medinfoАктуальные проблемы теоретической и клинической медициныActual Problems of Theoretical and Clinical Medicine2790-12892790-1297Казахстанско-Российский медицинский университет10.24412/2790-1289-2022-4-3541medinfo-250Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESВнеклеточная ДНК как новый индикатор клеточной ишемии при изолированной эктазии коронарной артерииCell-free DNA as a new indicator of cellular ischemia in isolated coronary artery ectasiahttps://orcid.org/0000-0002-2940-7248ЙолцуМ.YolcuM.

Мустафа Йолцу

медицинский факультет

отделение кардиологии

Стамбул

Mustafa Yolcu

Faculty of Medicine

Department of Cardiology

 Istanbul

yolcudoctor@gmail.comhttps://orcid.org/0000-0002-4996-8165ДоганА.DoganA.

Али Доган

медицинский факультет

отделение кардиологии

Стамбул

Ali Dogan

Faculty of Medicine

Department of Cardiology

 Istanbul

https://orcid.org/0000-0003-2994-1077ХансерВ. С.HancerV. S.

медицинский факультет

кафедра медицинской генетики

Стамбул

 Veysel S. Hancer

Faculty of Medicine

Department of Medical Genetics

Istanbul

https://orcid.org/0000-0003-1524-0587ГурбузельM.GurbuzelM.

медицинский факультет

кафедра медицинской биологии

Эрзинджан

Mehmet Gurbuzel

Faculty of Medicine

Department of Medical Biology

Erzincan

https://orcid.org/0000-0003-4251-0327БатыралиевT.BatyralievT.

Талантбек Абдуллаевич,Батыралиев, д. м. н., общественный и государственный деятель Кыргызской Республики, действительный член, член-корреспондент, заслуженный деятель науки Кыргызской Республики, профессор

Газиантеп

Кыргызстан

Бишкек

Scopus Author ID: 7004607065

Researcher ID: M-5826-2018

Talantbek Batyraliev

Faculty of Medicine

Department of Cardiology

Gaziantep

Kyrgyzstan

Bishkek

https://orcid.org/0000-0002-0579-8109ДжайнакбаевН. Т.JainakbayevN.

Нурлан Темирбекович Джайнакбаев, д. м. н., профессор

Scopus Author ID: 56495373800

Researcher ID: GPK-7563-2022

Алматы

Nurlan Jainakbayev

Non-state Educational İnstitution

Almaty

nauka@medkrmu.kzhttps://orcid.org/0000-0002-5356-1886ПершуковИ. В.PershukovI.

Игорь Викторович Першуков, д. м. н., доцент

Ош

Казахстан

Алматы

Scopus Author ID: 6602176611

Researcher ID: D-2135-2016

Igor Pershukov

Interntional Medical Faculty

Internal Diseases Chair

Osh

Non-state Educational İnstitution

Almaty

Университет Нового векаТурцияYeni Yuzyil UniverstyTurkeyУниверситет ИстиньеТурцияIstinye UniversityTurkeyЭрзинджанский университетТурцияErzincan UniverstyTurkeyУниверситет Санко; Университет Салымбекова; РАЕ; Американская коллегия кардиологовТурцияSanko University; Salymbekov UniversityTurkeyНУО «Казахстанско-Российский медицинский университет»КазахстанKazakh-Russian Medical UniversityKazakhstanОшский государственный университет; НУО «Казахстанско-Российский медицинский университет»КыргызстанOsh State University; Kazakh-Russian Medical UniversityKyrgyzstan202213122022043541Copyright © Йолцу М., Доган А., Хансер В.С., Гурбузель M., Батыралиев T., Джайнакбаев Н.Т., Першуков И.В., 20222022Йолцу М., Доган А., Хансер В.С., Гурбузель M., Батыралиев T., Джайнакбаев Н.Т., Першуков И.В.Yolcu M., Dogan A., Hancer V.S., Gurbuzel M., Batyraliev T., Jainakbayev N., Pershukov I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://kazrosmedjournal.krmu.edu.kz/jour/article/view/250

   Актуальность: Эктазия коронарных артерий (КАЭ) представляет собой диффузное или локальное расширение эпикардиальных коронарных артерий без дополнительных симптомов. Внеклеточная ДНК (вкДНК) определяется как ДНК, происходящая из ядерных клеток, которая свободно циркулирует в системе кровообращения. В нашем исследовании мы стремились измерить уровни вкДНК, индикатора ишемии на клеточном уровне, который, как показано, повышен при неинвазивных тестах с физической нагрузкой и перфузионной сцинтиграфией.   Методы: В исследование был включен 41 пациент с изолированной КАЭ и 39 пациентов с нормальной коронарной ангиограммой (НКА). Коронарографию выполняли при типичной стенокардии или положительной нагрузочной пробе. Количество вкДНК определяли центрифугированием образцов периферической крови обеих групп.   Результаты: Уровни вкДНК в плазме составили 5,86 ± 4,41 нг/мкл у изолированных пациентов с КАЭ и 2,36 ± 1,32 нг/мкл у пациентов с НКА (p = 0,000). При оценке ангиографических типов на основе классификации Маркиса уровни вкДНК оказались следующими: тип I (n=7) 10,15±5,25, тип II (n=5) 6,42±3,91, тип III (n=4) 5,15±3,74 и IV тип(n=25) 4,66±3,78. Уровень вкДНК был обнаружен значительно выше в группе КАЭ типа I по сравнению с другими группами на основе классификации Маркис (p = 0,028).   Заключение: Высокий уровень вкДНК у пациентов с КАЭ предполагает, что нарушение перфузии миокарда и возникающая в результате ишемия вызывают лизис клеток миокарда или быстрый апоптоз, что приводит к более ранней запрограммированной гибели клеток. Высокий уровень вкДНК у этих пациентов может быть использован в качествемаркера повышенного сердечно-сосудистого риска.

   Background: Coronary artery ectasia (CAE) is the diffuse or localized enlargement of the epicardial coronary arteries without any particular symptoms. Cell-free DNA (cfDNA) is defined as the DNA originating from nucleated cells which circulates freely in circulatory system. In our study, we aimed to measure the cfDNA levels, an indicator of ischemia at cellular level, which is shown to be elevated in non-invasive exercise tests and perfusion scintigraphies.   Methods: 41 patients with isolated CAE and 39 patients with normal coronary angiograms (NCA) were included in the study. Coronary angiography was performed in case of typical angina or a positive exercise test. The amount of cfDNA was determined by centrifugation of peripheral blood samples from both groups.   Results: Plasma cfDNA levels were 5.86 ± 4.41 ng/µl in isolated CAE patients and 2.36 ± 1.32 ng/µl in NCA group (p=0.000). When angiographic types were evaluated based on Markis Classification, cfDNA levels were found as follows: type I (n=7) 10.15±5.25, type II (n=5) 6.42±3.91, type III (n=4) 5.15±3.74 and type IV (n=25) 4.66±3.78. The level of cfDNA was found significantly higher in type I CAE group when compared to other groups based on the Markis Classification (p=0.028).   Conclusion: High levels of cfDNA in patients with CAE suggest that impaired myocardial perfusion and the resulting ischemia cause myocardial cell lysis or rapid apoptosis that leads to earlier programmed cell death. High levels in cfDNA in these patients might be used as a marker of increased cardiovascular risk.

коронарографияишемия миокардавнеклеточные нуклеиновые кислотыкоронарная аневризманагрузочный тестcoronary angiographymyocardial ischemiacell-free nucleic acidscoronary aneurysmexercise testЭто исследование не получило конкретного гранта от какого-либо финансирующего агентства в государственном, коммерческом или некоммерческом секторахThis study has not received a specific grant from any funding agency in the public, commercial or non-profit sectorsReferencesYetkin E.., Waltenberger J. Novel insights into an old controversy: is coronary artery ectasia a variant of coronary atherosclerosis? Clin Res Cardiol 2007; 96 [6]: 331 – 9.Yetkin E.., Waltenberger J. Novel insights into an old controversy: is coronary artery ectasia a variant of coronary atherosclerosis? Clin Res Cardiol 2007; 96 [6]: 331 – 9.Markis J. E., Joffe C. D., Cohn P. F., Feen D. J., Herman M. V., Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 1976; 37 [2]: 217 – 22.Markis J. E., Joffe C. D., Cohn P. F., Feen D. J., Herman M. V., Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 1976; 37 [2]: 217 – 22.Yolcu M., Ipek E., Turkmen S., Ozen Y., Yildirim E., Sertcelik A., et al. The relationship between elevated magnesium levels and coronary artery ectasia. CVJ Africa 2016; 27 [5]: 294 – 8.Yolcu M., Ipek E., Turkmen S., Ozen Y., Yildirim E., Sertcelik A., et al. The relationship between elevated magnesium levels and coronary artery ectasia. CVJ Africa 2016; 27 [5]: 294 – 8.Giannoglou G. D., Antoniadis A. P., Chatzizisis Y. S., Damvopoulou E., Parcharidis G. E., Louridas G. E. Prevalence of ectasia in human coronary arteries in patients in northern Greece referred for coronary angiography. Am J Cardiol 2006; 98 [3]: 314 – 8.Giannoglou G. D., Antoniadis A. P., Chatzizisis Y. S., Damvopoulou E., Parcharidis G. E., Louridas G. E. Prevalence of ectasia in human coronary arteries in patients in northern Greece referred for coronary angiography. Am J Cardiol 2006; 98 [3]: 314 – 8.Krüger D., Stierle U., Herrmann G., Simon R., Sheikhzadeh A. Exercise - induced myocardial ischemia in isolated coronary artery ectasias and aneurysms [‘dilated coronopathy’]. J Am Coll Cardiol 1999; 34: 1461 – 70.Krüger D., Stierle U., Herrmann G., Simon R., Sheikhzadeh A. Exercise - induced myocardial ischemia in isolated coronary artery ectasias and aneurysms [‘dilated coronopathy’]. J Am Coll Cardiol 1999; 34: 1461 – 70.Befeler B., Aranda M.J., Embi A., Mullin F. L., El-Sherif N., Lazzara R. Coronary artery aneurysms: study of their etiology, clinical course a defect on left ventricular function and prognosis. Am J Med 1977; 62: 597 – 607.Befeler B., Aranda M.J., Embi A., Mullin F. L., El-Sherif N., Lazzara R. Coronary artery aneurysms: study of their etiology, clinical course a defect on left ventricular function and prognosis. Am J Med 1977; 62: 597 – 607.Rath S., Har-Zahav Y., Battler A., Agranat O., Rotstein Z., Rabinowitz B., et al. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J 1985; 109: 785 – 791.Rath S., Har-Zahav Y., Battler A., Agranat O., Rotstein Z., Rabinowitz B., et al. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J 1985; 109: 785 – 791.Doi T., Kataoka Y., Noguchi T., Shibata T., Nakashima T., Kawakami S., et al. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients with Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol. 2017; 37 [12]: 2350 – 2355.Doi T., Kataoka Y., Noguchi T., Shibata T., Nakashima T., Kawakami S., et al. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients with Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol. 2017; 37 [12]: 2350 – 2355.Lo Y. M. D., Tein M. S. C., Lau T. K., Haines C. J., Leung T. N., Poon Pm., et al. Quantitative analysis of fetal DNA in maternal plasma and serum: implications for noninvasive prenatal diagnosis. Am J Hum Genet1998; 62: 768 – 775.Lo Y. M. D., Tein M. S. C., Lau T. K., Haines C. J., Leung T. N., Poon Pm., et al. Quantitative analysis of fetal DNA in maternal plasma and serum: implications for noninvasive prenatal diagnosis. Am J Hum Genet1998; 62: 768 – 775.Lo Y. M., Rainer T. H., Chan L. Y., Hjelm N. M., Cocks R. A. Plasma DNA as a prognostic marker in trauma patients. Clin Chem 2000; 46:319 - 323.Lo Y. M., Rainer T. H., Chan L. Y., Hjelm N. M., Cocks R. A. Plasma DNA as a prognostic marker in trauma patients. Clin Chem 2000; 46:319 - 323.Song H., Nan Y., Cheng X. W. Circulating cf - DNA: A promising, noninvasive tool for assessment of early cardiometabolic risk. Atherosclerosis 2014; 233: 307 - 9.Song H., Nan Y., Cheng X. W. Circulating cf - DNA: A promising, noninvasive tool for assessment of early cardiometabolic risk. Atherosclerosis 2014; 233: 307 - 9.Mandel P., Metais P. C R Seances Soc Biol Fil 1948; 142: 241 – 3.Mandel P., Metais P. C R Seances Soc Biol Fil 1948; 142: 241 – 3.Pathak A. K., Bhutani M., Kumar S., Mohan A., Guleria R. Circulating cell-free DNA in plasma / serum of lung cancer patients as a potential screening and prognostic tool.Clin Chem. 2006 Oct; 52 [10]: 1833 - 42.Pathak A. K., Bhutani M., Kumar S., Mohan A., Guleria R. Circulating cell-free DNA in plasma / serum of lung cancer patients as a potential screening and prognostic tool.Clin Chem. 2006 Oct; 52 [10]: 1833 - 42.Bendich A., Wilczok T., Borenfreund E. Circulating DNA as a possible factor in oncogenesis. Science 1965; 148: 374 – 6.Bendich A., Wilczok T., Borenfreund E. Circulating DNA as a possible factor in oncogenesis. Science 1965; 148: 374 – 6.Tan E. M., Schur P. H., Carr R. I., Kunkel H. G. Deoxybonucleic acid [DNA] and antibodies to DNA in the serum of patients with systemic lupus erythematosus. J Clin Invest 1966; 45: 1732 – 40.Tan E. M., Schur P. H., Carr R. I., Kunkel H. G. Deoxybonucleic acid [DNA] and antibodies to DNA in the serum of patients with systemic lupus erythematosus. J Clin Invest 1966; 45: 1732 – 40.Koffler D., Agnello V., Winchester R., Kunkel H. G. The occurrence of single-stranded DNA in the serum of patients with systemic lupus erythematosus and other diseases. J Clin Invest 1973; 52: 198 – 204.Koffler D., Agnello V., Winchester R., Kunkel H. G. The occurrence of single-stranded DNA in the serum of patients with systemic lupus erythematosus and other diseases. J Clin Invest 1973; 52: 198 – 204.Leon S. A., Shapiro B., Sklaroff D. M., Yaros M. J. FreeDNA in the serum of cancer patients and the effect of therapy. Cancer Res 1977; 37: 646 – 50.Leon S. A., Shapiro B., Sklaroff D. M., Yaros M. J. FreeDNA in the serum of cancer patients and the effect of therapy. Cancer Res 1977; 37: 646 – 50.Ponti G., Maccaferri M., Manfredini M., Kaleci S., Mandrioli M., Pellacani G., et al. The value of fluorimetry [Qubit] and spectrophotometry [NanoDrop] in the quantification of cell-free DNA [cfDNA] in malignant melanoma and prostate cancer patients.Clinica Chimica Acta 2018; 479: 14 – 19.Ponti G., Maccaferri M., Manfredini M., Kaleci S., Mandrioli M., Pellacani G., et al. The value of fluorimetry [Qubit] and spectrophotometry [NanoDrop] in the quantification of cell-free DNA [cfDNA] in malignant melanoma and prostate cancer patients.Clinica Chimica Acta 2018; 479: 14 – 19.Francaviglia I., Magliacane G., Grassini G., et al. Identification and monitoring of somatic mutations in circulating cell-free DNA by next-generation sequencing in patients with lung adenocarcinoma. Cancer Research 2018; 78 [13 Supplement]: 5580.Francaviglia I., Magliacane G., Grassini G., et al. Identification and monitoring of somatic mutations in circulating cell-free DNA by next-generation sequencing in patients with lung adenocarcinoma. Cancer Research 2018; 78 [13 Supplement]: 5580.Lin C. T., Chen C. W., Lin T. W., Lin C. L. Coronary artery ectasia. Tzu Chi Med 2008; 20 [14]: 270 – 4.Lin C. T., Chen C. W., Lin T. W., Lin C. L. Coronary artery ectasia. Tzu Chi Med 2008; 20 [14]: 270 – 4.Yilmaz H., Sayar N., Yilmaz M., Tangurek B., Cakmak N., Gurkan U., et al. Coronary artery ectasia clinical and angiographical evaluation. Turk Kardiyol Dern Ars 2008; 36 [8]: 530 – 5.Yilmaz H., Sayar N., Yilmaz M., Tangurek B., Cakmak N., Gurkan U., et al. Coronary artery ectasia clinical and angiographical evaluation. Turk Kardiyol Dern Ars 2008; 36 [8]: 530 – 5.Ismail A. M., Rayan M., Adel A., Demerdash S., Atef M., Abdallah M., et al. Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy. Int J Cardiovasc Imaging 2014: 30: 425 – 430.Ismail A. M., Rayan M., Adel A., Demerdash S., Atef M., Abdallah M., et al. Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy. Int J Cardiovasc Imaging 2014: 30: 425 – 430.Tambe A. A., Demany M. A., Zimmerman Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries: a new angiographic finding. Am Heart J 1972; 84: 66 –71.Tambe A. A., Demany M. A., Zimmerman Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries: a new angiographic finding. Am Heart J 1972; 84: 66 –71.Papadakis M. C., Manginas A., Cotileas P., Demopoulus V., Voudris V., Pavlides G., et al. Documentation of slow coronary flow by the TIMI frame count in patients with corona ry ectasia. Am J Cardiol 2001; 88: 1030 – 1032.Papadakis M. C., Manginas A., Cotileas P., Demopoulus V., Voudris V., Pavlides G., et al. Documentation of slow coronary flow by the TIMI frame count in patients with corona ry ectasia. Am J Cardiol 2001; 88: 1030 – 1032.Gibson C. M., Cannon C. P., Daley W. L., Dodge J. T. Jr, Alexander B. Jr, Marble S. J., et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879 – 88.Gibson C. M., Cannon C. P., Daley W. L., Dodge J. T. Jr, Alexander B. Jr, Marble S. J., et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879 – 88.Huang W. H., Luo J. F., Zhou H. L., Chen J. Y. Exercise-induced myocardial ischemia in patients with coronary artery ectasia without significant coronary stenosis. Di Yi Jun Yi Da Xue Xue Bao. 2005; 25 [7]: 899 - 900.Huang W. H., Luo J. F., Zhou H. L., Chen J. Y. Exercise-induced myocardial ischemia in patients with coronary artery ectasia without significant coronary stenosis. Di Yi Jun Yi Da Xue Xue Bao. 2005; 25 [7]: 899 - 900.Abdel Dayem T. M., El-Mawardy R., Abdel-Dayem M. K., Rayan M., El-Mahmoudy A., Shawky G., et al. Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin. Echocardiography 2010; 27 [8]: 1004 – 10.Abdel Dayem T. M., El-Mawardy R., Abdel-Dayem M. K., Rayan M., El-Mahmoudy A., Shawky G., et al. Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin. Echocardiography 2010; 27 [8]: 1004 – 10.Akyürek O., Berkalp B., Sayin T., Kumbasar D., Kervancioglu C., Oral D. Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 2003; 145: 66 – 72.Akyürek O., Berkalp B., Sayin T., Kumbasar D., Kervancioglu C., Oral D. Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 2003; 145: 66 – 72.Krüger D., ElMokhtari N. E., Wieckhorst A., Simon-Herrmann G., Simon R. Intravascular ultrasound study and evidence of pathological coronary flow reserve in patients with isolated coronary artery aneurysms. Clin Res Cardiol 2010; 99: 157 – 64.Krüger D., ElMokhtari N. E., Wieckhorst A., Simon-Herrmann G., Simon R. Intravascular ultrasound study and evidence of pathological coronary flow reserve in patients with isolated coronary artery aneurysms. Clin Res Cardiol 2010; 99: 157 – 64.Gulec S., Atmaca Y., Kilickap M., Akyurek O., Aras O., Oral D. Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol 2003; 91: 996 – 9.Gulec S., Atmaca Y., Kilickap M., Akyurek O., Aras O., Oral D. Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol 2003; 91: 996 – 9.Lou X., Hou Y., Liang D., Peng L., Chen H., Ma S., et al. A novel Alu-basedreal-time PCR method for the quantitative detection of plasma circulating cell free DNA: sensitivity and pecificity for the diagnosis of myocardial infarction. Int J Mol Med. 2015; 35 [1]: 72 - 80.Lou X., Hou Y., Liang D., Peng L., Chen H., Ma S., et al. A novel Alu-basedreal-time PCR method for the quantitative detection of plasma circulating cell free DNA: sensitivity and pecificity for the diagnosis of myocardial infarction. Int J Mol Med. 2015; 35 [1]: 72 - 80.Jung K., Fleischlacker M. and Rabien A. Cell-free DNA in the blood as a solid tumor biomarker-a critical appraisal of the literature. Clin Chim Acta 2010; 411: 1611 – 24.Jung K., Fleischlacker M. and Rabien A. Cell-free DNA in the blood as a solid tumor biomarker-a critical appraisal of the literature. Clin Chim Acta 2010; 411: 1611 – 24.Chang C. P., Chia R. H., Wu T. L., Tsao K. C., Sun C. F., Wu J. T. Elevated cell-free serum DNA detected in patients with myocardial infarction. Clin Chim Acta 2003; 327: 95-101.Chang C. P., Chia R. H., Wu T. L., Tsao K. C., Sun C. F., Wu J. T. Elevated cell-free serum DNA detected in patients with myocardial infarction. Clin Chim Acta 2003; 327: 95-101.Jing R. R., Wang H. M., Cui M., Fang M. K., Qui X. J., Wu X. H., et al. A sensitive method to quantify human cell-free circulating DNA in blood: relevance to myocardial infarction screening. Clin Biochem 2011; 44: 1074 – 79.Jing R. R., Wang H. M., Cui M., Fang M. K., Qui X. J., Wu X. H., et al. A sensitive method to quantify human cell-free circulating DNA in blood: relevance to myocardial infarction screening. Clin Biochem 2011; 44: 1074 – 79.Destouni A., Vrettou C., Antonatos D., Chouliaras G., Traeger-Synodinos J., Patsilinakos S., et al. Cell-free DNA levels in acute myocardial infarction patients during hospitalization. Acta Cardiol 2009; 64: 51 - 7.Destouni A., Vrettou C., Antonatos D., Chouliaras G., Traeger-Synodinos J., Patsilinakos S., et al. Cell-free DNA levels in acute myocardial infarction patients during hospitalization. Acta Cardiol 2009; 64: 51 - 7.Cui M., Fan M., Jing R., Wang H., Qin J., Sheng H., et al. Cell-free circulating DNA: a new biomarker for the acute coronary syndrome. Cardiology 2013; 124: 76 - 84.Cui M., Fan M., Jing R., Wang H., Qin J., Sheng H., et al. Cell-free circulating DNA: a new biomarker for the acute coronary syndrome. Cardiology 2013; 124: 76 - 84.Baman T. S., Cole J. H., Devireddy C. M., Sperling L. S. Risk factors and outcomes in patients with coronary artery aneurysms. Am J Cardiol. 2004; 93: 1549 - 51.Baman T. S., Cole J. H., Devireddy C. M., Sperling L. S. Risk factors and outcomes in patients with coronary artery aneurysms. Am J Cardiol. 2004; 93: 1549 - 51.Yolcu M., Dogan A., Kurtoglu N., Hancer V. S., Gürbüzel M. New indicator of cellular ischemia in coronary slow-flow phenomenon: Cell-free DNA. Turk Kardiyol Dern Ars. 2020 Sep; 48 (6): 558-565. doi: 10.5543/tkda.2020.45605. PMID: 32955030.Yolcu M., Dogan A., Kurtoglu N., Hancer V. S., Gürbüzel M. New indicator of cellular ischemia in coronary slow-flow phenomenon: Cell-free DNA. Turk Kardiyol Dern Ars. 2020 Sep; 48 (6): 558-565. doi: 10.5543/tkda.2020.45605. PMID: 32955030.

The authors declare that there are no conflicts of interest present.