Correspondence

Widespread Coronary Inflammation in Unstable Angina

N Engl J Med 2003; 348:1931May 8, 2003

Article

To the Editor:

We share Buffon and colleagues' belief in widespread coronary inflammation (July 4 issue).1 However, believing in a hypothesis is not the same as proving it. Conclusions drawn from these experiments are not based on anatomical fact.

The authors cite Ganz et al.2 as their authority for the assumption that right-sided venous drainage does not enter the great cardiac vein. We believe that there are a number of problems with this assumption. Ganz et al. provide no data to rule out the possibility that right-coronary-artery inflow makes a significant contribution to great-cardiac-vein and coronary-sinus outflow. Their measured coronary-sinus blood flow is similar to the required flow computed for left ventricular muscle mass. This is not the same as proof that all this blood is supplied by the left coronary artery. Anatomical studies have shown that there are significant anastomoses at all levels of the coronary circulation and significant variability in venous drainage.3 As many as 30 percent of people have venous drainage from the anterior surface of the right ventricle into the coronary sinus. Interpretation of the difference in oxygen tension between left-sided and right-sided experiments depends on knowledge of relative blood flow, a critical determinant of oxygen tension. Even without this information, Buffon and colleagues' own oxygen-tension experiments suggest that the right coronary artery has some venous drainage into the great cardiac vein.

Therefore, changes in the neutrophil myeloperoxidase index in patients with isolated right coronary artery disease cannot be attributed to left coronary artery inflammation. As such, the hypothesis is not proven.

Craig J.H. Russell, M.R.C.S.
Andrew R. Exley, M.D.
Andrew J. Ritchie, Ph.D.
Papworth Hospital, Cambridge CB3 8RE, United Kingdom

3 References

1. 1

   Buffon A, Biasucci LM, Liuzzo G, et al. Widespread coronary inflammation in unstable angina. N Engl J Med 2002;347:5-12
   Full Text | Web of Science | Medline

2. 2

   Ganz W, Tamura K, Marcus HS, Donoso R, Yoshida S, Swan HJ. Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation 1971;44:181-195
   Web of Science | Medline

3. 3

   Baroldi G, Scomazzoni G. Coronary circulation in the normal and the pathologic heart. Washington, D.C.: Office of the Surgeon General, 1967.
   

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   James T. Wu, Lily L. Wu. (2006) Linking inflammation and atherogenesis: Soluble markers identified for the detection of risk factors and for early risk assessment. Clinica Chimica Acta 366:1-2, 74-80
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