Clinical features, diagnosis, treatment, and prognosis of coronary artery ectasia: a systematic review

doi:10.3877/cma.j.issn.1674-0785.2017.12.007

Abstract

Abstract:

Coronary artery ectasia (CAE) is defined as the inappropriate dilatation of a coronary artery, with the luminal diameter 1.5 or more times wider than that of adjacent normal segments. The main clinical manifestations of CAE are angina and myocardial infarction, and its pathological manifestations are characterized by an extensive destruction of musculoelastic elements, particularly elastin fibers, which are the predominant components of the extracellular matrix of the coronary wall. There is obviously slow coronary blood flow and microcirculation dysfunction in dilated coronary artery. Coronary angiography is the gold standard for CAE diagnosis, and treatments for coronary artery disease (CAD) are recommended for most CAE patients in an individualized manner, but nitrates should be avoided. The prognosis of CAE patients is similar to that of CAD patients with lesions of the three main coronary arteries.

Key words: Coronary artery ectasia, Angina, Slow blood flow, Protease hydrolysis

Ruifeng Liu, Siwen Liang, Xiangyu Gao, Beibing Di, Yue Zhang, Bing Hua, Huiqiang Zhao. Clinical features, diagnosis, treatment, and prognosis of coronary artery ectasia: a systematic review[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(12): 1946-1950.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2017.12.007

https://zhlcyszz.cma-cmc.com.cn/EN/Y2017/V11/I12/1946

Figures/Tables 1

References 43

[1]	Swaye PS, Fisher LD, Litwin P, et al. Aneurysmal coronary artery disease [J]. Circulation, 1983, 67(1): 134-138.
[2]	Eitan A, Roguin A. Coronary artery ectasia: New insights into pathophysiology, diagnosis, and treatment [J]. Coron Artery Dis, 2016, 27(5): 420-428.
[3]	Liu R, Chen L, Wu W, et al. Neutrophil serine proteases and their endogenous inhibitors in coronary artery ectasia patients [J]. Anatol J Cardiol, 2016, 16(1): 23-28.
[4]	Pasha AK, Jokerst CE, Janardhanan R. Myocardial infarction related to a coronary artery aneurysm [J]. Am J Med, 2015, 128(2): e5-e6.
[5]	Erden I, Erden EC, Ozhan H, et al. Outcome of primary percutaneous intervention in patients with infarct-related coronary artery ectasia [J]. Angiology, 2010, 61(6): 574-579.
[6]	Gulec S, Atmaca Y, Kilickap M, et al. Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia [J]. Am J Cardiol, 2003, 91(8): 996-999.
[7]	Akyürek Ö, Berkalp B, Sayın T, et al. Altered coronary flow properties in diffuse coronary artery ectasia [J]. Am Heart J, 2003, 145(1): 66-72.
[8]	Ozturk S, Ozyasar M, Ayhan SS, et al. Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: An observational study [J]. Anadolu Kardiyol Derg, 2012, 12(8): 637-643.
[9]	Karakaya O, Saglam M, Barutcu I, et al. Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity [J]. J Electrocardiol, 2007, 40(2): 203-206.
[10]	Morimoto N, Nishioka N, Yoshida M, et al. Rapid expansion of mycotic aneurysm of left coronary sinus of valsalva causing myocardial ischemia: report of a case [J]. Gen Thorac Cardiovasc Surg, 2016, 64(3): 160-162.
[11]	Akyurek O, Berkalp B, Sayin T, et al. Altered coronary flow properties in diffuse coronary artery ectasia [J]. Am Heart J, 2003, 145(1): 66-72.
[12]	Huang QJ, Liu J, Chen MH, et al. Relation of diabetes to coronary artery ectasia: A meta-analysis study [J]. Anadolu Kardiyol Derg, 2014, 14(4): 322-327.
[13]	Markis JE, Joffe CD, Cohn PF, et al. Clinical significance of coronary arterial ectasia [J]. Am J Cardiol, 1976, 37(2): 217-222.
[14]	Giannoglou GD, Antoniadis AP, Chatzizisis YS, et al. Prevalence of ectasia in human coronary arteries in patients in northern greece referred for coronary angiography [J]. Am J Cardiol, 2006, 98(3): 314-318.
[15]	Yilmaz H, Sayar N, Yilmaz M, et al. coronary artery ectasia: Clinical and angiographical evaluation [J]. Turk Kardiyol Dern Ars, 2008, 36(8): 530-535.
[16]	Papadakis MC, Leontiadis E, Manginas A, et al. Frequency of coronary artery ectasia in patients undergoing surgery for ascending aortic aneurysms [J]. Am J Cardiol, 2004, 94(11): 1433-1435.
[17]	Androulakis AE, Katsaros AA, Kartalis AN, et al. Varicose veins are common in patients with coronary artery ectasia. Just a coincidence or a systemic deficit of the vascular wall? [J]. Eur J Vasc Endovasc Surg, 2004, 27(5): 519-524.
[18]	Ozcan OU, Gulec S. Coronary artery ectasia [J]. Cor et Vasa, 2013, 55(3): e242-e247.
[19]	Newburger JW, Burns JC. Kawasaki disease [J]. Vasc Med, 1999, 4(3): 187-202.
[20]	Demirkol S, Balta S, Kucuk U, et al. Current opinions about coronary artery ectasia [J]. Angiology, 2013, 64(8): 634-635.
[21]	Lamblin N, Bauters C, Hermant X, et al. Polymorphisms in the promoter regions of mmp-2, mmp-3, mmp-9 and mmp-12 genes as determinants of aneurysmal coronary artery disease [J]. J Am Coll Cardiol, 2002, 40(1): 43-48.
[22]	Finkelstein A, Michowitz Y, Abashidze A, et al. Temporal association between circulating proteolytic, inflammatory and neurohormonal markers in patients with coronary ectasia [J]. Atherosclerosis, 2005, 179(2): 353-359.
[23]	Lee NY, Park HY, Park CK, et al. Analysis of systemic endothelin-1, matrix metalloproteinase-9, macrophage chemoattractant protein-1, and high-sensitivity c-reactive protein in normal-tension glaucoma [J]. Curr Eye Res, 2012, 37(12): 1121-1126.
[24]	Akyel A, Sahinarslan A, Kiziltunc E, et al. Neutrophil gelatinase-associated lipocalin levels in isolated coronary artery ectasia [J]. Can J Cardiol, 2011, 27(6): 773-778.
[25]	Bakuy V, Gursoy M, Hokenek F, et al. Prolidase activity in patients with coronary artery aneurysm [J]. Angiology, 2014, 65(7): 574-579.
[26]	Sarli B, Baktir AO, Saglam H, et al. Neutrophil-to-lymphocyte ratio is associated with severity of coronary artery ectasia [J]. Angiology, 2014, 65(2): 147-151.
[27]	Balta S, Demir M, Ozturk C, et al. The relation between inflammation and coronary artery ectasia [J]. Rev Port Cardiol, 2016, 35(10): 553-554.
[28]	Sezen Y, Bas M, Polat M, et al. The relationship between oxidative stress and coronary artery ectasia [J]. Cardiol J, 2010, 17(5): 488-494.
[29]	Rha SW, Suh SY, Kim JW, et al. Tu-p7: 145 coronary artery ectasia and coronary endothelial dysfunction [J]. Atheroscler Suppl, 2006, 7(3): 217.
[30]	Koc F, Ardic I, Erdem S, et al. Relationship between l-arginine/ asymmetric dimethylarginine, homocysteine, folic acid, vitamin b levels, and coronary artery ectasia [J]. Coron Artery Dis, 2010, 21(8): 445-449.
[31]	Uyarel H, Okmen E, Tartan Z, et al. The role of angiotensin converting enzyme genotype in coronary artery ectasia [J]. Int Heart J, 2005, 46(1): 89-96.
[32]	İçli A, Altınbaş A, Türker Y, et al. Op-067 the relationship between endothelial nitric oxide synthase gene polymorphism (t-786c) and isole coronary artery ectasia [J]. Int J Cardiol, 2013, 163(3, Supplement 1): S27.
[33]	Lin YJ, Chang JS, Liu X, et al. Sorting nexin 24 genetic variation associates with coronary artery aneurysm severity in kawasaki disease patients [J]. Cell Biosci, 2013, 3(1): 44.
[34]	Dede O, Varol E, Altinbas A, et al. Chronic fluoride exposure has a role in etiology of coronary artery ectasia: Sialic acid/glycosaminoglycan ratio [J]. Biol Trace Elem Res, 2011, 143(2): 695-701.
[35]	Johanning JM, Franklin DP, Han DC, et al. Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion [J]. J Vasc Surg, 2001, 33(3): 579-586.
[36]	Demir M, Demir C, Keceoglu S. The relationship between vitamin d deficiency and coronary artery ectasia [J]. Postepy Kardiol Interwencyjnej, 2014, 10(4): 238-241.
[37]	Jin C, Phillips VL, Williams MJ, et al. Plasma heat shock protein 27 is associated with coronary artery disease, abdominal aortic aneurysm and peripheral artery disease [J]. Springer Plus, 2014, 3: 635.
[38]	Baman TS, Cole JH, Devireddy CM, et al. Risk factors and outcomes in patients with coronary artery aneurysms [J]. Am J Cardiol, 2004, 93(12): 1549-1551.
[39]	Wilson WR, Evans J, Bell PR, et al. Hmg-coa reductase inhibitors(statins) decrease mmp-3 and mmp-9 concentrations in abdominal aortic aneurysms [J]. Eur J Vasc Endovasc Surg, 2005, 30(3): 259-262.
[40]	Fede A, Reimers B, Sacca S. Stent-assisted coil embolization for the treatment of aneurysm involving a coronary bifurcation [J]. Catheter Cardiovasc Interv, 2016, 87(7): 1269-1272.
[41]	La Manna A, Geraci S, Tamburino C. A self-expandable coronary stent system to treat complex coronary stenosis complicated by poststenotic aneurysm: An optical coherence tomographic evidence-based case report [J]. J Invasive Cardiol, 2011, 23(12): E277-280.
[42]	Soto ME, Reyes-Villatoro MA, Marquez R, et al. Evaluation and analysis of plasma soluble adhesion molecules in patients with coronary ectasia and atherosclerotic coronary artery disease [J]. Arch Med Res, 2014, 45(6): 478-483.
[43]	Shakerian F, Sanati H, Kiani R, et al. Comparison of outcomes of diseased coronary arteries ectasia, stenosis and combined [J]. Res Cardiovasc Med, 2015, 4(1): e25206.

分类依据	类型	具体标准
按扩张冠状动脉的管腔直径	轻度CAE	扩张处的管腔直径：<5 mm
	中度CAE	扩张处的管腔直径：5~8 mm
	重度CAE	扩张处的管腔直径：>8 mm
按照受累血管分布情况	Markis Ⅰ型	两支或三支主要血管的弥漫性扩张
	Markis Ⅱ型	一支主要血管的弥漫扩张+其他血管的局部扩张
	Markis Ⅲ型	一支主要的血管弥漫扩张
	Markis Ⅳ型	局部或者节段性扩张

分类依据	类型	具体标准
按扩张冠状动脉的管腔直径	轻度CAE	扩张处的管腔直径：<5 mm
	中度CAE	扩张处的管腔直径：5~8 mm
	重度CAE	扩张处的管腔直径：>8 mm
按照受累血管分布情况	Markis Ⅰ型	两支或三支主要血管的弥漫性扩张
	Markis Ⅱ型	一支主要血管的弥漫扩张+其他血管的局部扩张
	Markis Ⅲ型	一支主要的血管弥漫扩张
	Markis Ⅳ型	局部或者节段性扩张

Please choose a citation manager

Content to export