Letter to the Editor
Reply to the letter “The relation between inflammation and coronary artery ectasia”
Resposta à carta «A relação entre a inflamação e a ectasia arterial coronária»
Abdullah Dogan, Akif Arslan
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Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
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"Arslan" "email" => array:1 [ 0 => "dr.akifarslan@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à carta «A relação entre a inflamação e a ectasia arterial coronária»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Balta et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> for their interest in our article.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> In our study, we evaluated the frequency of major cardiovascular risk factors and serum levels of gamma-glutamyltransferase (GGT) and high-sensitivity C-reactive protein (hs-CRP) in a relatively large population of patients with isolated coronary artery ectasia (CAE). We found 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.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Coronary artery ectasia is usually defined as dilation exceeding 1.5 times the diameter of adjacent normal segments in epicardial coronary arteries.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">3,4</span></a> Its underlying causes are poorly understood, but it has frequently been considered as a variant of atherosclerotic vascular disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Atherosclerosis is regarded as a low-grade inflammatory process<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> and thus it is not surprising that there may be a close association between inflammation and CAE. As reported by Balta et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> various studies have shown such an association.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6–10</span></a> Moreover, inflammation may be related to severity of CAE. However, the extent of CAE can be differently defined. Markis et al. categorized CAE in four types, with decreasing severity of CAE from type I to IV according to its topographical extent in the major coronary arteries.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Based on this definition, types I, II and III CAE can be considered severe ectasia. By contrast, we defined severe CAE as diffuse involvement (≥2 segments) in at least two vessels. This definition corresponds to type I CAE according to Markis's classification. Our definition has also been used in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We agree with Balta et al. that some disorders such as obesity, thyroid dysfunction and malignancy can trigger an inflammatory state in which inflammatory markers like hs-CRP may be elevated. We excluded patients with thyroid dysfunction and known malignancies and inflammatory diseases from the study. With obesity, we consecutively included CAE patients in the study and selected age- and gender-matched controls with normal coronary arteries. Although mean body mass index was comparable between CAE patients and controls, the obesity rate was slightly higher in CAE patients (16% vs. 9%, p=0.06) and obesity was positively associated with CAE. We think that inflammatory activity may contribute to the development of CAE in obese patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Serum GGT, a major antioxidant, can oxidize low-density lipoprotein cholesterol, and has a role in the pathogenesis of atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> GGT can also act as a proinflammatory protein in atherogenesis and is associated with atherosclerotic risk factors including obesity, dyslipidemia, metabolic syndrome, hypertension and diabetes.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12,13</span></a> Primary hepatic diseases such as alcoholic or viral hepatitis and Gilbert syndrome can lead to elevated transaminases, GGT, and bilirubin levels in hepatic function tests. We did not enroll patients who had previously known hepatic disease and who regularly drank ethyl alcohol. Accordingly, we think that the relatively elevated levels of GGT may be associated with CAE itself rather than other disorders or situations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, there is growing evidence that an inflammatory state may be activated in CAE patients and that its markers may be elevated in CAE patients as in obstructive coronary artery disease. As an oxidative stress and proinflammatory marker, GGT may also have a role in the pathogenesis of CAE. This consideration needs future studies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" 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:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relation between inflammation and coronary artery ectasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 3 | 10 |
| 2024 Outubro | 35 | 33 | 68 |
| 2024 Setembro | 44 | 23 | 67 |
| 2024 Agosto | 48 | 31 | 79 |
| 2024 Julho | 41 | 42 | 83 |
| 2024 Junho | 46 | 28 | 74 |
| 2024 Maio | 43 | 17 | 60 |
| 2024 Abril | 33 | 24 | 57 |
| 2024 Maro | 35 | 24 | 59 |
| 2024 Fevereiro | 24 | 27 | 51 |
| 2024 Janeiro | 27 | 37 | 64 |
| 2023 Dezembro | 28 | 20 | 48 |
| 2023 Novembro | 27 | 15 | 42 |
| 2023 Outubro | 23 | 16 | 39 |
| 2023 Setembro | 42 | 24 | 66 |
| 2023 Agosto | 37 | 20 | 57 |
| 2023 Julho | 28 | 8 | 36 |
| 2023 Junho | 24 | 16 | 40 |
| 2023 Maio | 28 | 19 | 47 |
| 2023 Abril | 18 | 2 | 20 |
| 2023 Maro | 29 | 23 | 52 |
| 2023 Fevereiro | 26 | 16 | 42 |
| 2023 Janeiro | 8 | 12 | 20 |
| 2022 Dezembro | 30 | 24 | 54 |
| 2022 Novembro | 36 | 23 | 59 |
| 2022 Outubro | 23 | 18 | 41 |
| 2022 Setembro | 21 | 25 | 46 |
| 2022 Agosto | 39 | 28 | 67 |
| 2022 Julho | 20 | 28 | 48 |
| 2022 Junho | 18 | 21 | 39 |
| 2022 Maio | 23 | 29 | 52 |
| 2022 Abril | 23 | 26 | 49 |
| 2022 Maro | 26 | 38 | 64 |
| 2022 Fevereiro | 17 | 27 | 44 |
| 2022 Janeiro | 23 | 21 | 44 |
| 2021 Dezembro | 16 | 34 | 50 |
| 2021 Novembro | 25 | 33 | 58 |
| 2021 Outubro | 80 | 37 | 117 |
| 2021 Setembro | 42 | 29 | 71 |
| 2021 Agosto | 43 | 32 | 75 |
| 2021 Julho | 35 | 23 | 58 |
| 2021 Junho | 18 | 21 | 39 |
| 2021 Maio | 23 | 26 | 49 |
| 2021 Abril | 49 | 25 | 74 |
| 2021 Maro | 63 | 19 | 82 |
| 2021 Fevereiro | 44 | 11 | 55 |
| 2021 Janeiro | 23 | 19 | 42 |
| 2020 Dezembro | 26 | 2 | 28 |
| 2020 Novembro | 33 | 17 | 50 |
| 2020 Outubro | 17 | 8 | 25 |
| 2020 Setembro | 62 | 15 | 77 |
| 2020 Agosto | 20 | 9 | 29 |
| 2020 Julho | 33 | 15 | 48 |
| 2020 Junho | 27 | 6 | 33 |
| 2020 Maio | 26 | 3 | 29 |
| 2020 Abril | 36 | 13 | 49 |
| 2020 Maro | 40 | 8 | 48 |
| 2020 Fevereiro | 51 | 15 | 66 |
| 2020 Janeiro | 37 | 5 | 42 |
| 2019 Dezembro | 28 | 6 | 34 |
| 2019 Novembro | 23 | 4 | 27 |
| 2019 Outubro | 22 | 6 | 28 |
| 2019 Setembro | 16 | 7 | 23 |
| 2019 Agosto | 30 | 6 | 36 |
| 2019 Julho | 39 | 8 | 47 |
| 2019 Junho | 36 | 20 | 56 |
| 2019 Maio | 33 | 7 | 40 |
| 2019 Abril | 26 | 13 | 39 |
| 2019 Maro | 74 | 9 | 83 |
| 2019 Fevereiro | 55 | 14 | 69 |
| 2019 Janeiro | 31 | 5 | 36 |
| 2018 Dezembro | 36 | 9 | 45 |
| 2018 Novembro | 60 | 8 | 68 |
| 2018 Outubro | 167 | 13 | 180 |
| 2018 Setembro | 20 | 9 | 29 |
| 2018 Agosto | 22 | 18 | 40 |
| 2018 Julho | 18 | 4 | 22 |
| 2018 Junho | 30 | 2 | 32 |
| 2018 Maio | 39 | 7 | 46 |
| 2018 Abril | 63 | 9 | 72 |
| 2018 Maro | 46 | 7 | 53 |
| 2018 Fevereiro | 38 | 3 | 41 |
| 2018 Janeiro | 36 | 8 | 44 |
| 2017 Dezembro | 71 | 10 | 81 |
| 2017 Novembro | 55 | 6 | 61 |
| 2017 Outubro | 21 | 11 | 32 |
| 2017 Setembro | 25 | 7 | 32 |
| 2017 Agosto | 29 | 11 | 40 |
| 2017 Julho | 28 | 9 | 37 |
| 2017 Junho | 24 | 7 | 31 |
| 2017 Maio | 26 | 11 | 37 |
| 2017 Abril | 17 | 4 | 21 |
| 2017 Maro | 20 | 12 | 32 |
| 2017 Fevereiro | 21 | 6 | 27 |
| 2017 Janeiro | 22 | 13 | 35 |
| 2016 Dezembro | 44 | 20 | 64 |
| 2016 Novembro | 28 | 19 | 47 |
| 2016 Outubro | 63 | 35 | 98 |
| 2016 Setembro | 29 | 32 | 61 |
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