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Öğe Acute pericarditis as a complication of percutaneous mitral balloon valvulotomy(I C R Publishers, 2006) Turhan, H; Basar, N; Yasar, AS; Erbay, AR; Atak, RDuring the past two decades, percutaneous mitral balloon valvulotomy (PMBV) has been frequently used, with high success and low complication rates, in the treatment of patients with moderate to severe rheumatic mitral stenosis. The case is reported of a patient with severe rheumatic mitral stenosis who developed acute pericarditis two days after successful PMBV. To the best of the authors' knowledge, this is the first such case to be reported.Öğe Comparison of C-reactive protein levels inpatients with coronary artery ectasia versus patients with obstructive coronary artery disease(Excerpta Medica Inc-Elsevier Science Inc, 2004) Turhan, H; Erbay, AR; Yasar, AS; Balci, M; Bicer, A; Yetkin, EThis study evaluated plasma C-reactive protein (CRP) levels, a specific marker of inflammation, in 32 patients with isolated coronary artery ectasia (CAE) and compared the results with those of 32 patients with obstrucfive coronary artery disease without coronary artery ectasia and 30 subjects with angiographically normal coronary arteries. CRP levels were found to be significandy higher in patients with isolated CAE (p < 0.001), suggesting that more severe inflammation may be involved in the pathogenesis of CAE. (C) 2004 by Excerpta Medica, Inc.Öğe Comparison of P-wave duration and dispersion in patients aged ?65 years with those aged ?45 years(Churchill Livingstone Inc Medical Publishers, 2003) Turhan, H; Yetkin, E; Sahin, O; Yasar, AS; Senen, K; Atak, R; Sasmaz, HP-wave dispersion (PWD) is a Dew electrocardiographic marker that reflects discontinuous and inhomogeneous propagation of sinus impulses, which has been studied in some cardiac conditions as a useful predictor of paroxysmal atrial fibrillation (AF). The aim of the peresent study was to compare P-wave duration and PWD in patients less than or equal to45 versus greater than or equal to65 years of age. The study consisted of 2 groups. Group I included 118 patients aged greater than or equal to65 years (86 men, 32 women, mean age = 69 +/- 4 years). Group II included 72 patients aged less than or equal to45 years (53 men, 19 women, mean age = 41 +/- 4 years). All patients were selected from those who were undertaken coronary angiography in our hospital with a suspicion of coronary artery disease and detected as having angiographically normal coronary arteries. All patients were undertaken transthoracic echocardiography to evaluate the presence of any structural and functional cardiac abnormality. Maximum and minimum P-wave durations and PWD were calculated from 12-lead surface electrocardiogram. Maximum P-wave duration and PWD were significantly higher in group I patients than in group II patients (P <.00 1). However, there was no statistically significant difference between group I patients and group H patients regarding minimum P-wave duration (p =0.9). Left atrial diameter, left ventricular wall thicknesses, mitral A velocity, deceleration time and isovolumic relaxation time were significantly higher in group I patients than in group 11 patients. However, mitral E velocity were significantly lower in group I patients than in group II patients. A significant positive correlation was detected between PWD and age, left atrial diameter, mitral A velocity, deceleration time and isovolumic relaxation time. in addition, we found a significant negative correlation between PWD and mitral E velocity. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients greater than or equal to65 years of age than in those less than or equal to45 years of age. Further prospective studies that include larger series and long term follow-up are needed to clarify the clinical utility of PWD as a predictor of increased risk for paroxysmal AF in old patients.Öğe Documentation of slow coronary flow by the thrombolysis in myocardial infarction frame count in habitual smokers with angiographically normal coronary arteries(Springer, 2004) Erbay, AR; Turhan, H; Senen, K; Yetkin, O; Yasar, AS; Sezgin, AT; Atak, RThe thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. In this study we aimed to evaluate the effects of long-term cigarette smoking on the TIMI frame count in patients with angiographically proven normal coronary arteries. Between May 2001 and January 2002, 41 habitual smokers and 41 sex-matched nonsmokers with angiographically proven normal coronary arteries were included in the study. The TIMI frame count was determined for each major coronary artery in each patient. The TIMI frame count of the smoking group was significantly higher than that of nonsmokers for all three coronary arteries: left anterior descending ( corrected), 39 +/- 13 vs 22 +/- 8; right coronary artery, 35 +/- 13 vs 24 +/- 11; and left circumflex artery, 37 +/- 13 vs 25 +/- 8 ( P < 0.001 for all). The smokers tended to be younger than nonsmokers ( 46 +/- 7 vs 49 +/- 9 years; P = 0.07). We have found that smokers with angiographically normal coronary arteries have a higher TIMI frame count than nonsmokers with angiographically normal coronary arteries. An increased TIMI frame count can be regarded as an index of the harmful effects of smoking on coronary circulation regardless of the underlying mechanism.Öğe Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis(Elsevier Ireland Ltd, 2005) Erbay, AR; Turhan, H; Yasar, AS; Bicer, A; Senen, K; Sasmaz, H; Sabah, IBackground: P-wave dispersion (PWD), has been defined as the difference between maximum and minimum P-wave duration. Prolonged P-wave duration and increased PWD have been reported to be related with increased risk for atrial fibrillation (AF). AF is the most common sustained arrhythmia encountered in patients with rheumatic mitral stenosis (MS). Beta-blockers are the mainstay of therapy in patients with rheumatic MS to control ventricular rate both during sinus rhythm and AF. In the present study, we aimed to evaluate the effect of long-term beta-blocker therapy on P-wave duration and PWD in patients with rheumatic MS. Method: Study population includes 46 patients (group I, 8 men, 38 women, mean age=34 +/- 8 years) with newly diagnosed moderate-to-severe rheumatic MS who have not taken any medication before and prescribed oral beta-blocker therapy and 46 healthy control subjects without any cardiovascular disease (group II, 8 men, 38 women, mean age=35 +/- 7 years). Mitral valve area, maximum and mean diastolic mitral gradients, left atrial diameter, and systolic pulmonary artery pressure were evaluated by transthoracic echocardiography before initiation of beta blocker therapy and repeated at the end of the first month. Baseline maximum and minimum P-wave duration and PWD were determined on 12-lead electrocardiogram recorded for each patient and control subject and repeated at the end of the first month after initiation of beta-blocker therapy in patient group. Results: Maximum P-wave duration and PWD were found to be significantly higher in patients with MS than those in control subjects (Maximum P-wave duration: 128 +/- 7 ms vs. 104 +/- 4 ms and PWD: 52 +/- 6 ms vs. 27 +/- 3 ms, p < 0.001 for both). Both groups had comparable minimum P-wave duration (75 +/- 4 ms vs. 76 +/- 4 ms, p=0.093). Maximum P-wave duration and PWD were found to be significantly decreased by long-term beta blocker therapy (Maximum P-wave duration; 128 +/- 7 ms vs. 122 +/- 6 ms, p < 0.001, PWD; 52 +/- 6 ms vs. 47 5 ms, p < 0.001). However, there was no significant difference between the values of minimum P wave duration measured before and at the end of the first month of beta-blocker therapy (75 +/- 4 ms vs. 75 +/- 3 ms, p=0.678). Statistically significant decrease were detected on maximum and mean mitral gradient and systolic pulmonary artery pressure and resting heart rate at the end of the first month of beta-blocker therapy. However, only the change in resting heart rate was found to be significantly correlated with the decrease in maximum P-wave duration and PWD (Maximum P-wave duration: r=0.327, p=0.026, PWD: r=0.378, p=0.01). Conclusion: We have shown for the first time that long-term beta-blocker therapy causes a significant decrease in maximum P-wave duration and PWD in patients with rheumatic MS. (c) 2004 Elsevier Ireland Ltd. All rights resrved.Öğe Elevated level of plasma homocysteine in patients with slow coronary flow(Elsevier Ireland Ltd, 2005) Erbay, AR; Turhan, H; Yasar, AS; Ayaz, S; Sahin, O; Senen, K; Sasmaz, HBack-ground: Elevated plasma levels of homocysteine are currently considered a major, independent risk factor for cardiovascular diseases. Recently, several investigators have Suggested that even mild elevation in plasma homocysteine level can severely disturb vascular endothelial function and subsequently impair coronary blood flow. Accordingly, we investigated plasma homocysteine level in patients with slow coronary flow. Method: Study population included 53 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group I, 21 females, 32 males, mean age=48 +/- 9 years), and 50 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 22 females, 28 males, mean age=50 +/- 8 years). Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction frame count (TIMI frame count). All patients in group I had TIMI frame counts greater than two standard deviations above those of control subjects (group II) and, therefore, were accepted as exhibiting slow coronary flow. The mean TIMI frame Count for each patient and control subject was calculated by adding the TIMI frame counts for each major epicardial coronary artery and then dividing the obtained value into 3. Plasma homocysteine level was measured in all patients and control subjects using commercially available homocysteine kits. Results: There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p > 0.05). Plasma homocysteine level of patients with slow coronary flow were found to be significantly higher than those of control subjects (15.5 +/- 5.7 vs. 8.7 +/- 4.2 mu M/l, respectively, p < 0.001). Moreover, we found a significant positive correlation between plasma homocysteine level and mean TIMI frame count (r=0.660, p < 0.001). Conclusion: We have shown that patients with slow coronary flow have raised level of plasma homocysteme compared to control subjects with normal coronary flow. This data suggests that elevated level of plasma homocysteine may play a role in the pathogenesis of slow coronary flow. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Free-floating left atrial ball thrombus developed in an 11-year-old child with restrictive cardiomyopathy during sinus rhythm: Manifested as a major thromboembolic event(Elsevier Ireland Ltd, 2005) Turhan, H; Ocal, A; Erbay, AR; Yasar, AS; Cicekcioglu, F; Yetkin, EFree-floating left atrial ball thrombus is an extremely rare and serious disorder that usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation. In the present case, we report a free-floating left atrial ball thrombus developed in an 11-year-old child with idiopathic restrictive cardiomyopathy during sinus rhythm and manifested as peripheral arterial embolic event. To our knowledge, this is the first case of free-floating left atrial ball thrombus developed in a patient with restrictive cardiomyopathy. Furthermore, this also is the first case of free-floating left atrial ball thrombus developed in a patient during sinus rhythm. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe High prevalence of metabolic syndrome among young women with premature coronary artery disease(Lippincott Williams & Wilkins, 2005) Turhan, H; Yasar, AS; Basar, N; Bicer, A; Erbay, AR; Yetkin, EBackground The metabolic syndrome is more prevalent with the use of the recently defined National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria and is associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. This study evaluated the prevalence of metabolic syndrome in female and male patients with newly diagnosed premature coronary artery disease. Method The study population included 582 consecutive patients (496 men, 86 women) with newly diagnosed premature coronary artery disease (aged less than or equal to 45 years). Besides classic major coronary risk factors, all patients were evaluated for the presence of metabolic syndrome based on the NCEP ATP III criteria. Results The majority of patients were male (85% versus 15%). The overall prevalence of metabolic syndrome was 37%. Women with premature coronary artery disease were found to have a higher prevalence of metabolic syndrome than men (73% versus 31% respectively, p < 0.001). Furthermore, the mean number of components of metabolic syndrome was significantly higher in women compared to men (2.81 +/- 1.09 versus 1.85 +/- 1.08 respectively, p < 0.001). In addition, metabolic syndrome was detected to be the most frequent coronary risk factor in women (73%). Besides, cigarette smoking was found to be significantly higher in males compared to females (70% versus 36% respectively, p < 0.001) and it was the most prevalent coronary risk factor in men with premature coronary artery disease. Conclusion We have shown for the first time a higher prevalence of metabolic syndrome in young females compared with young males with premature coronary artery disease. This data may be useful in directing primary and secondary preventive measures. (C) 2005 Lippincott Williams Wilkins.Öğe Impaired coronary blood flow in patients with metabolic syndrome: Documented by Thrombolysis in Myocardial Infarction (TIMI) frame count method(Mosby-Elsevier, 2004) Turhan, H; Erbay, AR; Yasar, AS; Bicer, A; Sasmaz, H; Yetkin, EBackground Endothelium plays an important role in regulating coronary vascular tone. In addition, several of cardiovascular risk factors that are associated metabolic syndrome have been reported to be associated with endothelial dysfunction. In the present study we aimed to evaluate the coronary blood flow in patients with metabolic syndrome by means of the Thrombolysis in Myocardial Infarction (TIMI) frame count. Method Forty-two patients with metabolic syndrome (group 1) and 42 control subjects without metabolic syndrome (group II) were included in the study. All subjects had angiographically proven normal coronary arteries. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Coronary flow rates of all subjects were documented by TIMI frame count method. Results TIMI frame counts for each of the major epicardial coronary arteries were found to be significantly higher in patients with metabolic syndrome compared with control subjects (corrected TIMI frame count for left anterior descending coronary artery: 35 +/- 7 vs 25 +/- 7, respectively; left circumflex coronary artery: 32 9 vs 25 7, respectively; right coronary artery: 31 +/- 9 vs 24 +/- 5, respectively; P <.001 for all). Statistically significant independent relationships were found between TIMI frame count and body mass index (R-2 = 0.480, P =.009), waist circumference (R-2 = 0.551, P = .001), and triglyceride level (R-2 = 0.434, P =.036). Conclusion We have shown for the first time that patients with metabolic syndrome and angiographically normal coronary arteries have higher TIMI frame counts for all 3 coronary vessels, indicating impaired coronary blood flow, compared to control subjects without metabolic syndrome.Öğe Impaired coronary collateral vessel development in patients with metabolic syndrome(Lippincott Williams & Wilkins, 2005) Turhan, H; Yasar, AS; Erbay, AR; Yetkin, E; Sasmaz, H; Sabah, IBackground The development of coronary collateral vessels is the physiological response of myocardial tissue to hypoxia or ischemia, which results in an increase in blood supply to the tissue. However, a lack of collateral vessels or the presence of poor collateralization in some patients despite the presence of significant coronary stenosis or obstruction and evidence of myocardial ischemia suggest that some other factors may affect the development of collateral circulation. In the present study we aimed to evaluate coronary collateral circulation in patients with metabolic syndrome with advanced coronary artery disease and compare the results with those of patients without metabolic syndrome. Method The study population comprised 102 patients with metabolic syndrome and advanced coronary artery disease (-90% diameter stenosis in at least one major epicardial coronary artery) and 102 control participants without metabolic syndrome who also had >= 90% diameter stenosis in at least one major epicardial coronary artery. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III clinical definition. Coronary collateral vessels were analysed according to the Cohen and Rentrop grading system. Both groups were also divided into two additional groups according to the Rentrop collateral score as patients with poor collateral circulation (Rentrop score 0-1) and good collateral circulation (Rentrop score 2-3). Results The mean Rentrop collateral score for patients with metabolic syndrome was significantly lower than for those without metabolic syndrome (1.38 +/- 0.79 compared with 1.99 +/- 1.08, respectively, P < 0.001). When two groups were compared with respect to poor and good collateral circulation, poor collateral circulation was found to be significantly higher in the metabolic syndrome group (70% compared with 32%, respectively, P < 0.001). Moreover, multivariate logistic regression analysis revealed a significant relationship between poor collateral circulation and metabolic syndrome (odds ratio=4.29, 95% confidence interval = 1.73-10.69, P = 0.002). Conclusion We have shown for the first time that the development of coronary collateral vessels is poorer in patients with metabolic syndrome with advanced ischemic heart disease than in control participants without metabolic syndrome. Thus, it can be suggested that metabolic syndrome is one of the significant factors affecting the development of coronary collateral vessels adversely.Öğe Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow(Elsevier Ireland Ltd, 2006) Turhan, H; Saydam, GS; Erbay, AR; Ayaz, S; Yasar, AS; Aksoy, Y; Basar, NBackground: Inflammation has been reported to be a major contributing factor to many cardiovascular events. In the present study, we aimed to evaluate plasma soluble adhesion molecules; intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin as possible indicators of endothelial activation or inflammation in patients with slow coronary flow. Method: Study population included 17 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group I, 11 male, 6 female, mean age=48 +/- 9 years), and 20 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 11 male, 9 female, mean age=50 +/- 8 years). Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction frame count (TIMI frame count). All patients in group I had TIMI frame counts greater than two standard deviation above those of control subjects (group 11) and, therefore, were accepted as exhibiting slow coronary flow. Serum levels of ICAM-1, VCAM-1, and E-selectin were measured in all patients and control subjects using commercially available ELISA kits. Results: Serum ICAM-1, VCAM-1, and E-selectin levels of patients with slow coronary flow were found to be significantly higher than those of control subjects with normal coronary flow (ICAM-1: 545 +/- 198 ng/ml vs. 242 +/- 113 ng/ml respectively, p < 0.001, VCAM-1: 2040 +/- 634 ng/ml vs. 918 +/- 336 ng/ml respectively, p < 0.001, E-selectin: 67 +/- 9 ng/ml vs. 52 +/- 8 ng/ml respectively, p < 0.001). Average TIMI frame count was detected to be significantly correlated with plasma soluble ICAM-1 (r=0.550, p < 0.001), VCAM-1 (r=0.569, p < 0.001) and E-selectin (r = 0.443, p = 0.006). Conclusion: Increased levels of soluble adhesion molecules in patients with slow coronary flow may be an indicator of endothelial activation and inflammation and are likely to be in the causal pathway leading to slow coronary flow. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy(Wiley, 2004) Kubilay, SA; Turhan, H; Erbay, AR; Basar, N; Yasar, AS; Sahin, O; Yetkin, EBackground: P-wave dispersion (PWD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate PWD in patients with dilated cardiomyopathy. Method: The study population consisted of 72 patients with dilated cardiomyopathy and 72 healthy control subjects. Left atrial diameter, left ventricular end-diastolic and end-systolic diameters and left ventricular ejection fraction of all patients and control subjects were measured by means of transthoracic echocardiography. Maximum P-wave duration (Pmaximum) and minimum P-wave duration (Pminimum) were measured from the 12-lead surface electrocardiogram. PWD was calculated as the difference between Pmaximum and Pminimum. Results: Pmaximum and PWD of patients with dilated cardiomyopathy were significantly higher than those of control subjects (Pmaximum: 126 +/- 12 ms vs. 116 10 ms, PWD: 47 +/- 6 ms vs. 38 +/- 7 ms, respectively, P < 0.001 for all). However, there was no statistically significant difference between patient group and control group regarding Pminimum (79 7 ms vs. 78 6 ms, respectively, P = 0.27). Left atrial diameter was significantly higher in patients with dilated cardiomyopathy compared to control subjects (4.51 +/- 0.62 cm vs. 3.60 +/- 0.43 cm, respectively, P < 0.001). Left ventricular ejection fraction was found to be significantly lower in patients with dilated cardiomyopathy compared to control subjects (33 +/- 5% vs. 63 +/- 7%, respectively, P < 0.001). Conclusion: PWD was found to be significantly higher in patients with dilated cardiomyopathy than in healthy control subjects. (C) 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.Öğe Plasma homocysteine levels in patients with isolated coronary artery ectasia(Elsevier Ireland Ltd, 2005) Turhan, H; Erbay, AR; Yasar, AS; Bicer, A; Sahin, O; Nurcan, B; Yetkin, EObjective: Hyperhomocysteinemia is recognized as an independent risk factor for arterial disease including coronary artery disease, cerebrovascular disease and peripheral vascular disease. Previously, an association between increased plasma homocysteine level and peripheral arterial aneurysms has been reported. However, the relationship between coronary artery ectasia (CAE) and plasma homocysteine level has not been investigated. Accordingly, this study was designed to investigate plasma homocysteine level in patients with isolated CAE. Methods: Thirty-two patients with isolated CAE without significant stenosis and 30 control subjects with angiographically normal coronary arteries were included in this study. Fasting plasma homocysteine concentrations were measured by Florescence Polarization Immunoassay method using homocysteine kids. Hyperhomocysteinemia is defined as plasma homocysteine levels above the 95th percentile of the control subjects (13.6 mu mol/l). Results: According to the definition of hyperhomocysteinemia, 19 (59%) of patients with isolated CAE had elevated levels of plasma hornocysteine compared to 2 (7%) in the control subjects with angiographically normal coronary arteries (p < 0.001). In addition, patients with isolated CAE had significantly higher levels of plasma homocysteine compared to control subjects (14.9 +/- 4.5 mu mol/l vs. 8.6 +/- 1.9 mu mol/l respectively, p < 0.001). Besides, we detected a significant positive correlation between the number of ectasic segment and plasma homocysteine level (r=0.537, p=0.002). Conclusion: We have shown for the first time an association between elevated plasma homocysteine level and isolated CAE. Larger prospective studies are needed to confirm the role of hyperhomocysteinemia in CAE and to evaluate the usefulness of homocysteine-lowering therapies. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe Plasma soluble adhesion molecules; intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and E-selectin levels in patients with isolated coronary artery ectasia(Lippincott Williams & Wilkins, 2005) Turhan, H; Erbay, AR; Yasar, AS; Aksoy, Y; Bicer, A; Yetkin, G; Yetkin, EPlasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM)-1, vascular cell adhesion molecule-1 (VCAM-1) and E-selectin leves of patients with isolated coronary artery ectasia (CAE), patients with obstructive coronary artery disease without CAE and subjects with angiographically normal coronary arteries were evaluated. Patients with isolated CAE were detected to have significantly higher levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive coronary artery disease without CAE OCAM, 673 153 versus 381 +/- 106, respectively, P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 61 +/- 18, respectively, P = 0.01) and subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively, P < 0.001; VCAM-1, 2366 925 versus 729 231, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively, P < 0.001), suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in patients with isolated CAE. \ Background The common coexistence of coronary artery ectasia (CAE) with coronary artery disease (CAD) suggests that it may be a variant of CAD. However, it is not clear why some patients with obstructive CAD develop CAE whereas most do not. inflammation has been reported to be a major contributing factor to both obstructive and aneurysmatic vascular disorders and therefore, in the present study, the plasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin levels in isolated CAE were investigated. Methods The study population consisted of three groups: the first consisted of 32 patients with isolated CAE without stenotic lesion; the second of 32 patients with obstructive CAD without CAE; and the third group of 30 control subjects with normal coronary arteries. Coronary diameters were measured as the maximum diameter of the ectasic segment by use of a computerized quantitative coronary angiography analysis system. According to the angiographic definition used in the Coronary Artery Surgery Study, a vessel is considered to be ectasic when its diameter is greater than or equal to 1.5 times that of the adjacent normal segment in segmental ectasia. Plasma soluble ICAM-1, VCAM-1 and E-selectin levels were measured in all patients and control subjects using commercially available enzyme-linked immunosorbent assay kits. Results Patients with isolated CAE were found to have significantly higher levels of plasma soluble ICAM-1, VCAM-1, and E-selectin in comparison with patients with obstructive CAD without CAE (ICAM, 673 +/- 153 versus 381 +/- 106, respectively; P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 61 +/- 18, respectively; P = 0.01) and control subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively;, P < 0.001; VCAM-1, 2366 +/- 925 versus 729 +/- 231, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively; P < 0.001). In addition, we detected statistically significant positive correlation between the total length of ectasic segments and the levels of plasma soluble ICAM-1 (r=0.625; P < 0.001), VCAM-1 (r= 0.548; P= 0.001) and E-selectin (r=0.390; P=0.027). Multivariate logistic regression analysis revealed a significant independent relation between isolated CAE and ICAM-1 [odds ratio (OR)= 1.023; 95% confidence interval (CI) = 1.0048-1.0414; P= 0.0129] and VCAM-1 (OR = 1.0057; 95% Cl = 1.0007-1.0106; P= 0.0240). Conclusions We have shown that patients with isolated CAE have raised levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive CAD without CAE and control subjects with normal coronary arteries, suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in these patients. (C) 2005 Lippincott Williams Wilkins.
