Clinical Implication of Coronary Tortuosity in Patients with Coronary Artery Disease

Li, Yang; Shen, Chengxing; Ji, Yanan; Feng, Yan; Ma, Genshan; Liu, Naifeng

doi:10.1371/journal.pone.0024232

Cited by 84 publications

(97 citation statements)

References 18 publications

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“…Women were found to have more CT and smaller heart dimensions in comparison with men, and this was thought to be responsible for this trend [4,15]. A higher proportion of elderly people affected with CT has also been documented [3].…”

Section: Discussionmentioning

confidence: 95%

“…Li et al [15], found that CT was positively correlated with essential hypertension. Tortuosity of coronary arteries is also a common finding seen with hypertension due to elongation and dilatation of the arteries associated with left ventricular hypertrophy [4,15]. The authors assumed that arteries may become tortuous due to reduced axial strain and hypertensive pressure in an elastic cylindrical arterial model.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, VD suppresses degeneration of elastin in the arterial wall [24]. Li et al [15], found that CT was positively correlated with essential hypertension. Tortuosity of coronary arteries is also a common finding seen with hypertension due to elongation and dilatation of the arteries associated with left ventricular hypertrophy [4,15].…”

Section: Discussionmentioning

confidence: 99%

“…The aetiology and clinical importance of CT are still unclear. CT is associated with increased acute occlusion of coronary arteries, diabetes, and coronary artery fistula [4,15]. CT hampers ventricular function and has been proposed as an indicator of ventricular dysfunction [16].…”

Section: Discussionmentioning

confidence: 99%

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Vitamin D insufficiency is associated with coronary artery tortuosity

et al. 2017

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A b s t r a c tBackground: Increasing evidence suggests a relationship between vitamin D (VD) insufficiency and cardiovascular disease. Aim:We aimed to investigate the association between serum 25-hydroxyvitamin D (25-OH VD) with coronary tortuosity (CT) in patients with normal or near-normal (< 40% stenosis) coronary arteries. Methods:The present study was cross-sectional and observational. We enrolled 356 consecutive patients who had undergone coronary angiography for suspected ischaemic heart disease and were found to have normal or near-normal coronary arteries. Patients were categorised as VD insufficient (< 30 ng/mL) or VD sufficient (≥ 30 ng/dL). CT was defined as the presence of ≥ three bends (defined as ≥ 45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole. Results:The study populations were divided into two groups according to the presence of CT: patients with CT (n = 103, 29%) and patients without CT (NCT; n = 253, 71%). CT is more frequently seen in elderly women and is positively correlated with hypertension. The incidence of VD insufficiency was significantly higher in the CT group (n = 46, 45%) than in the NCT group (n = 90, 36%; p = 0.005). In further multivariate logistic regression analyses, adjustment for major clinical parameters affecting CT showed statistically significant correlations between 25-OH VD and CT (odds ratio = 0.77, 95% confidence interval 0.66-0.98, p = 0.006). Conclusions: Vitamin D insufficiency was independently associated with coronary tortuosity.Key words: vitamin D insufficiency, coronary tortuosity, coronary artery disease, biomarkers, coronary angiography Kardiol Pol 2017; 75, 2: 174-180 INTRODUCTIONCoronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Coronary angiography is still the gold standard for the diagnosis of CAD, and coronary artery tortuosity (CT) is a common coronary angiography (CAG) finding [1][2][3]. The aetiology and clinical importance of CT are still unclear. CT is generally attributed to age-dependent, pathologic changes of elastic material in the vessel, and hypertension due to elongation and dilatation of the arteries with left ventricular hypertrophy [3,4]. A recent clinical trial showed that CT was associated with subclinical atherosclerosis and increased coronary artery calcification, even in the absence of significant obstructive lesion [5].

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vitamin D insufficiency is associated with coronary artery tortuosity

et al. 2017

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“…Coronary tortuosity (CT) is a finding commonly found at the angiographic evaluation 1 . This condition is defined by the presence of ≥3 bends (≥45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole 2 .…”

mentioning

confidence: 99%

Coronary tortuosity: normal variant or pathological condition?

Cortese¹,

Gesualdo²,

Acquaviva³

et al. 2016

ICFJ

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Coronary tortuosity (CT) is a finding commonly found at the angiographic evaluation 1 . This condition is defined by the presence of ≥3 bends (≥45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole 2 . Up to date, the aetiology and the clinical significant are not well defined. Evidence suggests an association between CT, chronic pressure load and impaired left ventricular relaxation [2][3][4] . Moreover degeneration of elastin in the arterial wall plays an important role in development of arterial tortuosity 3 . Elastin is a fundamental component of arterial tunica media and is the basis of retraction forces. This latter normally opposes to the forces of traction and pressure that tend to lengthen vessels and this explains why tortuosity of arteries is a phenomenon age-dependent and related to pathological changes of the elastic material of vessels 3 . At this purpose arterial tortuosity syndrome is a rare autosomal recessive connective tissue disorder determining tortuosity and elongation of arteries, especially of aorta and coronary arteries 5 . Other conditions predisposing to tortuosity are atherosclerosis and hypertension. Tortuosity is more present in atherosclerotic arteries than in others. Mechanical forces related to the dynamics of blood flow in arteries can induce the development of atherosclerotic process [5][6] . Moreover experimental model in animal showed that enlargement, elongation, and tortuosity of arteries represent adaptive changes to high flow and high shear stress associated to smooth muscle cell and endothelial cell proliferation and migration 7 . CT is therefore one of the forms of artery remodelling induced by hypertension and can be recognized as an adaptive change of hypertension. Furthermore Yang Li et al. found an association between CT and female gender independently by the level of arterial hypertension 1 . Few cases in literature showed the presence of angina symptoms with abnormal exercise stress test in patients with CT without fixed atherosclerotic stenosis. We report a case of stress-induced myocardial ischemia in a middle age female with CT without coronary atherosclerosis.A 53-year old women was referred to our Operative Unit for exertional (emotional and physical stress) angina disappearing at rest and after nitrates. She had undergone to an ECG exercise stress test, positive for chest pain and electrocardiographic changes (ST depression in left and inferior leads). Stress/rest myocardial scintigraphy showed a reversible defect in the proximal portion of the antero-lateral wall (figure 1). She had arterial hypertension and dyslipidemia under farmacological treatment, without other cardiovascular risk factors. Physical examination showed no abnormalities. Laboratory findings and echocardiography were normal. Coronary angiography showed marked tortuosity of all 3 coronary arteries (figure 2) without any fixed atherosclerotic lesions. The patient was discharged with beta blocker, cardioaspirin, antihyper...

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Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease

Pyo

2016

Interventional Cardiology

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Clinical Implication of Coronary Tortuosity in Patients with Coronary Artery Disease

Cited by 84 publications

References 18 publications

Vitamin D insufficiency is associated with coronary artery tortuosity

Vitamin D insufficiency is associated with coronary artery tortuosity

Coronary tortuosity: normal variant or pathological condition?

Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease

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