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
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Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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[ "EPUB" => 189 "HTML" => 1586 "PDF" => 432 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to the letter “The relation between inflammation and coronary artery ectasia”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "555" "paginaFinal" => "556" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à carta «A relação entre a inflamação e a ectasia arterial coronária»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Abdullah Dogan, Akif Arslan" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Abdullah" "apellidos" => "Dogan" ] 1 => array:2 [ "nombre" => "Akif" "apellidos" => "Arslan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916301647" "doi" => 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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. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 5 | 5 | 10 |
| 2024 Outubro | 38 | 28 | 66 |
| 2024 Setembro | 47 | 24 | 71 |
| 2024 Agosto | 52 | 25 | 77 |
| 2024 Julho | 40 | 37 | 77 |
| 2024 Junho | 46 | 21 | 67 |
| 2024 Maio | 53 | 15 | 68 |
| 2024 Abril | 40 | 26 | 66 |
| 2024 Maro | 39 | 24 | 63 |
| 2024 Fevereiro | 35 | 29 | 64 |
| 2024 Janeiro | 21 | 31 | 52 |
| 2023 Dezembro | 33 | 24 | 57 |
| 2023 Novembro | 46 | 17 | 63 |
| 2023 Outubro | 21 | 14 | 35 |
| 2023 Setembro | 31 | 18 | 49 |
| 2023 Agosto | 39 | 14 | 53 |
| 2023 Julho | 30 | 10 | 40 |
| 2023 Junho | 27 | 15 | 42 |
| 2023 Maio | 34 | 19 | 53 |
| 2023 Abril | 16 | 1 | 17 |
| 2023 Maro | 27 | 15 | 42 |
| 2023 Fevereiro | 33 | 19 | 52 |
| 2023 Janeiro | 14 | 11 | 25 |
| 2022 Dezembro | 31 | 15 | 46 |
| 2022 Novembro | 49 | 24 | 73 |
| 2022 Outubro | 24 | 14 | 38 |
| 2022 Setembro | 21 | 29 | 50 |
| 2022 Agosto | 34 | 31 | 65 |
| 2022 Julho | 27 | 28 | 55 |
| 2022 Junho | 26 | 16 | 42 |
| 2022 Maio | 26 | 28 | 54 |
| 2022 Abril | 29 | 27 | 56 |
| 2022 Maro | 31 | 37 | 68 |
| 2022 Fevereiro | 14 | 19 | 33 |
| 2022 Janeiro | 32 | 19 | 51 |
| 2021 Dezembro | 23 | 34 | 57 |
| 2021 Novembro | 53 | 40 | 93 |
| 2021 Outubro | 56 | 43 | 99 |
| 2021 Setembro | 31 | 28 | 59 |
| 2021 Agosto | 31 | 38 | 69 |
| 2021 Julho | 23 | 29 | 52 |
| 2021 Junho | 32 | 15 | 47 |
| 2021 Maio | 30 | 21 | 51 |
| 2021 Abril | 54 | 46 | 100 |
| 2021 Maro | 62 | 23 | 85 |
| 2021 Fevereiro | 52 | 11 | 63 |
| 2021 Janeiro | 37 | 17 | 54 |
| 2020 Dezembro | 49 | 10 | 59 |
| 2020 Novembro | 30 | 19 | 49 |
| 2020 Outubro | 19 | 7 | 26 |
| 2020 Setembro | 54 | 7 | 61 |
| 2020 Agosto | 29 | 7 | 36 |
| 2020 Julho | 38 | 9 | 47 |
| 2020 Junho | 33 | 8 | 41 |
| 2020 Maio | 22 | 2 | 24 |
| 2020 Abril | 31 | 17 | 48 |
| 2020 Maro | 27 | 6 | 33 |
| 2020 Fevereiro | 35 | 23 | 58 |
| 2020 Janeiro | 29 | 4 | 33 |
| 2019 Dezembro | 30 | 6 | 36 |
| 2019 Novembro | 20 | 10 | 30 |
| 2019 Outubro | 34 | 5 | 39 |
| 2019 Setembro | 25 | 9 | 34 |
| 2019 Agosto | 24 | 7 | 31 |
| 2019 Julho | 36 | 6 | 42 |
| 2019 Junho | 41 | 15 | 56 |
| 2019 Maio | 35 | 6 | 41 |
| 2019 Abril | 20 | 13 | 33 |
| 2019 Maro | 43 | 9 | 52 |
| 2019 Fevereiro | 43 | 9 | 52 |
| 2019 Janeiro | 32 | 6 | 38 |
| 2018 Dezembro | 43 | 11 | 54 |
| 2018 Novembro | 62 | 7 | 69 |
| 2018 Outubro | 107 | 17 | 124 |
| 2018 Setembro | 36 | 11 | 47 |
| 2018 Agosto | 45 | 11 | 56 |
| 2018 Julho | 18 | 4 | 22 |
| 2018 Junho | 43 | 4 | 47 |
| 2018 Maio | 31 | 17 | 48 |
| 2018 Abril | 79 | 15 | 94 |
| 2018 Maro | 66 | 10 | 76 |
| 2018 Fevereiro | 35 | 2 | 37 |
| 2018 Janeiro | 85 | 11 | 96 |
| 2017 Dezembro | 78 | 17 | 95 |
| 2017 Novembro | 48 | 11 | 59 |
| 2017 Outubro | 19 | 9 | 28 |
| 2017 Setembro | 27 | 13 | 40 |
| 2017 Agosto | 27 | 10 | 37 |
| 2017 Julho | 23 | 6 | 29 |
| 2017 Junho | 29 | 8 | 37 |
| 2017 Maio | 34 | 8 | 42 |
| 2017 Abril | 17 | 3 | 20 |
| 2017 Maro | 19 | 4 | 23 |
| 2017 Fevereiro | 16 | 6 | 22 |
| 2017 Janeiro | 19 | 12 | 31 |
| 2016 Dezembro | 41 | 28 | 69 |
| 2016 Novembro | 31 | 19 | 50 |
| 2016 Outubro | 53 | 46 | 99 |
| 2016 Setembro | 33 | 33 | 66 |
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