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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017
386
AFRICA
coronary artery (LAD), left circumflex coronary artery (LCX)
and right coronary artery (RCA) were observed in various
angulations. CorT was evaluated on special angulations, the
LAD was assessed in the right anterior oblique view with cranial
angulations, and the LCX in the left anterior oblique with caudal
angulations, while the RCA was assessed in the right anterior
oblique view. CorT was identified by three or more bends
(defined as
≥
45° change in vessel direction) along the main trunk
of at least one artery, present both in systole and diastole.
1
Prior to coronary angiography, eight-hour postprandial
venous blood was collected from all patients for routine
laboratory testing. Haematological parameters, including
haemoglobin, haematocrit and white blood cell count were
analysed using an automated CBC device (Abbott Cell Dyn;
Abbott Laboratories, Effingham, Illinois, USA). Biochemical
parameters were measured using an Olympus AU 600 auto-
analyser (Olympus Optical Co, Ltd, Schimatsu-Mishima, Japan).
All study parameters were reviewed and approved by the local
ethics committee.
Statistical analysis
Statistical analysis was performed using the SPSS (version 20.0,
SPSS Inc, Chicago, Illinois) software package. Continuous
variables are expressed as mean
±
standard deviation (mean
±
SD)
and categorical variables as percentages (%). The Kolmogorov–
Smirnov test was used to evaluate the distribution of variables.
The Student’s
t
-test was used to evaluate continuous variables
showing normal distribution and the Mann–Whitney
U
-test was
used to evaluate variables that did not show normal distribution.
A
p
-value
<
0.05 was considered statistically significant.
To identify predictors of CorT, the following variables were
initially assessed in a univariate model: age, hypertension,
female gender, diabetes, hyperlipidaemia, current smoking and
haematological parameters. Significant variables in univariate
analysis were then entered into a multivariate logistic regression
analysis using backward stepwise selection.
Results
The coronary tortuosity and normal coronary groups
comprised 106 and 108 patients, respectively. The demographic
characteristics of both groups are summarised in Table 1.
There was no significant difference between the groups
regarding current smoking (28.3 vs 20.4%
p
=
0.176) (Table
1). There was no significant difference between the groups
regarding total cholesterol, high-density lipoprotein cholesterol
and triglyceride levels, haemoglobin, white blood cell and
neutrophil counts, C-reactive protein, urea and creatinine levels,
and ejection fraction [209.9
±
30.5 vs 206.3
±
31.8 mg/dl (5.44
±
0.79 vs 5.34
±
0.82 mmol/l),
p
=
0.478; 48
±
13.6 vs 43.3
±
5.6 mg/
dl (1.24
±
0.35 vs 1.12
±
0.12 mmol.l),
p
=
0.075; 152.4
±
27.4 vs
163.1
±
48.5 mg/dl (1.72
±
0.31 vs 1.84
±
0.55 mmol/l),
p
=
0.517;
13.3
±
1.5 vs 14.4
±
1.2 g/dl,
p
=
0.527; 6.96
±
2.12 vs 7.0
±
1.3
10
3
/
µ
l,
p
=
0.683; 4.35
±
1.6 vs 3.97
±
0.99 10
3
/
µ
l,
p
=
0.408; 0.48
±
0,14 vs 0.44
±
0.18 mg/dl,
p
=
0.267; 35.0
±
10.5 vs 38.7
±
5.8 mg/
dl,
p
=
0.428; 0.79
±
0.18 vs 0.83
±
0.12 mg/dl;
p
=
0.367; 60.4
±
2.5 vs 61.6
±
3.2%,
p
=
0.751, respectively] (Table 2).
However, there was a significant difference between the
groups regarding hypertension, with more hypertensive patients
in the CorT group (90.6 vs 50%,
p
<
0.001) (Table 1). There were
also significant differences between the groups regarding age,
female gender, diabetes mellitus and low-density lipoprotein
cholesterol levels [61.8
±
8.7 vs 52.9
±
8.1 years,
p
<
0.001; 70.8
vs 44.4%,
p
<
0.001; 18.9 vs 1.9%,
p
<
0.001; 139.9
±
24.7 vs
132.7
±
27.4 mg/dl (3.62
±
0.64 vs 3.44
±
0.71 mmol/l),
p
=
0.02,
respectively].
The median PCT, MPV, P-LCR, NLR and PLR values 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) (Table 2).
The results of univariate analyses are presented in Table 3.
On univariate analysis, age, diabetes mellitus, hypertension,
female gender, PCT and NLR were associated with CorT (Table
3). On multivariate analysis age, hypertension, diabetes mellitus
and PCR were independent predictors for CorT (OR 1.826; 95%
CI: 1.354–2.167;
p
<
0.001, OR 2.158; 95% CI: 1.462–2.937;
p
<
0.001, OR 1.583; 95% CI: 1.362–2.835;
p
<
0.001, OR 1.634; 95%
CI: 1.345–2.724;
p
<
0.001, respectively) (Table 4).
Table 1. General characteristics of the patients
Patient characteristics
Coronary tortuosity
p
-value
+
(
n
=
106)
–
(
n
=
108)
Age, years
61.8
±
6.1 (61)
52.9
±
8.1 (51)
<
0.001
Female gender,
n
(%)
75 (70.8)
48 (44.4)
<
0.001
Hypertension,
n
(%)
96 (90.6)
54 (50)
<
0.001
Diabetes mellitus,
n
(%)
20 (18.9)
2 (1.9)
<
0.001
Current smoking,
n
(%)
30 (28.3)
22 (20.4)
0.176
Table 2. Laboratory and echocardiographic parameters
Laboratory and
echocardiographic
variables
Coronary tortuosity
p-
value
+
(
n
=
106)
–
(
n
=
108)
Haemoglobin (g/dl)
13.3
±
1.5 (13.9)
14.4
±
1.2 (14.1)
0.527
Platelets (10
3
/
µ
l)
236.5
±
57.1 (229.0) 218.5
±
32.1 (219.0)
0.009
White blood cells (10
3
/
µ
l)
6.96
±
2.12 (6.84)
7.0
±
1.3 (6.9)
0.683
Mean platelet volume (fl) 10.6
±
1.4 (10.5)
9.5
±
0.65 (9.5)
<
0.001
Neutrophils (10
3
/
µ
l)
4.35
±
1.6 (4.1)
3.97
±
0.99 (4.39)
0.408
Lymphocytes (10
3
/
µ
l)
1.99
±
1 (1.96)
2.77
±
0.58 (2.65)
<
0.001
Neutrophil:lymphocyte
ratio
2.3
±
1 (2.06)
1.47
±
0.48 (1.45)
<
0.001
Platelet:large-cell ratio
29.3
±
6.7 (29)
23.4
±
5.1 (23.1)
<
0.001
Platelet:lymphocyte ratio 1.28
±
0.5 (1.1)
0.82
±
0.23 (0.8)
<
0.001
Plateletcrit (%)
0.26
±
0.16 (0.24)
0.21
±
0.03 (0.20)
<
0.001
C-reactive protein (mg/dl) 0.48
±
0.14 (0.45)
0.44
±
0.18 (0.41)
0.267
Total cholesterol (mg/dl) 209.9
±
30.5 (210)
206.3
±
31.8 (204)
0.478
[mmol/l]
[5.44
±
0.79 (5.44)]
[5.34
±
0.82 (5.28)]
High-density lipoprotein
cholesterol (mg/dl)
48
±
13.6 (45)
43.3
±
5.9 (43)
0.075
[mmol/l]
[1.24
±
0.35 (1.17)]
[1.12
±
0.15 (1.11)]
Low-density lipoprotein
cholesterol (mg/dl)
139.9
±
24.7 (148)
132.7
±
27.4 (134)
0.02
[mmol/l]
[3.62
±
0.64 (3.83)]
[3.44
±
0.71 (3.47)]
Triglycerides (mg/dl)
152.4
±
27.4 (134)
163.1
±
48.5 (154.5)
0.517
[mmol/l]
[1.72
±
0.31 (1.51)]
[1.84
±
0.55 (1.75)]
Urea (mg/dl)
35.0
±
10.5 (36)
38.7
±
5.8 (38)
0.428
Creatinine (mg/dl)
0.79
±
0.18 (0.76)
0.83
±
0.12 (0.80)
0.367
Ejection fraction (%)
60.4
±
2.5 (61.1)
61.6
±
3.2 (62.4)
0.751