Cardiovascular Journal of Africa: Vol 31 No 5 (September/October 2020)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020 AFRICA 227
Cardiovascular Topics
A new inflammatory marker: elevated eosinophil-to-
lymphocyte ratio associated with presence and severity
of isolated coronary artery ectasia
Mücahid Yilmaz, Hidayet Kayançiçek, Hasan Korkmaz, Nevzat Gözel, Mehmet Nail Bilen, Özlem
Seçen, Pinar Öner, Ökkeş Uku, Suat Demirkiran, Yusuf Çekici, Orkun Eroğlu, Kurtoğlu Ertu ğrul
Abstract
Objectives: The pathophysiology of isolated coronary artery
ectasia (CAE) involves atherosclerosis and inflammation.
Eosinophils and lymphocytes have been found to play a
significant role in inflammation, atherosclerosis and endothe-
lial dysfunction. Many studies have explored the relation-
ship between isolated CAE and systemic inflammation.
However, there are no data regarding the relationship between
eosinophil-to-lymphocyte ratio (ELR) and isolated CAE.
Therefore, this study analysed the relationship between ELR
and isolated CAE.
Methods: All patients who underwent coronary angiography
between January 2009 and June 2018 were investigated retro-
spectively. Of 16 240 patients, 232 patients with isolated CAE
(141 males) and 247 age- and gender-matched control subjects
(130 males) with normal coronary angiography (NCA) were
enrolled in this study. Baseline demographic and laboratory
data were obtained from the hospital database. The severity
of isolated CAE was determined according to the Markis
classification, vessel count and diffuseness of ectasia.
Results: Patients with angiographic isolated CAE had signifi-
cantly elevated white blood cell (WBC) and eosinophil counts
and ELR values compared to patients with NCA [8.11 ±
1.75 vs 7.49 ± 1.80 × 109 cells/l, p < 0.0001; 0.22 (0.13–0.32)
vs 0.19 (0.12–0.28) × 109 cells/l, p = 0.02; 0.11 (0.06–0.17) vs
0.08 (0.05–0.12), p < 0.0001. The ELR value for Markis I
was significantly higher than for Markis IV (p = 0.04), and
three-vessel isolated CAE was significantly higher than one-
vessel isolated CAE (p = 0.04). Additionally, the ELR value
for diffuse ectasia (Markis class I, II and III) was significantly
higher compared to focal (Markis class IV) ectasia ( p = 0.02).
In receiver operating characteristics (ROC) analyses, it was
determined that an ELR value > 0.099, measured in isolated
CAE patients at application, had a predictive specificity of
60.3% and a sensitivity of 56.5% (area under the curve: 0.604,
95% confidence interval: 0.553–0.655, p < 0.0001).
Conclusion: Patients with isolated CAE had higher blood
eosinophil counts and ELR. Furthermore, the ELR was
significantly correlated with severity of isolated CAE. These
findings demonstrate that ELR may have a significant role in
the aetiopathogenesis of isolated CAE.
Keywords: eosinophil count, eosinophil-to-lymphocyte ratio,
isolated coronary artery ectasia, inflammation
Submitted 17/4/19, accepted 21/8/19
Published online 2/10/20
Cardiovasc J Afr 2020; 31: 227–235
DOI: 10.5830/CVJA-2019-049
Coronary artery ectasia (CAE) is a congenital or acquired
coronary anomaly. CAE is described as the local or wide
extension of a partial or entire epicedial coronary artery
that is 1.5 times larger than the diameter of the adjacent
Department of Cardiology, Elazığ Medical Park Hospital
and Department of Cardiology, Istinye University, Elazığ,
Turkey
Hidayet Kayançiçek, MD
Suat Demirkıran, MD
Department of Cardiology, Fırat University School of
Medicine, Elazığ, Turkey
Hasan Korkmaz, MD
Department of Internal Medicine, Fırat University School of
Medicine, Elazığ, Turkey
Nevzat Gözel, MD
Department of Cardiology, Elazığ Education and Research
Hospital, Elazığ , Turkey
Mücahid Yilmaz, MD,
Mehmet Nail Bilen, MD
Özlem Seçen, MD
Ökkeş Uku, MD
Yusuf Çekici, MD
Department of Microbiology, Elazığ Education and
Research Hospital, Elazığ , Turkey
Pinar Öner, MD
Department of Ear, Nose and Throat, Elazığ Education and
Research Hospital, Elazığ , Turkey
Orkun Eroğlu, MD
Department of Cardiology, Malatya Education and
Research Hospital, Malatya, Turkey
Kurtoğlu Ertuğrul, MD