Arq Bras Cardiol abc Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia - SBC W7HT5dv4q7TKCXvW4KSVD8M 00055 S0066-782X2021000100055 abc.20200580 10.36660/abc.20200580 Minieditorial A Relação entre PCR e EAC: Associação de Proteína C Reativa para Proporção de Albumina em Pacientes com Ectasia Isolada da Artéria Coronária 0000-0001-5123-3080 Castro Iran 1 Fontana Hugo Antonio Filho 1 Instituto de Cardiologia Porto Alegre RS Brasil Instituto de Cardiologia - Direção científica, Porto Alegre, RS – Brasil Correspondência: Iran Castro • Instituto de Cardiologia - Direção científica - Av. Princesa Isabel, 395. CEP 90620-000, Santana, Porto Alegre, RS – Brasil E-mail: icastro@cardiol.br 03 02 2021 01 2021 116 1 55 55 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Doença Arterial Coronária Dilatação Patológica Aterosclerose Lipoproteínas Estresse Oxidativo Fatores de Risco

Ectasia arterial coronária (EAC), definida como um aumento do diâmetro coronariano 1,5 vez o diâmetro do leito adjacente normal,1 é um achado incomum em cineangiocoronariografias, com incidência de 1,2 a 4,9%.2 Na maioria das vezes, está relacionada com doença aterosclerótica coronariana (DAC),3 sendo que apresentam vários fatores em comum, como acumulação de lipoproteínas na camada íntima, infiltração de células inflamatórias, ativação do sistema renina-angiotensina e geração de estresse oxidativo, com expansão e remodelamento arterial. Os elevados níveis de oxido nítrico causam vasodilatação e ativação excessiva de metaloproteinases da matriz extracelular, resultando em dilatação vascular.4 Pode ainda, menos comumente, estar relacionada com doença de Kawasaky, doenças do tecido conjuntivo, infecciosas ou autoimunes.

A incidência é maior em homens, hipertensos e tabagistas. Usuários de cocaína apresentam maior incidência de EAC e aneurismas coronarianos.5 Interessantemente, diabetes melito (DM) parece não ter relação com EAC, podendo até mesmo ser fator protetor, fato relacionado com a inibição da expressão das metaloproteinases da matriz extracelular.6

A elevação da proteína C reativa (PCR) é fator amplamente relacionado com aumento da atividade inflamatória e do risco cardiovascular,7 - 8 assim como a redução dos níveis séricos de albumina (A).9

Em recente publicação10 com 102 pacientes com EAC e o mesmo número de participantes sem EAC, os autores demonstraram que pacientes com EAC apresentaram alta relação PCR/albumina (CAR) em comparação ao grupo-controle, levando à possibilidade de identificação de EAC e sua relação inflamatória, implicando prognóstico e manejo terapêutico. Este estudo é pioneiro em mostrar tal associação e certamente ajudará na prática cardiológica. No entanto, diferenciar se os níveis elevados desta relação estão relacionados a ectasia coronariana ou aos fatores de risco mais prevalentes no grupo de casos, como tabagismo, hipertensão e dislipidemia, e o consequente aumento da prevalência de DAC, ainda carece de estudos prospectivos ou que, talvez, usem como grupo controle pacientes com DAC e sem ectasia coronariana.

Referências 1. Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, et al. Aneurysmal coronary artery disease. Circulation. 1983;67(1):134-8. Swaye PS Fisher LD Litwin P Vignola PA Judkins MP Kemp HG et al Aneurysmal coronary artery disease Circulation 1983 67 1 134 138 2. Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J. 1985;54(4):392-5. Hartnell GG Parnell BM Pridie RB Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients Br Heart J 1985 54 4 392 395 3. Roberts WC. Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults. Am J Cardiol. 2011;108(6):814-21. Roberts WC Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults Am J Cardiol 2011 108 6 814 821 4. Johanning JM, Franklin DP, Han DC, Carey DJ, Elmore JR. Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion. J Vasc Surg. 2001;33(3):579-86. Johanning JM Franklin DP Han DC Carey DJ Elmore JR Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion J Vasc Surg 2001 33 3 579 586 5. Satran A, Bart BA, Henry CR, Murad BSM, Talukdar S, Satran BSD, et al. Increased prevalence of coronary artery aneurysms among cocaine users. Circulation. 2005;111(19):2424-9. Satran A Bart BA Henry CR Murad BSM Talukdar S Satran BSD et al Increased prevalence of coronary artery aneurysms among cocaine users Circulation 2005 111 19 2424 2429 6. Kornowski R, Mintz GS, Lansky AJ, Hong MK, Kent KM, Pichard AD, et al. Paradoxic decreases in atherosclerotic plaque mass in insulin-treated diabetic patients. Am J Cardiol. 1998;81(11):1298-304. Kornowski R Mintz GS Lansky AJ Hong MK Kent KM Pichard AD et al Paradoxic decreases in atherosclerotic plaque mass in insulin-treated diabetic patients Am J Cardiol 1998 81 11 1298 1304 7. Bisoendial RJ, Boekholdt SM, Vergeer M, Stroes ESG, Kastelein JJP. C-reactive protein is a mediator of cardiovascular disease. Eur Heart J. 2010;31(17):2087-91. Bisoendial RJ Boekholdt SM Vergeer M Stroes ESG Kastelein JJP C-reactive protein is a mediator of cardiovascular disease Eur Heart J 2010 31 17 2087 2091 8. Karadeniz M, Duran M, Akyel A et al. High sensitive CRP level is associated with intermediate and high SYNTAX score in patients with acute coronary syndrome. Int Heart J. 2015;56(4):377-80. Karadeniz M Duran M Akyel A et al High sensitive CRP level is associated with intermediate and high SYNTAX score in patients with acute coronary syndrome Int Heart J 2015 56 4 377 380 9. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, et al. Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome. Angiology. 2016;67(1):34-40. Kurtul A Murat SN Yarlioglues M Duran M Ocek AH Koseoglu C et al Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome Angiology 2016 67 1 34 40 10. Sercelik A, Tanrıverdi O, Askin L, Turkmen S. A associação da relação proteína C-reativa/albumina em pacientes com ectasia da artéria coronária isolada. Sercelik A Tanrıverdi O Askin L Turkmen S Nagumo MM Martinelli M Filho et al A associação da relação proteína C-reativa/albumina em pacientes com ectasia da artéria coronária isolada Arq Bras Cardiol 2021 116 1 48 54

A Associação da Relação Proteína C-Reativa/Albumina em Pacientes com Ectasia da Artéria Coronária Isolada

 Short Editorial The Relationship between CAR and CAE: Association of C-Reactive Protein to Albumin Ratio in Patients with Isolated Coronary Artery Ectasia 0000-0001-5123-3080 Castro Iran 1 Fontana Hugo Antonio Filho 1 Brazil Instituto de Cardiologia - Scientific direction, Porto Alegre, RS – Brazil Mailing Address: Iran Castro • Instituto de Cardiologia - Scientific direction - Av. Princesa Isabel, 395. Postal Code 90620-000, Santana, Porto Alegre, RS – Brazil E-mail: icastro@cardiol.br Coronary Artery Disease Dilatation, Pathologic Atherosclerosis Lipoproteins Oxidative Stress Risk Factors

Coronary artery ectasia (CAE), defined as an increase in coronary diameter 1.5 times the diameter of the normal adjacent bed,1 is an uncommon finding in coronary angiography, with an incidence of 1.2 to 4.9%.2 Most of the times, it is related to coronary atherosclerotic disease (CAD),3 and they have several factors in common, such as lipoprotein accumulation f in the intimal layer, inflammatory cell infiltration, activation of the renin-angiotensin system and oxidative stress generation, with arterial expansion and remodeling. The high levels of nitric oxide cause vasodilation and excessive activation of extracellular matrix metalloproteinases, resulting in vascular dilation.4 Less commonly, it can also be related to Kawasaky disease, connective tissue, infectious or autoimmune diseases.

The incidence is higher in men, hypertensive individuals and smokers. Cocaine users have a higher incidence of CAE and coronary aneurysms.5 Interestingly, Diabetes Mellitus (DM) seems to be unrelated to CAE, and may even be a protective factor, a fact related to the inhibition of the expression of extracellular matrix metalloproteinases.6

The increase in C-reactive protein (CRP) is a factor largely related to increased inflammatory activity and cardiovascular risk,7 , 8 as well as the reduction in serum albumin levels (A).9

In this recent publication10 with 102 patients with and the same number without CAE, the authors demonstrated that patients with CAE had a high CRP/albumin (CAR) ratio compared to the control group, leading to the possibility of identifying CAE and its inflammatory association, implying prognosis and therapeutic management. This study is a pioneer in showing this association, and will certainly help in cardiology practice; however, to differentiate whether the high levels of this association are related to coronary ectasia or to the most prevalent risk factors in the group of cases, such as smoking, hypertension and dyslipidemia, and the consequent increase in the prevalence of CAD, prospective studies are still necessary, or perhaps, using patients with CAD and without coronary ectasia as a control group.

Association of C-Reactive Protein to Albumin Ratio in Patients with Isolated Coronary Artery Ectasia