Isolated coronary artery ectasia debate: Inflammation versus atherosclerosis

BackgroundThe underlying pathogenesis of isolated coronary artery ectasia (CAE) is still unknown. The aim of this study was to shed light on the potential mechanisms underlying the development of isolated CAE and its relation to carotid intima media thickness (IMT) and certain inflammatory markers especially adhesion molecules and uric acid.MethodsThe study included 16 patients with isolated CAE, 16 patients with obstructive coronary artery disease (CAD) without CAE, and 10 gender and age matched subjects with normal coronary arteries as control group. All patients underwent diagnostic coronary angiography, B-mode ultrasonography to measure carotid IMT, and serum levels of soluble intercellular adhesion molecule (ICAM-1), E-selectin and uric acid.ResultsSerum ICAM-1 levels were found to be significantly higher in patients with isolated CAE compared to CAD and control subjects (p = 0.0001). E-selectin levels showed no difference between the three groups, while serum uric acid was significantly higher in patients with isolated CAE and patients with obstructive CAD compared to control group (p = 0.004). There were no difference in carotid IMT between isolated CAE and CAD. Univariate analysis showed that the carotid IMT, serum levels of ICAM-1, E-selectin, and uric acid were related with CAE. ICAM-1 was the independent variable most strongly associated with CAE by multiple linear regression analysis (p = 0.0001).ConclusionIsolated CAE reflects atherosclerosis associated with high grade vascular inflammation out of proportion to, atherosclerotic involvement. Serum levels of ICAM-1 were the most independent predictor of vascular inflammation.