Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis?

Abstract

Background Coronary tortuosity (C-Tor) is a common finding in coronary angiography (CAG). There are conflicting data about its link to atherosclerosis: one study found a negative relationship with coronary artery disease (CAD), although it had been linked to age and hypertension (HTN), which are CAD risk factors. Carotid intima-media thickness (C-IMT) is a measure of early atherosclerosis and a surrogate for CAD, diastolic dysfunction is also associated with CAD risk factors. In this retrospective case-control study, we investigated the relationship between C-Tor, C-IMT, diastolic dysfunction, and the other risk factors in patients undergoing CAG in a tertiary hospital between July 2017 and June 2018, after excluding patients with significant CAD. C-Tor was defined as the presence of ≥ 3 bends (≥ 45°) along the trunk of at least one main coronary artery in CAG. Results After excluding 663 patients due to exclusion criteria, 30 patients with C-Tor were compared with age and gender-matched controls. HTN was significantly more common in the C-Tor group (86.7% vs. 30%, p < 0.002); other clinical characteristics were similar. The C-IMT was abnormal in the C-Tor group only (p: 0.007). The diastolic dysfunction parameters differed between the two groups: the E/A ratio was < 1 in the C-Tor group and > 1 in the normal group (p: < 0.001); the E velocity and deceleration time were significantly lower in the C-Tor group (p: 0.001 and < 0.001 respectively); the E/E′ ratio, A, and A′ velocities were significantly higher (p: 0.005, < 0.001, < 0.001 respectively); while the S′ velocity was similar in the 2 groups (p: 0.078). The C-Tor group had higher total cholesterol and LDL (p: 0.003 and 0.006 respectively). All C-Tor patients undergoing stress tests had positive results. The only independent C-Tor predictors in a regression analysis were HTN, total cholesterol, A-wave velocity, and deceleration time (DT) (odds ratio: 14.7, 1.03, 1.15, and 0.95, all p: < 0.05). A-wave velocity had the best area under the curve, sensitivity, and specificity for C-Tor prediction (0.88, 73.3%, and 96.7% respectively) followed by DT (0.86, 66.67%, and 96.6% respectively). Conclusion C-Tor is associated with increased C-IMT, HTN, hyperlipidemia, and left ventricular diastolic dysfunction; all contributing to an ongoing atherosclerotic process. A-wave velocity and DT were independent predictors of C-Tor. C-Tor may cause microvascular ischemia that merits further investigation.

Is coronary artery tortuosity a precursor of atherosclerosis and/or left ventricular diastolic dysfunction?

“…We read with interest the thoughtful paper by Ahmed Alamragy et al [1] that highlighted the association of coronary artery tortuosity (CAT) with increased carotid intima-media thickness (CIMT), hypertension, hyperlipidemia, left ventricular diastolic dysfunction (DD), and coronary artery atherosclerosis, so this study contributes well to the existing literature especially if we consider how common is this socalled benign coronary phenotype and how limited data are there regarding its significance. Nevertheless, there are certain issues that we would like to raise regarding this study.…”

Spontaneous Coronary Artery Dissection: Review of Possible Pathophysiological Risk Factors

“…Interestingly, a review of a cohort of SCAD patients with known FMD showed 45% of the patients to be postmenopausal and 27% to have a history of migraines. 16 Histological analysis of FMD patients with SCAD has showed that there is the typical FMD vascular changes such as circumferential intimal 36 thickening and fibrosis and no evidence of vasculitis, atherosclerotic changes, or cystic medial necrosis at sites of dissections. 28,29 In terms of the clinical course of FMD patients presenting with SCAD, there was no association between the prevalence of FMD and SCAD recurrence and long-term adverse events after initial presentation.…”

“…3). 26,36 While coronary artery tortuosity has been seen more commonly in patients who are female, of advanced age, or have chronic HTN, the exact mechanism of its development is unclear. 26,37 Coronary artery tortuosity has also been seen in other connective tissue diseases including FMD.…”

“…Coronary angiography image demonstrating tortuosity in multiple coronary arteries and their branches. Adapted from Elamragy et al 36 …”