The coronary artery ectasia and ABO blood groups distribution

Б  том ХXXI, 2025, № 3 ДРУЖЕСТВО НА КАРДИОЛОЗИТЕ В БЪЛГАРИЯ АВТОРСКИ СТАТИИ ORIGINAL ARTICLES THE CORONARY ARTERY ECTASIA AND ABO BLOOD GROUPS DISTRIBUTION THE CORONARY ARTERY ECTASIA AND ABO BLOOD GROUPS DISTRIBUTION H. Nough1, A. Amani2, A. Andishmand1, M. Emami1, S. Vaziribozorg3, A. Nough2 1Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences – Yazd, Iran 2General Practitioner, Shahid Sadoughi University of Medical Sciences – Yazd, Iran 3Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences – Yazd, Iran ЕКТАЗИЯ НА КОРОНАРНИТЕ АРТЕРИИ И РАЗПРЕДЕЛЕНИЕ НА КРЪВНИТЕ ЕКТАЗИЯ НА КОРОНАРНИТЕ АРТЕРИИ И РАЗПРЕДЕЛЕНИЕ НА КРЪВНИТЕ ГРУПИ ABO ГРУПИ ABO Х. Наф1, А. Амани2, А. Андишманд1, M. Емами1, С. Вазирибозорг3, A. Наф3 1Център за сърдечно-съдови изследвания, Медицински университет „Шахид Садуги“ – Язд, Иран 2Общопрактикуващ лекар, Медицински университет „Шахид Садуги“ – Язд, Иран 3Център за оториноларингологични изследвания, Медицински университет „Шахид Садуги“ – Язд, Иран Abstract. Introduction: Pure coronary artery ectasia (CAE) was defi ned as segmental or diffuse coronary artery dilatation ≥ 1.5-fold the adjacent normal segment in the absence of ≥ 50% stenosis in any epicardial vessel. Previous studies on the relationship between ABO blood groups and ischemic heart disease have reported inconsistent fi ndings. This study aimed to investigate the distribution of blood groups in patients with pure CAE. Methods: This descriptive cross-sectional study included 250 patients diagnosed with pure CAE based on angiography fi ndings between 2015 and 2022 at two teaching hospitals. Data on age, gender, ABO blood group, Rh factor, white blood cell (WBC) count, lymphocyte and neutrophil percentages, and number of involved coronary vessels were collected. A control group was selected from patients undergoing coronary angiography in 2019-2020 without CAE and matched with the CAE group. Statistical analyses included Chi-square, Fisher’s Exact test, T-test, ANOVA, and logistic regression. Results: The mean age of patients was 56.2 ± 12.5 years; 160 (64%) were male and 90 (36%) were female. Rh positivity was observed in 222 (88.8%) patients, while 28 (11.2%) were Rh-negative. Blood group distribution among CAE patients was: O, 41.6%; B, 30.4%; A, 21.6%; and AB, 6.4%. Compared with the control group, a signifi cantly higher frequency of blood group O was observed among CAE patients (P < 0.001). In multivariable logistic regression adjusted for age, gender, and number of involved vessels, blood group O remained independently associated with CAE (OR = 1.78, 95% CI: 1.12–2.82, P = 0.015). Conclusion: Blood group O was signifi cantly more frequent among CAE patients compared with controls, even after adjusting for confounders. Key words: coronary artery ectasia; ABO blood group; coronary angiography; Rh factor Address for correspondence: Arman Nough, General Practitioner, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, е-mail: [email protected] Резюме.Въведение: Чистата ектазия на коронарната артерия (coronary artery ectasia – CAE) се дефинира като сегментна или дифузна дилатация на коронарната артерия ≥ 1,5 пъти по-голяма от съседния нормален сегмент при липса на ≥ 50% стеноза в някой от епикардните съдове. Предходни проучвания за връзката между кръвните групи ABO и исхемичната болест на сърцето докладват противоречиви резултати. Настоящото проучване има за цел да изследва разпределението на кръвните групи при пациенти с чиста CAE. Материал и методи: Това описателно кроссекционно проучване включва 250 пациенти, диагностицирани с чиста CAE въз основа на ангиографските им резултати и е проведено между 2015 и 2022 г. в две университетски болници в Иран. Бяха събрани данни за възраст, пол, кръвна група ABO, Rh фактор, брой на белите кръвни клетки (WBC), процентно съотношение на лимфоцити и неутрофили и брой на засегнатите коронарни съдове. Контролната група бе подбрана сред пациенти, подложени на коронарна ангиография през 2019-2020 г. без CAE и съпоставена с групата с CAE. Статистическите анализи включваха: хи-квадрат, точен тест на Фишър, T-тест, ANOVA и логистична регресия. Резултати: Средната възраст на пациентите бе 56,2 ± 12,5 г. 160 (64%) бяха мъже и 90 (36%) – жени. Rh-положителна кръвна група беше наблюдавана при 222-ма (88,8%) пациенти, докато 28 (11,2%) бяха Rh-отрицателни. Разпределението на кръвните групи сред пациентите с CAE беше: O – 41,6%; B – 30,4%; A – 21,6%; и AB – 6,4%. В сравнение с контролната група сред пациентите с CAE се наблюдаваше значително по-висока честота на кръвна група O (p < 0,001). При мултивариативна логистична регресия, коригирана за възраст, пол и брой засегнати съдове, кръвната група O остана независимо свързана с CAE (OR = 1,78, 95% CI: 1,12-2,82, p = 0,015). Заключение: Кръвната група O се срещаше значително по-често сред пациентите с CAE в сравнение с контролната група, дори и след коригиране за смесващи фактори. Ключови думи:ектазия на коронарната артерия; кръвна група ABO; коронарна ангиография; Rh фактор Адрес за кореспонденция:д-р Арман Наф, общопрактикуващ лекар, МУ „Шахид Садуги“, Язд, Иран, е-mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. doi: 10.3897/bgcardio.31.e163761 H. Nough, A. Amani, A. Andishmand et al. 78 I Coronary artery ectasia (CAE) is defi ned as diff use or localized dilation of a coronary artery ≥ 1.5 times the diameter of the adjacent normal segment. The prevalence of CAE ranges from 0.6 to 12.7%, and patients often present with chest pain. Etiologies include degenerative, congenital, infl ammatory, viral, and traumatic causes. Although CAE is most often associated with atherosclerosis, it may also occur as a compensatory mechanism in coronary stenosis or in association with anomalies such as coronary fi stulas and anomalous origins of coronary arteries [1]. Markis et al. classifi ed CAE into four types: Type I, diff use ectasia in two or three vessels; Type II, diff use ectasia in one vessel with localized ectasia in another; Type III, diff use ectasia confi ned to one vessel; and Type IV, localized segmental ectasia [2]. Pure CAE was defi ned as segmental or diff use coronary artery dilatation ≥ 1.5-fold the adjacent normal segment in the absence of ≥ 50% stenosis in any epicardial vessel [3-5]. Coronary angiography or CT angiography is typically required for diagnosis [6]. The ABO blood group system is a carbohydrate polymorphism with antigenic structures on red blood cells determined by glycoproteins and glycolipids [6, 7]. Since the 1960s, ABO groups have been linked to venous thrombosis and ischemic heart disease, with non-O groups showing ~25% higher von Willebrand factor (VWF) levels than group O, conferring greater thrombotic risk [8-10]. However, results regarding ischemic heart disease and blood groups are inconsistent [11]. Given these contradictions, we aimed to investigate the relationship between ABO blood groups and pure CAE. M  M This cross-sectional study was approved by the local ethics committee, and written informed consent was obtained. A total of 369 patients with CAE undergoing angiography between 2015 and 2022 were screened at two teaching hospitals. After excluding 119 patients (2 deceased, 19 lost to follow-up, 98 with incomplete records), 250 patients with pure CAE were included. Pure CAE was defi ned as segmental or diff use coronary artery dilatation ≥ 1.5-fold the adjacent normal segment in the absence of ≥ 50% stenosis in any epicardial vessel, confi rmed by an interventional cardiologist. Data collected included age, sex, ABO blood group, Rh factor, WBC count, lymphocyte and neutrophil percentages, and number of involved vessels (LAD, LCX, RCA). A control group was selected from patients undergoing angiography in 2019-2020 without CAE and matched with the CAE group. ABO distribution in the general Yazd population was obtained from the Blood Transfusion Organization [12]. Data were analyzed using SPSS version 22. Chi-square, Fisher’s Exact, T-test, and ANOVA were applied. In addition, binary logistic regression was performed to evaluate the independent association between ABO groups and CAE, adjusting for age, sex, and vessel involvement. Results were reported as odds ratios (OR) with 95% confi dence intervals (CI). P-value < 0.05 was considered signifi cant. R Of the 250 patients, 160 (64%) were male and 90 (36%) female. The mean age was 56.2 ± 12.5 years (range: 27-93). Single-vessel ectasia occurred in 81 (32.4%), double-vessel in 79 (31.6%), and triple-vessel in 90 (36%) patients. WBC counts ranged from 1.3 × 10³/μL to 15.6 × 10³/μL (mean 7.49 ± 2). Lymphocyte percentages ranged from 10% to 93% (mean 33.5 ± 10.4), and neutrophil percentages from 25% to 87% (mean 59.3 ± 10.5). Among CAE patients, blood group O was most common (41.6%), followed by B (30.4%), A (21.6%), and AB (6.4%). Rh positivity was 88.8%. In the control group, blood groups were: A, 27%; B, 30.6%; AB, 12%; and O, 30.4%. Signifi cant diff erences were observed for blood group O (P = 0.001) and AB (P = 0.006), but not for A (P = 0.054), B (P = 0.945), or Rh factor (P = 0.188) (Table 3). Logistic regression showed blood group O remained independently associated with CAE (OR = 1.78, 95% CI: 1.12-2.82, P = 0.015). Groups A, B, and AB were not signifi cantly associated after adjustment. Table 1. Demographic characteristics of the control group (n = 250) Mean age 53.9 ± 13.6 years Male 61.3% Female 38.7% Rh-positive 85.9% Rh-negative 14.1% Table 2. Clinical and laboratory variables of CAE patients (n = 250) Variables Frequency Age 56.2 ± 12.5 years Gender Male 64% Female 36% Vessels 132.4% 231.6% 336% WBC 7.49 ± 2 (range: (1.3–15.6) × 10³/μL) Lymphocyte% 33.5 ± 10.4 (range: 10–93) Neutrophil% 59.3 ± 10.5 (range: 25–87) 79 The coronary artery ectasia and ABO blood groups... Table 3. Comparison of ABO and Rh blood group distribution between CAE patients and controls Blood group CAE patients (%) Controls (%) P-value A 21.6 27.0 0.054 B 30.4 30.6 0.945 AB 6.4 12.0 0.006 O 41.6 30.4 0.001 Rh+88.8 85.9 0.188 Rh–11.2 14.1 – D CAE is a relatively uncommon coronary abnormality with reported prevalence ranging from 0.6 to 12.7% [1]. In our study, blood group O was signifi cantly more frequent in CAE patients compared to controls, and this association persisted after multivariable adjustment. Previous studies largely report non-O groups as risk factors for ischemic heart disease, due to higher plasma VWF and factor VIII levels [8-10]. For example, Carpeggiani et al [9] and Sun et al. found non-O blood groups associated with atherosclerosis [13]. Conversely, Omidi et al [14] and Biswas et al [15] observed more severe coronary involvement in blood group O, supporting our results. These discrepancies may refl ect diff erences between CAE and typical atherosclerotic coronary disease, as CAE may be more infl uenced by vascular remodeling and infl ammatory processes rather than thrombosis alone. Our results are consistent with reports showing CAE is more common in men [1618] and typically presents in the sixth decade of life. The distribution of single-, double-, and triple-vessel involvement in our cohort was similar to prior Iranian studies [19]. Taken together, our fi ndings suggest a distinct role of blood group O in CAE compared to its role in ischemic atherosclerotic disease. However, the cross-sectional design limits causal inference. C Blood group O was signifi cantly more prevalent in patients with CAE compared to controls, and this association remained signifi cant after adjusting for confounders, while our fi ndings suggest a potential link between blood group O and CAE. Limitations: Low sample size was one of our main study limitations. Recommendations: Large, prospective, multicenter studies are recommended to confi rm this relationship and clarify underlying mechanisms. Compliance with Ethical Standards: Authors have no confl icts of interest. 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