 1 phosphate (S1P) receptor status, and apoptosis. Mice receiving fenofibrate had reduced suprarenal aortic diameter, reduced aortic arch Sudan IV staining, higher serum HDL levels, increased serum S1P concentrations, and increased aortic Akt1 and eNOS activities compared with control mice. Macrophages, T lymphocytes, and apoptotic cells were less evident and eNOS, iNOS, and S1P receptors 1 and 3 were up-regulated in aortas from mice receiving fenofibrate. The present findings suggest that fenofibrate antagonizes AngII-induced AAA and atherosclerosis by up-regulating serum HDL and S1P levels, with associated activation of NO-producing enzymes and reduction of aortic inflammation., (Copyright © 2012 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

Objective: Coronary artery ectasia (CAE) is a congenital or acquired anomaly characterized with localized or diffuse dilatations of coronary arteries. Paraoxonase (PON-1) is a high-density lipoprotein-cholesterol (HDLC) associated antioxidant enzyme that prevents atherosclerosis. The aim of this study was to investigate serum paraoxonase-1 enzyme activity (SPA) in patients with CAE in comparison patients with coronary artery disease (CAD) and normal coronary arteries., Methods: We have evaluated 44 patients with isolated IKAE, 40 cases with normal coronary arteries (NCA), 40 cases with critical CAD (CAD) and 40 cases with minimal CAD (MCAD) in this cross-sectional observational study. Demographic and biochemical data of patients were collected. SPA was determined spectrophotometrically. Among-group comparisons, ANOVA, Kruskal-Wallis and Chi-square tests were used; Bonferroni test was used for post-hoc analysis, Pearson's correlation analysis to determine the parameters associated with the SPA., Results: There were no differences among groups with regard to age, sex, presence of diabetes, hypertension and smoking (p>0.05 for all). The highest HDLC was detected in patients with NCA and lowest HDLC was detected in patients with CAD (respectively 52±15 mg/dL; 41±16 mg/d L, p=0.021). CAD and CAE groups were similar with respect to HDLC levels (p>0.05). The highest SPA level was detected in patients with NKA and the lowest SPA level was detected in patients with CAD (respectively 250.78±59.37U/L; 163.39±49.28 U/L, p=0.005). CAD and CAE groups were similar with respect to SPA levels (p>0.05)., Conclusion: Both decreased SPA and decreased HDLC levels are closely related to the development of the CAE similar to CAD.

Background: Sonographic assessment of jugular venous distension (US-JVD) has been described as a sensitive test for pulmonary oedema on chest x-ray in patients with dyspnoea, but chest x-ray may not detect all patients with raised B-type natriuretic peptide (BNP) levels., Objective: To compare US-JVD and initial BNP levels in patients with dyspnoea., Methods: This was a secondary analysis of a previously collected dataset from a prospective study of US-JVD in patients with dyspnoea due to suspected congestive cardiac failure. Initial BNP levels were obtained for each patient. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios (LR) of US-JVD ≥8 cm H(2)O for BNP ≥500 pg/ml were calculated. The product moment correlation coefficient between US-JVD and BNP was also calculated., Results: 119 patients were included in the initial study. US-JVD ≥8 cm H(2)O had a sensitivity of 100% (95% CI 92% to 100%), specificity of 43% (95% CI 31% to 56%), PPV of 61% (95% CI 50% to 71%), NPV of 100% (95% CI 84% to 100%), LR+=1.75 (95% CI 1.41 to 2.17), and LR-=0 for a BNP ≥ 500 pg/ml. The Pearson correlation coefficient between US-JVD and BNP was 0.35 (95% CI 0.18 to 0.50) and the Spearman correlation coefficient was 0.73 (95% CI 0.63 to 0.80), suggesting a monotonic, but non-linear relationship between US-JVD and BNP., Conclusion: US-JVD correlates with initial BNP levels and is a sensitive test for raised BNP levels in patients with dyspnoea due to suspected congestive cardiac failure.

Some evidence suggests that chronic inflammation plays a critical role in the development and progression of coronary artery ectasia. Lectin-like oxidized low-density lipoprotein receptor-1 is involved in multiple phases of vascular dysfunction, including endothelial dysfunction, atherogenesis, initiation of plaque rupture, and restenosis. The objectives was to study the purpose of the current study was to determine whether soluble lectin-like oxidized low-density lipoprotein receptor-1 is associated with isolated coronary artery ectasia patients. Forty-six patients with isolated coronary artery ectasia without stenosis and 46 control subjects with angiographically normal coronary arteries were included in this study. Lectin-like oxidized low-density lipoprotein receptor-1 levels were measured in serum by sandwich enzyme-linked immunosorbent assay. Baseline characteristics of the two groups were similar. Plasma levels of lectin-like oxidized low-density lipoprotein receptor-1 were significantly higher in the coronary artery ectasia group than normal coronary artery group (1.7 ± 0.8 ng/ml vs. 1.1 ± 0.3 ng/ml, P < 0.001, respectively). No correlation was found between plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels and different types of ectasia in patients with coronary artery ectasia. In this study, we found significantly higher levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 in coronary artery ectasia patients when compared to control subjects with normal coronary arteries, suggesting that soluble lectin-like oxidized low-density lipoprotein receptor-1 may be involved in the pathogenesis of coronary artery ectasia.

Objectives: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. Red cell distribution width (RDW) is a measure of heterogeneity in the size of red blood cell. In this study, we aimed to investigate RDW levels in patients with CAE., Methods: The study population included 54 patients with CAE (28 males; mean age, 59 ± 12) and 40 individuals comprising the control group who had normal coronary arteries (17 males; mean age, 56 ± 10). Admission RDW was measured as part of the automated complete blood count., Results: The RDW was significantly higher in the CAE group than the control (P < .001). Also, high-sensitive C-reactive protein (hs-CRP) levels in patients with CAE were significantly higher as compared with controls (P < .001)., Conclusion: This study demonstrates that RDW and hs-CRP were higher in the CAE group compared with the control group. These results show that RDW is a reliable, simple, and inexpensive marker for patients with CAE.

Isolated coronary artery ectasia (ICAE) is defined as the ectasia of the coronary arteries without concomitant coronary artery stenosis. The etiology and the clinical course of ICAE are still not clear. Increased levels of plasminogen activator inhibitor-1 (PAI-1) inhibit vasa vasorum, leading to diminished vessel wall supply and thus contributes to aortic aneurysm expansion. Whether the same process has role in coronary artery ectasia is not known. The aim of this study is to investigate the association between PAI-1 and coronary artery ectasia in patients without concomitant obstructive coronary artery disease. Among 2830 patients who underwent coronary angiography between March 2010 and 2011, 55 patients (40 male, 15 female, mean age 60 ± 8 years) with ICAE, formed our study group. 27 patients with similar patient characteristics, with angiographically proven normal coronary arteries, were enrolled as the control group. The basal characteristics were similar between two groups. PAI-1 levels were statistically higher in the ICAE group compared to the control group (104.13 ± 56.65 and 63.39 ± 35.01 ng/dl, respectively) (P = 0.008). A significant positive correlation between CAE and PAI-1 (r = 0.358, P = 0.007) was also demonstrated. Serum high sensitive C reactive protein (hsCRP) levels did not differ between two groups (P > 0.05). The plasma PAI-1 levels were significantly higher in ICAE patients compared to normal coronary artery group. Increased PAI-1 levels may diminish vasa vasorum by antiangiogenic activity leading to coronary ectasia.

Background: Epicardial adipose tissue (EAT), localized beneath the visceral pericardium, is a metabolically active endocrine and paracrine organ with possible interactions within the heart. Coronary artery ectasia (CAE) is a clinical entity characterized with localized or diffuse dilatation, of the coronary arteries, with a diameter of greater than 1.5 times that of adjacent segments. Although the etiopathogenesis is not clearly understood, some studies have revealed that CAE may be a form of atherosclerosis that has greater inflammatory properties than atherosclerosis. The goal of this study was to investigate whether EAT and the level of C-reactive protein (CRP) are increased in patients with isolated CAE compared to normal subjects., Methods: Thirty-three patients with isolated CAE (mean age: 57±9 years) and 32 age- and gender-matched control participants with NCA, but without CAE (mean age: 56±10 years), were included in the study. The relationship between EAT thickness, CRP levels and the presence of CAE was investigated., Results: Epicardial adipose tissue thickness was significantly higher in CAE group compared to NCA group (7.2±3.2 vs. 4.7±2.1 mm, p<0.001). Body mass index (BMI, p=0.013), CRP (p=0.047), and the percentage of isolated CAE (p=0.012) were significantly higher in patients with an increased EAT thickness. While CRP correlated with increased EAT, it was not related to CAE. However, CRP levels were higher in patients with diffuse coronary ectatic involvement than the focal lesions (0.58±0.32 vs. 0.31±0.11 mg/dL, p=0.046). When we performed multiple logistic regression analysis, only increased EAT thickness was related to CAE independent of CRP and BMI (OR: 1.442, 95%CI: 1.066-1.951, p=0.018)., Conclusion: This is the first study, displaying a significantly higher EAT-thickness in patients with isolated CAE. We believe that further studies are needed to clarify the role of adipose tissue in patients with isolated CAE.

The sialic acid/glycosaminoglycan ratio was determined in 35 coronary artery ectasia patients and 35 control subjects to determine the possible role of fluoride in the etiology of the disease. The coronary artery ectasia patients and controls were selected from subjects who underwent coronary angiography. The mean serum sialic acid level was significantly lower in patients with coronary artery ectasia (CAE) than in controls (340.3±28.6 vs. 427.0±15.9 μg/mL, respectively; p<0.001). The mean serum glycosaminoglycan level was significantly higher in patients with CAE than in controls (5,013.1±158.6 vs. 3,833.6±237.1 μg/mL, respectively; p<0.001). The sialic acid/glycosaminoglycan ratio in patients with coronary artery ectasia was significantly lower than in controls (0.068±0.007 vs. 0.111±0.005; p<0.001). There was more than 38.7% reduction in this ratio in patients with CAE when compared with controls. We demonstrated that chronic fluoride exposure has an important role in pathogenesis of coronary artery ectasia.

Background: Coronary artery ectasia (CAE) is a rare coronary artery anomaly. In this study, we investigated superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and γ-glutamyltransferase (GGT) activities, and antioxidant vitamin levels (vitamins A and E) in patients with CAE., Methods: Forty-five patients who were diagnosed with CAE using coronary angiography were included in the study (26 men; mean age, 57 ± 9 years). The control group consisted of 35 participants who had normal coronary arteries as shown by coronary angiography (14 men; mean age, 54 ± 7 years). The plasma activity of SOD, GSH-Px, GGT, and levels of vitamins A and E were measured., Results: The plasma SOD activity was significantly lower in the CAE group compared with the control group (0.70 ± 0.64 vs. 1.52 ± 0.85 U/ml; P=0.001). The serum GGT activity was higher in the CAE group compared with the control group (34 ± 20 vs. 26 ± 13 U/ml; P=0.04). There were no significant differences in the plasma GSH-Px activity and vitamin A and E levels. There was a positive correlation between SOD activity and low-density lipoprotein cholesterol levels (r=0.418; P=0.01). There was also a positive correlation between vitamin E and low-density lipoprotein cholesterol (r=0.410; P=0.01) and triglyceride levels (r=0.310; P=0.04) in patients with CAE., Conclusion: In this study, patients with CAE had a decreased SOD plasma activity and an increased GGT activity compared with normal controls. These results suggest that oxidative stress and antioxidant status may have an important role in the pathogenesis of CAE.

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is among the multiple cardiovascular biomarkers that have been associated with increased cardiovascular disease. Lp-PLA2 appears, however, to be relatively unique in its high specificity for vascular inflammation as opposed to systemic inflammation, its low biologic variability, and its direct role in the causal pathway of plaque inflammation. Nevertheless, the relation between LP-PLA2 and isolated coronary artery ectasia (CAE) has not been investigated yet. The aim of our study was to assess this relation., Methods: Twenty-five patients with isolated CAE without stenosis and 25 control subjects with angiographically normal coronary arteries were included in this study. Lp-PLA2 mass was determined in serum by a dual monoclonal antibody immunoassay., Results: Patients with isolated CAE had significantly higher level of Lp-PLA2 compared to the control subjects with angiographically normal coronary arteries (284 ± 102 ng/ml in ectasia and 199 ± 62 ng/ml in control group, respectively, p 0.001). Also we detected a significant positive correlation between the presence of CAE and Lp-PLA2 (r = 0.452, p 0.001)., Conclusion: We have demonstrated for the first time increased Lp-PLA2 level in patients with isolated CAE, suggesting that Lp-PLA2 may be involved in the pathogenesis of CAE.

Background: Coronary artery ectasia (CAE) is defined as localized or diffuse dilation of the coronary arteries. There are scarce data about the role of dendritic cells in CAE development. In this study we investigated the activation markers on the surface of monocyte-derived dendritic cells (mDCs) in coronary artery disease (CAD) patients with or without CAE., Method: The study consisted of 6 patients who had obstructive CAD with CAE, 6 CAD patients without CAE and 6 subjects with angiographically normal coronary arteries. mDCs were cultivated from peripheral blood monocytes. Surface activation markers were detected by flow cytometry., Results: CAD patients with CAE were detected to have significantly higher mean fluorescence intensities of CD11b, CD11c, CD54 , CD83, CD86 and MHC Class II molecules on mDCs in comparison to CAD patients without CAE and normal controls (P < .001 for all). A significant positive correlation was found between the number of vessels with CAE and the levels of CD11c, CD86, and MHC Class II molecules., Conclusion: mDCs display an increased cell surface concentration of activation molecules in CAD patients with CAE compared to patients with CAD alone. DC activation may play an important role for CAE development in patients with CAD.

Objectives: It has been shown that serum uric acid (SUA) constitutes an important independent risk factor for cardiovascular disease. We investigated SUA levels in patients with coronary artery ectasia (CAE)., Study Design: Serum uric acid levels were measured in three groups of patients who underwent coronary angiography. One group consisted of 97 consecutive patients (69 males, 28 females; mean age 58.1+/-9.5 years) with isolated CAE, another group included 104 patients (79 males, 25 females; mean age 58.4+/-8.8 years) with coronary artery disease (CAD), and finally 90 subjects (66 males, 24 females; mean age 57.6+/-10.1 years) with normal coronary arteries comprised the control group. Coronary artery ectasia was defined as a luminal dilatation of at least 1.5 times of the adjacent normal coronary segments, without any stenotic lesions. In addition, patients with CAE were assessed in four groups of severity and extension., Results: The three groups were similar with respect to age, sex, body mass index, and the frequencies of hypertension, diabetes mellitus, and smoking (p>0.05). The mean SUA level did not differ significantly between the CAE and CAD groups (6.6+/-1.9 mg/dl and 6.3+/-1.9 mg/dl, respectively; p=0.184); however, compared with the control group (5.4+/-1.8 mg/dl), SUA levels were significantly higher in both groups (p<0.001). A significant correlation was found between the SUA level and the presence of isolated CAE (r=0.625; p<0.001). Multivariate logistic regression analysis showed an independent relationship between isolated CAE and SUA (OR 1.896; 95% CI 1.1048-1.5014; p<0.001). Serum uric acid levels did not differ significantly among the four subgroups of CAE severity., Conclusion: Our study is the first to demonstrate significantly increased SUA levels in patients with isolated CAE. Our results support relevant data suggesting an association between endothelial function and the SUA level.

Coronary artery ectasia (CAE) is a variant of coronary atherosclerosis. Mean platelet volume (MPV), an indicator of platelet activation, has been shown to be elevated in patients with acute coronary syndromes and myocardial infarction in the setting of obstructive coronary artery disease. The aim of this study was to assess the MPV in patients with CAE. We retrospectively studied 366 consecutive patients with CAE (195 men/171 women; mean age 55.4 +/- 10.9 years) and 160 control patients (81 men/79 women; mean age 53.5 +/- 10.2 years). MPV values were recorded in all study and control patients. The MPV values of patients with CAE were found to be significantly higher than those of the controls (9.2 +/- 1.1 versus 8.8 +/- 1.2 fl, respectively; P < 0.001). The platelet count was detected to be significantly lower in patients with CAE group than in patients with control group (233.7 +/- 70.7 versus 264.7 +/- 102.8 (x10(9)/l), respectively; P < 0.0001). We have shown that MPV was significantly elevated in patients with CAE compared with controls.

Background: Coronary artery ectasia (CAE) is well-recognized, angiographic finding of abnormal coronary dilatation. The role of inflammation in atherosclerosis is increasingly well known. However, the association between inflammation and CAE has been controversial., Method: Fifty-five patients with CAE and non-obstructive coronary artery disease (CAD), 38 with obstructive CAD, and 33 angiographically normal coronary controls were enrolled in the study. The peripheral blood was taken, and white blood cell count (WBCC) as well as other leukocyte subtypes including neutrophils, lymphocytes, and monocyte cell count (MCC) were measured. The plasma levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined by ELISA., Results: The higher number of WBCC, neutrophil and MCC were found in patients with CAE compared with obstructive CAD patients as well as normal controls (p<0.01, respectively). Moreover, levels of plasma CRP and IL-6 were also significantly higher in patients with CAE than that in patients with obstructive CAD, and subjects without coronary artery disease (p<0.001, respectively). Univariate analysis showed that the sex, current smoking, numbers of WBCC, neutrophil, MCC, levels of CRP and IL-6 were related with CAE, while MCC was independently linked with a diagnosis of CAE. CRP was the independent variable most strongly associated with CAE by multivariate analysis., Conclusions: Taken together, this study confirmed and expanded previous limited findings that a more significant chronic inflammation might be linked with the pathogenesis of CAE that was associated with not only inflammatory markers but also inflammatory cells in patients with CAE.