ABC | Volume 113, Nº1, July 2019

Original Article Does Mean Platelet Volume Decrease in the presence of Coronary Artery Fistula? Isa Sincer , 1 Y usuf Çekici, 2 Mehmet Cosgun , 1 G ulali Aktas, 1 Yilmaz Gunes, 1 Emrah Erdal, 1 Asli Kurtar Mansiroglu, 1 Mehmet Inanı r 1 Abant Izzet Baysal University Hospital, 1 Bolu – Turkey Gaziantep Dr. Ersin Arslan Education and Research Hospital, 2 Gaziantep – Turkey Mailing Address: Isa Sincer • Abant Izzet Baysal University Hospital - Department of Cardiology - Alpagut mah. 223 sok.no: 20 Camlıbel apt. BOLU, Bolu 14280 – Turkey E-mail: isasincer@yahoo.com Manuscript received July 03, 2018, revised manuscript October 05, 2018, accepted November 01, 2018 DOI: 10.5935/abc.20190088 Abstract Background: Coronary artery fistula (CAF) is an abnormal connection that links a coronary artery to a cardiac chamber or another major blood vessel. Several studies have shown the association between mean platelet volume (MPV) and cardiovascular diseases. In the literature, there is no previous study about the association between hematologic parameters and congenital CAF. For this reason, we aimed to investigate the association of MPV with CAF. Methods: 70 patients with normal coronary arteries and 50 with coronary artery fistulas were included. Routine blood and biochemical parameters were measured before the arteriography. Differences between groups for continuous variables were analyzed with t- test or Mann-Whitney test. P values < 0.05 were considered significant. Regression analysis was used to find independent predictors of CAF. Results: Baseline patient demographics, including age and clinical risk factors, were similar between the groups. Compared to the control group, median (IQR) High-density lipoprotein cholesterol (HDL) levels were significantly higher (p=0.04) and MPV levels were significantly lower in the CAF group (8.84 ± 1.71fL vs. 10.43 ± 1.34, p < 0.001). In the multivariate analysis, only MPV was a significant predictor of CAF (p < 0.001, 95% CI for OR: 0.438 (0.306-0.629). A negative correlation was found between MPV and fistulae in Pearson’s correlation test (r: –0.454, p < 0.001). An MPV level of < 9,6 fL showed sensitivity, specificity, positive predictive value and negative predictive value of 80%, 68%, 71% and 78% respectively (AUC = 0.766, 95% CI, 0.678–0.854) for the prediction of CAF. Conclusion: The present study suggests that MPV may decrease in patients with CAF. (Arq Bras Cardiol. 2019; 113(1):71-76) Keywords: Arteriovenous Fistula; Coronary Artery Disease; Mean Platelet Volume; Angiography; Endothelium/dysfunction. Introduction Coronary artery fistula (CAF) is an abnormal connection that links a coronary artery to a cardiac chamber or another major blood vessel. 1 In the former case, although CAF is generally congenital, the development and dissemination of interventional and surgical techniques over the years, with a higher prevalence of acquired forms, has led to a change in etiology. 2 CAF is frequently identified incidentally through diagnostic angiography. Very rarely, ischemia may occur due to increased myocardial oxygen demand, and presents with angina or dyspnea on during exertion. The exact incidence of CAF is not certain, since the underdiagnosis rate is high. However, several studies have reported the presence of CAF in 0.13–0.22% of adults undergoing coronary angiography. 3 Around 75% of incidentally-found CAFs are small and clinically silent. Up to 90% of all CAFs are single and multiple fistulae, present in 10.7–16% of the cases. 4 Coronary artery fistulae arise more commonly from the right coronary artery (%50–60%) and often drain into the right heart (80%). 1 A fistula between a coronary artery and a right structure shows a continuous flow from coronary vasculature to the low‑pressure right chamber. When the drainage site is located in the left atrium or pulmonary vein, there is an effective left-to-left shunt that determines a volume overload to the left heart only. This volume overload may lead to endothelial dysfunction. In the case of a large-caliber CAF, coronary steal may play a role in myocardial ischemia. 5 Several studies have shown the association between mean platelet volume (MPV) and cardiovascular diseases. 6,7 In the literature, there is no previous study about the association between hematological parameters and congenital coronary artery fistulas. For this reason, we aimed to investigate the association of MPV with CAF. Methods Angiographic data of the patients who underwent coronary angiography (CAG) between 2014 February and 2018 March were retrospectively analyzed. A total 71