Is coronary artery tortuosity a precursor of atherosclerosis and/or left ventricular diastolic dysfunction?,The Egyptian Heart Journal

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Is coronary artery tortuosity a precursor of atherosclerosis and/or left ventricular diastolic dysfunction?
The Egyptian Heart Journal Pub Date : 2021-07-28 , DOI: 10.1186/s43044-021-00192-3
Zainab Atiyah Dakhil ₁

Affiliation

To the Editor,

RE: “Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis?”, March 31, 2021.

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 so-called 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.

This study referred only to tortuous main coronary arteries without mentioning if sizable side branches’ tortuosity was excluded or not from the control group; side branch tortuosity has been reported as negative predictor of atherosclerosis [2], and we think it might be important to at least mention if they were considered especially if they were large side branches that irrigate large area of myocardium.

The researchers did well with choosing age- and gender-matched control patients because of the debate of the impact of these factors on CAT; however, one of the main findings of this study is the diastolic dysfunction that was observed more in the CAT group, yet the researchers did not exclude other causes of DD from the CAT group like hypertension, obesity, and thyroid diseases [3, 4], and this might remarkably affect the results especially if we consider that the study showed that 86.7% of the CAT group vs. 30% of the control group were hypertensive which might explain the higher prevalence of DD in the CAT group. Despite that the researchers excluded uncontrolled hypertension (which the study did not define), still hypertension is well recognized cause of DD that might impact the results. This is more crucial if we consider that no multiple regression analysis was done to assess the predictors of DD in this study which could better waive the impact of the case selection issue.

The main question of this study was to determine the predictors for CAT, yet the title did not clearly reflect this objective; however, the question was clearly answered despite the small study population.

It is also noteworthy to mention that coronary artery tortuosity can be part of systemic arterial tortuosity [5], so carotid artery tortuosity can be associated with CAT, which might explain the increased CIMT here rather than the direct association of this CIMT increase with CAT, as the atherosclerotic changes in tortuous arteries are reported to be due to local shear stress forces, so such possibility needs to be evaluated in future studies especially with the conflicting existing literature.

Interestingly, assessment of coronary artery calcium burden by CT coronary angiography is a surrogate for coronary atherosclerosis, and its relation with CAT is also a matter of debate [6, 7], so it can be further investigated in future studies.

Despite the raised issues, we believe that this study can open the door for future researchers to further explore the significance of coronary artery tortuosity.

Not applicable.

CAT:: Coronary artery tortuosity
CIMT:: Carotid intima-media thickness
DD:: Left ventricular diastolic dysfunction

1.
Elamragy A, Yakoub S, AbdelGhany M, Ammar W (2021) Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis? The Egyptian Heart Journal 73(1):1–9
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2.
Kurihara K, Fujimori Y, Yamanaka Y, Baba T, Hashimoto S, Takeuchi W, Wakabayashi T, Yokota D, Imai T (2020 Mar 24) Tortuous coronary segments with bending and stretching motion: a possible preventive factor against coronary atherosclerosis. J Am Coll Cardiol 75(11_Supplement_1):89
Article Google Scholar
3.
Slama M, Susic D, Varagic J, Frohlich ED (2002 Jul 1) Diastolic dysfunction in hypertension. Curr Opin Cardiol 17(4):368–373. https://doi.org/10.1097/00001573-200207000-00008
Article PubMed Google Scholar
4.
Neves JS, Vale C, von Hafe M, Borges-Canha M, Leite AR, Almeida-Coelho J, Lourenço A, Falcão-Pires I, Carvalho D, Leite-Moreira A (2020) Thyroid hormones and modulation of diastolic function: a promising target for heart failure with preserved ejection fraction. Therapeutic Advances in Endocrinology and Metabolism 11:2042018820958331
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5.
Davutoglu V, Dogan A, Okumus S, Demir T, Tatar G, Gurler B, Ercan S, Sari I, Alici H, Altunbas G (2013 Jan 1) Coronary artery tortuosity: comparison with retinal arteries and carotid intima-media thickness. Kardiol Pol 71(11):1121–1128. https://doi.org/10.5603/KP.a2013.0292
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6.
Kahe F, Sharfaei S, Pitliya A, Jafarizade M, Seifirad S, Habibi S, Chi G (2020 Mar 1) Coronary artery tortuosity: a narrative review. Coron Artery Dis 31(2):187–192. https://doi.org/10.1097/MCA.0000000000000769
Article PubMed Google Scholar
7.
Dakhil ZA, Farhan HA Clinical landscape, calcium burden and angiographic profile in coronary artery tortuosity: how does the gender contribute? Catheter Cardiovasc Interv 99(S1):S48–S49

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Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
Zainab Atiyah Dakhil

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Zainab Atiyah DakhilView author publications
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ZD conceptualize the letter, drafted, and revised the letter. The author read and approved the final manuscript.

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Correspondence to Zainab Atiyah Dakhil.

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Dakhil, Z.A. Is coronary artery tortuosity a precursor of atherosclerosis and/or left ventricular diastolic dysfunction?. Egypt Heart J 73, 68 (2021). https://doi.org/10.1186/s43044-021-00192-3

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Received: 13 April 2021
Accepted: 16 July 2021
Published: 28 July 2021
DOI: https://doi.org/10.1186/s43044-021-00192-3

中文翻译：

冠状动脉迂曲是动脉粥样硬化和/或左心室舒张功能障碍的先兆吗？

致编辑，

RE：“冠状动脉迂曲与颈动脉内中膜厚度、冠状动脉疾病危险因素和舒张功能障碍的关系：它是早期动脉粥样硬化的标志吗？”，2021 年 3 月 31 日。

我们饶有兴趣地阅读了 Ahmed Alamragy 等人的深思熟虑的论文。[1] 强调了冠状动脉迂曲 (CAT) 与颈动脉内膜中层厚度 (CIMT)、高血压、高脂血症、左心室舒张功能障碍 (DD) 和冠状动脉粥样硬化的关联，因此本研究对现有的尤其是当我们考虑到这种所谓的良性冠状动脉表型有多普遍以及关于其重要性的数据是多么有限时。尽管如此，我们还是想就这项研究提出一些问题。

本研究仅提及主动脉迂曲，未提及对照组是否排除了相当大的侧支迂曲；据报道，侧支迂曲是动脉粥样硬化的负面预测因素 [2]，我们认为至少提及是否考虑它们可能很重要，特别是如果它们是灌溉大面积心肌的大侧支。

研究人员在选择年龄和性别匹配的对照患者方面做得很好，因为这些因素对 CAT 的影响存在争议。然而，这项研究的主要发现之一是在 CAT 组中观察到更多的舒张功能障碍，但研究人员并未从 CAT 组中排除 DD 的其他原因，如高血压、肥胖和甲状腺疾病 [3, 4] ，如果我们认为研究表明 CAT 组的 86.7% 与 30% 的对照组患有高血压，这可能解释了 CAT 组中 DD 的较高患病率。尽管研究人员排除了不受控制的高血压（该研究未定义），但仍然公认高血压是可能影响结果的 DD 的原因。

这项研究的主要问题是确定 CAT 的预测因子，但标题并没有清楚地反映这一目标；然而，尽管研究人群很小，但问题得到了明确回答。

还值得注意的是，冠状动脉迂曲可能是全身动脉迂曲的一部分 [5]，因此颈动脉迂曲可能与 CAT 相关，这可能解释了此处 CIMT 的增加，而不是 CIMT 增加与 CAT 的直接关联，由于据报道曲折动脉的动脉粥样硬化变化是由局部剪切应力引起的，因此需要在未来的研究中评估这种可能性，尤其是现有文献相互矛盾。

有趣的是，CT冠状动脉造影评估冠状动脉钙负荷是冠状动脉粥样硬化的替代指标，其与CAT的关系也是有争议的[6, 7]，因此可以在未来的研究中进一步研究。

尽管提出了一些问题，但我们相信这项研究可以为未来的研究人员进一步探索冠状动脉迂曲的重要性打开大门。

不适用。

猫：: 冠状动脉迂曲
CIMT：: 颈动脉内中膜厚度
DD：: 左心室舒张功能障碍

1.
Elamragy A、Yakoub S、AbdelGhany M、Ammar W（2021）冠状动脉曲折与颈动脉内中膜厚度、冠状动脉疾病危险因素和舒张功能障碍的关系：它是早期动脉粥样硬化的标志吗？埃及心脏杂志 73(1):1-9
文章谷歌学术
二。
Kurihara K、Fujimori Y、Yamanaka Y、Baba T、Hashimoto S、Takeuchi W、Wakabayashi T、Yokota D、Imai T（2020 年 3 月 24 日）弯曲和拉伸运动的曲折冠状节段：冠状动脉粥样硬化的可能预防因素。J Am Coll Cardiol 75(11_Supplement_1):89
文章谷歌学术
3.
Slama M、Susic D、Varagic J、Frohlich ED（2002 年 7 月 1 日）高血压舒张功能障碍。Curr Opin Cardiol 17（4）：368-373。https://doi.org/10.1097/00001573-200207000-00008
文章 PubMed Google Scholar
4.
Neves JS、Vale C、von Hafe M、Borges-Canha M、Leite AR、Almeida-Coelho J、Lourenço A、Falcão-Pires I、Carvalho D、Leite-Moreira A（2020）甲状腺激素和舒张功能的调节：a射血分数保留的心力衰竭的有希望的靶点。内分泌与代谢治疗进展 11:2042018820958331
CAS 文章 Google Scholar
5.
Davutoglu V、Dogan A、Okumus S、Demir T、Tatar G、Gurler B、Ercan S、Sari I、Alici H、Altunbas G（2013 年 1 月 1 日）冠状动脉弯曲度：与视网膜动脉和颈动脉内中膜厚度的比较。Kardiol Pol 71(11):1121–1128。https://doi.org/10.5603/KP.a2013.0292
文章 PubMed Google Scholar
6.
Kahe F、Sharfaei S、Pitliya A、Japharity M、Seifirad S、Habibi S、Chi G（2020 年 3 月 1 日）冠状动脉迂曲：叙述性回顾。冠状动脉 Dis 31（2）：187-192。https://doi.org/10.1097/MCA.0000000000000769
文章 PubMed Google Scholar
7.
Dakhil ZA、Farhan HA 冠状动脉迂曲的临床情况、钙负荷和血管造影特征：性别如何起作用？Cardiovasc Interv 99(S1):S48–S49 导管

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巴格达大学 Al-Kindy 医学院，伊拉克巴格达
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