Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017 AFRICA 385
Relationship between coronary tortuosity and plateletcrit
coronary tortuosity and plateletcrit
Levent Cerit, Zeynep Cerit
Abstract
Background: Coronary tortuosity (CorT) is a common angio-
graphic finding and may be associated with myocardial
ischaemia, even without coronary artery disease. Platelets
play a crucial role in inflammatory and thrombotic processes
and the physiopathology of cardiovascular disease. Larger
platelets are more active enzymatically and have higher
thrombotic ability compared to smaller platelets. Plateletcrit
(PCT) provides complete information on total platelet mass.
We aimed to evaluate the relationship between CorT and PCT
in patients with chronic stable angina.
Methods: The medical records of consecutive patients
who underwent coronary angiography from January 2013
to January 2016 were retrospectively reviewed for CorT.
CorT and clinical, echocardiographic, haematological and
biochemical parameters were evaluated. Taking into consid-
eration the inclusion criteria, 106 patients with CorT and 108
with normal coronary angiographies (control group) were
included in the study. CorT was defined as three fixed bends
during both systole and diastole, with each bend ≥ 45°.
Results: The median PCT, mean platelet volume (MPV),
platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio
(NLR) and platelet:lymphocyte ratio (PLR) of the CorT
group were significantly higher than those of the control
group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6
± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1
vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001,
respectively). The incidence of diabetes mellitus, hyperten-
sion and female gender were significantly higher in the CorT
group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8
vs 44.4%, p < 0.001, respectively). Multivariate logistic regres-
sion analysis revealed age, hypertension, diabetes mellitus and
plateletcrit were independently associated with CorT.
Conclusion: CorT was associated with increased PCT, MPV,
P-LCR, NLR and PLR, even in the absence of coronary
artery disease. Age, hypertension, diabetes mellitus and
plateletcrit were independently associated with CorT.
Keywords: coronary angiography, plateletcrit, mean platelet
volume
Submitted 2/6/16, accepted 11/4/17
Published online 26/4/17
Cardiovasc J Afr 2017; 28: 385–388
DOI: 10.5830/CVJA-2017-023
Coronary tortuosity (CorT) is a common coronary angiographic
finding. CorT is defined as three fixed bends during both systole
and diastole in at least one epicardial artery, with each bend
showing a 45° change in vessel direction. 1 The aetiology, clinical
implications and long-term prognosis are not well clarified.
Clinical studies have demonstrated that CorT may be related
to aging, hypertension, atherosclerosis and diabetes mellitus.2,3
CorT is associated with reversible myocardial perfusion defects
and chronic stable angina.4,5 Zegers et al.6 demonstrated three
cases of patients with CorT and hypothesised that CorT may
lead to ischaemia. Patients with CorT may suffer from effort-
induced chest pain and pain at rest.6 The relationship between
CorT and coronary atherosclerosis is unclear.
Platelets play a key role in the genesis of thrombosis.
Platelets, the amount of which in the blood is indicated with
plateletcrit (PCT), are important for inflammation, thrombosis
and cardiovascular pathophysiology. Increased mean platelet
volume (MPV) has been found to be associated not only with
coronary artery disease but also with carotid artery disease,
deep-vein thrombosis and pulmonary embolism.7-9 Platelets with
larger volumes are more active and vulnerable and therefore are
a topic of interest in the development of atherosclerosis.10
PCT provides more comprehensive data about total platelet
mass because it is equivalent to MPV and platelet count (PLT),
where PCT = PLT × MPV/107. To the best of our knowledge,
PCT and its association with CorT has not been previously
reported. In this study, we investigated the relationship between
all platelet markers and CorT.
Methods
A retrospective evaluation was performed of consecutive patients
undergoing coronary angiography due to stable angina pectoris.
Stable angina was defined as discomfort in the chest, back, jaw,
shoulder or arms, typically elicited by exertion or emotional
stress, and relieved by rest or nitroglycerin. All patients enrolled
in the study underwent coronary angiography as a result of chest
pain and objective signs of ischaemia during treadmill exercises.
Routine laboratory and clinical parameters (hypertension,
hypercholesterolaemia, diabetes mellitus and tobacco use) were
obtained from the patient medical records. Study exclusion criteria
included acute or chronic hepatic and renal failure, chronic
obstructive pulmonary disease, peripheral and cerebral arterial
disease, inflammatory diseases, congenital heart disease, restrictive
cardiomyopathy, dilated cardiomyopathy, hypothyroidism,
hyperthyroidism, malignancies, autoimmune diseases, acute or
chronic infectious disease, coronary ectasia, severe coronary
artery disease, coronary slow flow, mild-to-severe valvular disease,
heart failure, anaemia and patients on anti-aggregation therapy.
All patients underwent coronary angiography according to
the Judkins technique. Angiograms were reviewed by at least
two blinded reviewing cardiologists. The left anterior descending
Near East University Hospital, Nicosia, Cyprus
Levent Cerit, MD,
Zeynep Cerit, MD