Letter to the Editor
The relation between inflammation and coronary artery ectasia
A relação entre a inflamação e a ectasia arterial coronária
Sevket Balta
, Mustafa Demir, Cengiz Ozturk, Turgay Celik
Corresponding author
Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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Ozturk, Turgay Celik" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Sevket" "apellidos" => "Balta" "email" => array:2 [ 0 => "drsevketb@gmail.com" 1 => "sevketb@gata.edu.tr" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mustafa" "apellidos" => "Demir" ] 2 => array:2 [ "nombre" => "Cengiz" "apellidos" => "Ozturk" ] 3 => array:2 [ "nombre" => "Turgay" "apellidos" => "Celik" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A relação entre a inflamação e a ectasia arterial coronária" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the article “Gamma glutamyltransferase, inflammation and cardiovascular risk factors in isolated coronary artery ectasia” by Dogan et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> They aimed to investigate major cardiovascular risk factors, serum gamma-glutamyltransferase (GGT) and high-sensitivity C-reactive protein (hs-CRP) levels in a large population of patients with coronary artery ectasia (CAE). They concluded that CAE can be independently and positively associated with obesity, GGT and hs-CRP levels, but inversely with diabetes. Moreover, its severity may be related to GGT and hs-CRP levels.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Coronary artery ectasia is defined as a localized or diffuse non-obstructive lesion of the epicardial coronary arteries with a luminal dilation exceeding 1.5 times the normal adjacent segment or vessel diameter. Although the etiology of CAE is not well understood, atherosclerosis may be considered a major part of the process.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Inflammation is an important step in the atherosclerotic process.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> We have reported elevated inflammatory markers in CAE compare with controls.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4–6</span></a> In the present study,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> the authors showed a relation between CAE and inflammation. In this respect, we argue that some aspects should be considered when assessing the relation between CAE and inflammation. Firstly, classification of CAE is an important factor in study design. In the CAE classification proposed by Markis et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> in decreasing order of severity, diffuse ectasia of two or more vessels was classified as type I, diffuse disease in one vessel and localized disease in another vessel as type II, diffuse ectasia of one vessel only as type III and localized or segmental ectasia only as type IV. Inflammatory markers may be different depending on the severity of CAE according to Markis’ classification. Secondly, certain conditions including metabolic syndrome,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> thyroid dysfunction, and known malignancy<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> may alter inflammatory conditions in these patients. Besides, we have reported elevated inflammatory markers in inflammatory diseases like Behçet's disease.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a> We have also shown that some medications decrease inflammatory markers.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore, in their article the authors showed an association between serum GGT and CAE, but some important issues should be addressed. Serum GGT activity is a marker of oxidative stress and endothelial dysfunction. We previously showed that serum GGT levels may be an independent marker of the severity of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> GGT may change as a result of hepatic dysfunction even if there is no overt liver disease. Secondly, Gilbert syndrome is a common condition worldwide that can affect liver function tests. GGT is also a widely measured serum enzyme and is commonly elevated in cases of biliary epithelial damage and excessive alcohol intake.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, although the authors concluded that CAE can be independently and positively associated with inflammation in their study, we strongly believe that inflammatory conditions in CAE patients should be thoroughly assessed in future studies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma glutamyltransferase, inflammation and cardiovascular risk factors in isolated coronary artery ectasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Dogan" 1 => "A. Arslan" 2 => "H. Yucel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2015.05.009" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "33" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26711537" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary artery ectasia as a histopathological pattern of atherosclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Balta" 1 => "S. Demirkol" 2 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 5 | 14 |
| 2024 October | 30 | 25 | 55 |
| 2024 September | 46 | 23 | 69 |
| 2024 August | 43 | 26 | 69 |
| 2024 July | 42 | 37 | 79 |
| 2024 June | 27 | 15 | 42 |
| 2024 May | 38 | 28 | 66 |
| 2024 April | 44 | 24 | 68 |
| 2024 March | 64 | 18 | 82 |
| 2024 February | 28 | 29 | 57 |
| 2024 January | 21 | 25 | 46 |
| 2023 December | 25 | 33 | 58 |
| 2023 November | 39 | 24 | 63 |
| 2023 October | 16 | 15 | 31 |
| 2023 September | 21 | 19 | 40 |
| 2023 August | 32 | 23 | 55 |
| 2023 July | 19 | 6 | 25 |
| 2023 June | 20 | 16 | 36 |
| 2023 May | 45 | 23 | 68 |
| 2023 April | 14 | 2 | 16 |
| 2023 March | 44 | 19 | 63 |
| 2023 February | 37 | 19 | 56 |
| 2023 January | 25 | 13 | 38 |
| 2022 December | 33 | 19 | 52 |
| 2022 November | 55 | 22 | 77 |
| 2022 October | 30 | 21 | 51 |
| 2022 September | 23 | 33 | 56 |
| 2022 August | 21 | 22 | 43 |
| 2022 July | 26 | 26 | 52 |
| 2022 June | 22 | 25 | 47 |
| 2022 May | 26 | 25 | 51 |
| 2022 April | 34 | 23 | 57 |
| 2022 March | 22 | 35 | 57 |
| 2022 February | 26 | 10 | 36 |
| 2022 January | 26 | 20 | 46 |
| 2021 December | 16 | 29 | 45 |
| 2021 November | 30 | 33 | 63 |
| 2021 October | 80 | 28 | 108 |
| 2021 September | 41 | 17 | 58 |
| 2021 August | 47 | 28 | 75 |
| 2021 July | 11 | 25 | 36 |
| 2021 June | 30 | 14 | 44 |
| 2021 May | 36 | 44 | 80 |
| 2021 April | 82 | 46 | 128 |
| 2021 March | 65 | 16 | 81 |
| 2021 February | 56 | 14 | 70 |
| 2021 January | 33 | 20 | 53 |
| 2020 December | 31 | 8 | 39 |
| 2020 November | 32 | 16 | 48 |
| 2020 October | 20 | 17 | 37 |
| 2020 September | 44 | 6 | 50 |
| 2020 August | 15 | 5 | 20 |
| 2020 July | 35 | 9 | 44 |
| 2020 June | 30 | 14 | 44 |
| 2020 May | 39 | 5 | 44 |
| 2020 April | 29 | 10 | 39 |
| 2020 March | 36 | 8 | 44 |
| 2020 February | 48 | 15 | 63 |
| 2020 January | 24 | 6 | 30 |
| 2019 December | 38 | 3 | 41 |
| 2019 November | 25 | 6 | 31 |
| 2019 October | 32 | 8 | 40 |
| 2019 September | 50 | 7 | 57 |
| 2019 August | 20 | 6 | 26 |
| 2019 July | 36 | 10 | 46 |
| 2019 June | 22 | 16 | 38 |
| 2019 May | 39 | 7 | 46 |
| 2019 April | 27 | 14 | 41 |
| 2019 March | 27 | 12 | 39 |
| 2019 February | 32 | 21 | 53 |
| 2019 January | 23 | 7 | 30 |
| 2018 December | 20 | 11 | 31 |
| 2018 November | 39 | 11 | 50 |
| 2018 October | 84 | 11 | 95 |
| 2018 September | 29 | 10 | 39 |
| 2018 August | 18 | 10 | 28 |
| 2018 July | 14 | 1 | 15 |
| 2018 June | 17 | 3 | 20 |
| 2018 May | 32 | 7 | 39 |
| 2018 April | 26 | 10 | 36 |
| 2018 March | 20 | 6 | 26 |
| 2018 February | 15 | 1 | 16 |
| 2018 January | 13 | 4 | 17 |
| 2017 December | 35 | 7 | 42 |
| 2017 November | 23 | 9 | 32 |
| 2017 October | 12 | 14 | 26 |
| 2017 September | 21 | 10 | 31 |
| 2017 August | 28 | 11 | 39 |
| 2017 July | 20 | 9 | 29 |
| 2017 June | 31 | 5 | 36 |
| 2017 May | 24 | 13 | 37 |
| 2017 April | 37 | 4 | 41 |
| 2017 March | 46 | 62 | 108 |
| 2017 February | 22 | 11 | 33 |
| 2017 January | 25 | 19 | 44 |
| 2016 December | 51 | 23 | 74 |
| 2016 November | 42 | 20 | 62 |
| 2016 October | 40 | 18 | 58 |
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