Koroner arter tortuyozitesinin retinal arter tortuyozitesi ve karotis intima-media kalınlığı ile karşılaştırılması

Aim: Since an association between coronary tortuosity and carotid intimal-medial thickness has not been determined to date we conducted a prospective study to investigate the possible relationship between tortuosity of coronary arteries and carotid intimal-medial thickness. We therefore aimed to test our hypothesis: 1) Coronary tortuosity is a manifestation of subclinical atherosclerosis ? We sought to determine this hypothesis by comparing the coronary tortuosity with carotid intimal medial-thickness. 2) Coronary tortuosity is a piece of systemic arteriel tortuosity? We sought to determine this hypothesis by comparing the coronary artery tortuosity with retinal artery tortuosity.Methods: Patients with chest pain or positive exercise test referred to a single cardiac center for performing coronary angiography between February 2010 and May 2010, and who met the entry criteria for the study, were invited to participate. Subjects were excluded if they had significant coronary artery disease (presence of at least one lesion causing ? 50% diameter stenosis. The remaining 105 participants (aged 30?81 years) in this study were divided into two groups according to the presence of coronary tortuosity. Group 1 consisted of 58 individuals with tortuosity of coronary arteries, and group 2 consisted of 47 individuals without tortuosity of coronary arteries. Tortuosity was identified by the finding of ?3 bends (defined as ? 45o change in vessel direction) along the main trunk of at least one artery, present both in systole and in diastole. To determine subclinical atherosclerosis, maximum right and left intima-media thickness measured in the distal segment of both common carotid arteries, in mm. Subclinical atherosclerosis was defined as maximum right and left intima-media thickness ?1.0 mm. Ophthalmic evaluation included retinal tortuosity using digital imaging with a Topcon TRC-50IA retinal fundus camera without knowledge of the coronary tortuosity status of the patients.Results: The Group 1 included 58 patients (13 men and 45 women; mean age 55.5 ± 10 years) and the Group 2 included 47 patients (25 men and 22 women; mean age 53.8 ± 12 years). From all demographic variables and risk factors only female gender and smaller stature (height) were significantly associated with coronary angiographic tortuosity (p=0.001, p=0.01 respectively). Age, diabetes mellitus, hypertension, smoking, lipid profile, and BMI were not different between two groups. Identification of visible non-critical coronary angiographic plaque was not associated with coronary artery tortuosity. However, retinal artery tortuosity and retinal artery atherosclerosis were more common in patients with coronary artery tortuosity group (p<0.001, p=0.002, respectively). Likewise, carotid intima-media thickness was higher in participants with coronary tortuosity than without coronary tortuosity (p=0.001) and also presence of carotid artery plaque was more common in patients with tortuous coronary artery (p<0.001) group. There was significant correlation between presence of subclinical atherosclerosis and coronary artery tortuosity (p=0.005). Likewise, significant correlation were found between subclinical atherosclerosis and retinal artery tortuosity (p=0.02). Multivariate analysis was performed using stepwise logistic regression to obtain variables involved in tortuosity status. Coronary tortuosity was used as dependent variable. Following variables were used: gender, height, insignificant coronary artery visible plaque, carotid intima-media thickness, carotid artery plaque, retinal artery tortuosity and retinal artery atherosclerosis. Multivariate analysis identified female gender (p<0.008), retinal artery tortuosity (p<0.001), and carotid artery intima-media thickness (p=0.02) as independent predictors of coronary artery tortuosity.Conclusion: These results indicate that, whatever the mechanism is, 1) coronary artery tortuosity is associated with female gender and short stature, 2) coronary tortuosity is associated with subclinical atherosclerosis even in the present entirely normal appearence of coronary artery on angiography, 3) coronary tortuosity correlated with retinal artery implying that coronary tortuosity is a piece of systemic arterial tortuosity.Key Words: carotid intima-media thickness, Coronary tortuosity, retinal tortuosity, subclinical atherosclerosis