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Autosomal dominant polycystic kidney disease and coronary artery dissection or aneurysm: a systematic review
Joana Briosa Neves1, Filipe Brogueira Rodrigues1,2, José António Lopes3
1a Department of Medicine , Centro Hospitalar Lisboa Norte , Lisbon , Portugal ;
Insights
Autosomal dominant polycystic kidney disease (ADPKD) is linked to coronary artery dissection and aneurysms. These conditions may arise from different mechanisms in ADPKD patients, warranting further investigation.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Genetics
Background:
- Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder associated with various cardiovascular abnormalities, including intracranial and aortic aneurysms.
- The specific association between ADPKD and coronary artery dissection or aneurysm requires systematic review.
Observation:
- A systematic review of case reports and series identified 23 patients with ADPKD and coronary artery dissection or aneurysm.
- Coronary dissection in ADPKD patients showed female predominance and left anterior descending artery involvement, with an earlier median diagnostic age (41 years) compared to non-ADPKD patients.
- Coronary aneurysms in ADPKD patients exhibited male predominance, right coronary artery involvement, a median diagnostic age of 44 years, and a higher rate of multiple vessel involvement.
Findings:
- Coronary artery dissection in ADPKD patients shares some characteristics with non-ADPKD patients but occurs at a younger age.
- Coronary aneurysms in ADPKD patients present with distinct demographic and angiographic features compared to the general population, including earlier diagnosis and more frequent multi-vessel involvement.
- These clinical differences suggest potentially distinct mechanisms of aneurysm formation in ADPKD.
Implications:
- Coronary aneurysms and dissections are significant causes of coronary syndromes and mortality in ADPKD patients.
- Genetic mutations associated with ADPKD may predispose individuals to coronary abnormalities, particularly aneurysms.
- Further research is needed to elucidate the specific mechanisms linking ADPKD and coronary artery abnormalities.
Importance:
Autosomal dominant polycystic kidney disease (ADPKD) has been associated with cardiovascular abnormalities such as intracranial and aortic aneurysms.
Objective:
To systematically review the case reports and case series of ADPKD patients with coronary artery dissection or aneurysm. Evidence review Systematic review registration number: CRD42015015723.
Data Sources:
MEDLINE, Web of Science and OpenGrey, reference lists of studies.
Study Selection:
Published case reports and case series.
Data Extraction:
Two parties analyzed the studies. Disagreements were solved by consensus or by a third party.
Funding:
none. Findings The reports of 23 patients (22 from 17 studies--six with coronary artery dissection and 16 with coronary artery aneurysm--and one with coronary dissection) were analyzed and reported here. Most patients were symptomatic. Coronary dissection showed female and left descending anterior artery predominance, features similar to non-ADPKD patients, but a median diagnostic age below expected (41 vs. 50 years old). Coronary aneurysms had male and right coronary artery predominance but lower median diagnostic age (44 years old) and higher rate of multiple vessel affection than reported for non-ADPKD patients.
Conclusion And Relevance:
Clinical disparities may suggest a different mechanism of aneurysm formation compared to the population without ADPKD. Nevertheless, lack of access to data of one patient and text of one article limited our conclusions. Coronary aneurysms and dissections represent a source of coronary syndromes and death in ADPKD. Mutation of ADPKD-related genes may predispose to coronary abnormalities, especially aneurysms. Further analysis regarding this association is necessary.
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