40 / 64
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 3, May/June 2020
148
AFRICA
apoptosis and phagocytosis, as well as in pathological processes
such as inflammation, fibrosis and atherosclerosis.
10-13
It has
been suggested that it plays a key role in atherogenesis through
increased phagocytosis and induction of the proliferation of
vascular smooth muscle cells (VSMCs).
14,15
In addition, Gal-3 has been shown to play a central
pathophysiological role in the development of cardiovascular
diseases by enhancing cardiac hypertrophy, fibrosis, arterial
stiffness, inflammation and oxidative stress during cardiovascular
remodelling.
8
Recent studies have demonstrated not only the
potential role of Gal-3 in atherogenesis, but also an association
between increased Gal-3 expression and the development of
atherogenesis.
15
In the literature, there are several studies carried out in
animal and human models. In an animal model, inhibition of
Gal-3 was found to be associated with decreased atherosclerotic
plaque volume in mice with apolipoprotein E deficiency.
16
In a
recent study, the utility of Gal-3 as a diagnostic and prognostic
marker for cardiovascular conditions was reported.
17
In the light
of these data, Gal-3, which is associated with inflammation and
atherosclerosis, may play a major role in coronary artery disease
(CAD) as well as in CAE, which is considered to represent a
variant of CAD and to have a similar aetiopathology and clinical
course.
18
To the best of our knowledge, there is no study in the
literature examining serum Gal-3 levels in patients with isolated
CAE. In this study therefore we aimed to investigate the possible
relationship between serum Gal-3 levels and isolated CAE.
Methods
In this prospective, case-controlled study, we included a total of
49 consecutive isolated CAE patients diagnosed with CAE by
coronary angiography at the catheter laboratory of Medeniyet
University, Goztepe Training and Research Hospital between
March 2016 and March 2017. The control group consisted
of a total of 43 individuals with normal coronary arteries.
Detailed demographic data were obtained from each patient.
Physical examination, medical history, blood biochemistry and
transthoracic echocardiography were performed in both groups
to rule out systemic conditions.
Hypertension was defined as a systolic blood pressure of ≥
140 mmHg and/or a diastolic blood pressure of ≥ 90 mmHg
or current use of hypertensive agents. Diabetes was defined as
fasting blood glucose of > 126 mg/dl (6.99 mmol/l) or current
use of a diet or oral antidiabetic agents to lower blood glucose
levels. The use of anti-hyperlipidaemic agents or a fasting plasma
total cholesterol of > 200 mg/dl (5.18 mmol/l) or a low-density
lipoprotein cholesterol (LDL-C) of > 130 mg/dl (3.37 mmol/l)
were considered to denote hyperlipidaemia.
Exclusion criteria were as follows: the presence of acute
coronary syndrome, left ventricular dysfunction (ejection
fraction < 50%), left ventricular hypertrophy, valvular heart
disease, peripheral vascular disease, congenital cardiac disease,
hepatic, renal, inflammatory or connective tissue, infectious or
autoimmune disorders and malignancy.
A written informed consent was obtained from each
participant. The study protocol was approved by the local ethics
committee. The study was conducted in accordance with the
principles of the Declaration of Helsinki.
Morning venous blood samples were obtained after 12
hours of fasting. Serum glucose, creatinine, high-sensitivity
C-reactive protein (hs-CRP), total cholesterol, LDL-C, high-
density lipoprotein cholesterol (HDL-C) and triglycerides were
measured using standard laboratory methods. Additional blood
sampling was performed to measure serumGal-3 concentrations.
Blood samples were immediately centrifuged at 1 000 μg for 15
minutes and sera were separated and stored at –80°C until Gal-3
assays. Serum Gal-3 concentrations were analysed in a blinded
manner using a commercial enzyme-linked immunosorbent assay
(ELISA) in accordance with the manufacturer’s instructions
(eBioscience, CA, USA). The values were normalised to the
standard curve. Intra-assay and inter-assay variance for Gal-3
at a Gal-3 concentration of 1.5 ng/ml were 6.4 and 11.4%,
respectively.
Indications for coronary angiography were the presence of
typical angina pectoris symptoms or suspicious or positive test
results in non-invasive methods to assess coronary ischaemia
(dobutamine stress echocardiography, treadmill test ormyocardial
perfusion scintigraphy). Coronary angiography was performed
using the Judkins technique with left heart catheterisation and
without the use of nitroglycerine (Siemens, Medical Solutions
2007, Munich, Germany). The angiography results were based
on agreement between two experienced angiography specialists
blinded to the study groups. Isolated CAE was defined as the
dilatation of coronary arteries with a diameter of 1.5 times or
greater than that of the adjacent normal coronary artery without
significant stenotic lesions.
1,2
In the absence of an identifiable adjacent normal segment,
the mean diameter of the corresponding coronary segment in
the control group was accepted as the normal value. The severity
of ectasia was defined according to the Markis classification
on the basis of the extent of ectatic involvement, as follows,
in decreasing order of severity: diffuse ectasia in two or three
vessels (type 1); diffuse involvement in one vessel and segmental
involvement in another vessel (type 2); diffuse involvement in a
single vessel (type 3); and segmental or localised involvement
(type 4).
7
Statistical analysis
Statistical analysis was performed using the Statistical Package
for the Social Sciences (SPSS) version 22.0 software (IBM
Corp, Armonk, NY, USA). Descriptive data are expressed as
mean ± standard deviation (SD), median (min–max) or number
and frequency. The distribution of variables was analysed
using the Kolmogorov–Smirnov test. The Mann–Whitney
U
-test
and independent samples
t
-test were used for the analysis of
quantitative data. The chi-squared test was used for analysis
of qualitative data, and Fisher’s exact test was used when the
chi-squared test was not suitable. The impact level and cut-off
values were assessed using receiver operating characteristic
(ROC) curves. The impact level was examined using univariate
and multivariate logistic regression analyses. A
p-
value of < 0.05
was considered statistically significant.
Results
In the study population there were 31 males and 18 females in the
isolated CAE group and 19 males and 24 females in the control