Can Serum Endocan Levels Predict the Presence and Severity of Coronary Artery Ectasia?

Document Type: Original Article


1 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, IR Iran.

2 Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences and Department of Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran.


Background: The aim of this study was to investigate the relationship between serum endothelial cellspecific molecule-1 endocan levels and coronary artery ectasia (CAE).
Methods: This cross-sectional study was conducted on 99 patients. According to angiographic data, the patients were divided into 3 groups: 1) patients with isolated CAE (n = 33), 2) patients with documented coronary artery diseases without CAE (n = 33), and 3) those with normal coronary arteries (n = 33). The endocan concentration was measured via the ELISA technique.
Results: patients with isolated CAE had significantly lower levels of endocan than did the controls (261.30 ± 61.34 vs 564.58 ± 81.69; P < 0.05). There was no significant correlation between endocan levels and the severity of CAE according to the Markis classification (P > 0.05). The patients who used opium had a significantly higher prevalence rate of CAE (65.6% vs 35.3%; P = 0.012). Moreover, in the group with ectasia, by comparison with the non-ectatic group, significantly high levels of serum triglyceride, cholesterol, and LDL levels, as well as low HDL levels, were detected.
Conclusions: Among our study population, a decrease in endocan levels was a sensitive and accurate indicator for predicting the presence of CAE, although the level of this marker was not very effective in determining the severity of ectasia. In addition to a drop in endocan expression levels, the use of opium and also an abnormal lipid profile were the other predictors of CAE.


1. LaMotte, L.C. and V.S. Mathur, Atherosclerotic
coronary artery aneurysms: eight-year
angiographic follow-up. Texas Heart Institute
Journal, 2000. 27(1): p. 72.
2. Bermúdez, E.P., et al., Coronary ectasia:
prevalence, and clinical and angiographic
characteristics. Revista espanola de cardiologia,
2003. 56(05): p. 473-479.
3. Díaz-Zamudio, M., et al., Coronary artery
aneurysms and ectasia: role of coronary CT
angiography. Radiographics, 2009. 29(7): p.
4. Swanton, R., et al., Coronary artery ectasia--a
variant of occlusive coronary arteriosclerosis.
Heart, 1978. 40(4): p. 393-400.
5. Aintablian, A., et al., Coronary ectasia:
incidence and results of coronary bypass
surgery. American heart journal, 1978. 96(3): p.
6. Befeler, B., et al ,.Coronary artery aneurysms:
study of their etiology, clinical course and effect
on left ventricular function and prognosis. The
American journal of medicine, 1977. 62(4): p.
7. Swaye, P.S., et al., Aneurysmal coronary artery
disease. Circulation, 1983. 67(1): p. 134-138.
8. Krüger, D., et al., Exercise-induced myocardial
ischemia in isolated coronary artery ectasias and
aneurysms (“dilated coronaropathy”). Journal of
the American College of Cardiology, 1999.
34(5): p. 1461-1470.

9. Manginas, A. and D.V. Cokkinos, Coronary
artery ectasias: imaging, functional assessment
and clinical implications. European heart
journal, 2006. 27(9): p. 1026-1031.
10. Bohórquez, R., et al., Aneurysmatic coronary
artery disease: Presentation of a case and review
the literature. Acta Medica Colombiana, 2009.
34(1): p. 38-41.
11. Abou Sherif, S., et al., Coronary artery
aneurysms: a review of the epidemiology,
pathophysiology, diagnosis, and treatment.
Frontiers in cardiovascular medicine, 2017. 4: p.
12. Markis, J.E ,.et al., Clinical significance of
coronary arterial ectasia. American Journal of
Cardiology, 1976. 37(2): p. 217-222.
13. Yetkin, E. and J. Waltenberger, Novel insights
into an old controversy. Clinical research in
cardiology, 2007. 96(6): p. 331-339.
14. Erkan, H., et al., Coronary artery calcification
score is increased in patients with isolated
coronary artery ectasia. Clinical & Investigative
Medicine, 2013. 36(4): p. 191-196.
15. Keser, A., et al., Relationship between red cell
distribution with levels and severity of coronary
artery ectasia. European review for medical and
pharmacological sciences, 2016. 20: p. 1571-
16. Demir, M., C. Demir, and S. Keceoglu, The
relationship between blood monocyte count and
coronary artery ectasia. Cardiology research,
2014. 5(5): p. 151.
17. Kundi, H., et al., Relationship between plateletto-lymphocyte ratio and the presence and
severity of coronary artery ectasia. Anatolian
journal of cardiology, 2016. 16(11): p. 857.
18. Varol, E., et al., Mean platelet volume has a
prognostic value in patients with coronary artery
ectasia. Clinical and Applied
Thrombosis/Hemostasis, 2012. 18(4): p. 387-
19. Delehedde, M., et al., Endocan in cancers: a
lesson from a circulating dermatan sulfate
proteoglycan. International journal of cell
biology, 2013. Article ID 705027, 11 pages.
20. Tsai, J.C., et al., Cloning and characterization of
the human lung endothelial-cell-specific
molecule-1 promoter. Journal of vascular
research, 2002. 39(2): p. 148-159.
21. Aitkenhead, M., et al., Identification of
endothelial cell genes expressed in an in vitro
model of angiogenesis: induction of ESM-1,
βig-h3, and NrCAM. Microvascular research,
2002. 63(2): p. 159-171.
22. Scherpereel, A., et al., Endocan, a new
endothelial marker in human sepsis. Critical
care medicine, 2006. 34(2): p. 532-537.
23. Abbas AK, Lichtman AH, Pillai S. Basic
immunology: functions and disorders of the
immune system: Elsevier Health Sciences; 2014.
24. Sudhir, K., et al., Increased prevalence of
coronary ectasia in heterozygous familial
hypercholesterolemia. Circulation, 1995. 91(5):
p. 1375-1380.
25. Baysal, S., et al., Endothelium biomarkers
endocan and thrombomodulin levels in isolated
coronary artery ectasia. European review for
medical and pharmacological sciences, 2018.
22: p. 4677-4682.
26. Turan, T., et al., Plasma endocan levels in
patients with isolated coronary artery ectasia.
Angiology, 2016. 67(10): p. 932-936.
27. Gök, M., et al., The relationship between serum
endocan levels and the presence/severity of
isolated coronary artery ectasia. Cardiovascular
Endocrinology & Metabolism, 2018. 7(2): p. 42-