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. 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). 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.

中文翻译：

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冠状动脉弯曲与颈动脉内膜中层厚度，冠状动脉疾病危险因素和舒张功能障碍的关系：是否是早期动脉粥样硬化的标志？

冠状动脉曲折（C-Tor）是冠状动脉造影（CAG）的常见发现。关于它与动脉粥样硬化的联系有相互矛盾的数据：一项研究发现与冠心病（CAD）呈负相关，尽管它与年龄和高血压（HTN）相关，而后者是CAD的危险因素。颈动脉内膜中层厚度（C-IMT）是早期动脉粥样硬化的一种测量指标，是CAD的替代指标，舒张功能障碍也与CAD危险因素有关。在这项回顾性病例对照研究中，我们将2017年7月至2018年6月在三级医院接受CAG的患者中的C-Tor，C-IMT，舒张功能障碍和其他危险因素之间的关系进行了调查，排除了患有严重CAD的患者。C-Tor定义为：CAG中至少一条主冠状动脉主干存在≥3个弯曲（≥45°）。根据排除标准排除了663例患者后，将30例C-Tor患者与年龄和性别匹配的对照组进行了比较。在C-Tor组中，HTN更为常见（86.7％vs. 30％，p <0.002）；其他临床特征相似。仅在C-Tor组中C-IMT异常（p：0.007）。两组的舒张功能障碍参数有所不同：C / Tor组的E / A比<1，正常组的E / A比> 1（p：<0.001）。C-Tor组的E速度和减速时间明显更低（分别为0.001和<0.001）；E / E'比，A和A'速度明显更高（分别为p：0.005，<0.001和<0.001）；而两组的S'速度相似（p：0.078）。C-Tor组的总胆固醇和LDL较高（分别为0.003和0.006）。所有接受压力测试的C-Tor患者均获得阳性结果。回归分析中唯一独立的C-Tor预测因子是HTN，总胆固醇，A波速度和减速时间（DT）（优势比：14.7、1.03、1.15和0.95，所有p：<0.05）。在C-Tor预测的曲线，灵敏度和特异性下，A波速度的面积最大（分别为0.88、73.3％和96.7％），其次是DT（分别为0.86、66.67％和96.6％）。C-Tor与C-IMT，HTN，高脂血症和左心室舒张功能障碍有关；所有这些都有助于正在进行的动脉粥样硬化过程。A波速度和DT是C-Tor的独立预测因子。