Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia

Abstract

The aim of this study was to investigate the angiographic predictors of exercise induced ischemia in patients with isolated coronary ectasia. We have prospectively analysed coronary angiograms of 1521 consecutive patients undergoing cardiac catheterisation. The overall incidence of coronary ectasia was 6.7% (102 patients). Forty-six patients (3%) with non-obstructive, diffuse or segmental coronary ectasia (i.e. isolated coronary ectasia) constituted the main study group. Coronary angiograms were reviewed for stigmata of an impaired coronary blood flow such as 'slow flow', 'segmental backflow phenomenon' and stasis. 'Slow flow' was quantified with frame counting. An ectasia-jeopardy score was also described in order to assess the effect of the extent of coronary ectasia on exercise induced ischemia. Exercise induced ischemia was observed in 24 patients (52%). Exercise test was abnormal in 70% of the patients with diffuse ectasia and 26% of patients with segmental ectasia (p = 0.003). The frame count of the arteries of the study group was higher than the control group but the correlation between the frame count of the ectatic vessels and exercise induced ischemia was not significant. Stasis of the dye also did not correlate with ischemia. There was a significant correlation between exercise induced ischemia and backflow phenomenon in left anterior descending artery (LAD) (r = 0.56, p = 0.0001). Exercise induced ischemia was best correlated with the ectasia-jeopardy score (r = 0.77, p = 0.0001) and a score of > or =4 identified the patients at risk with 90% sensitivity and 80% specificity. In conclusion, the extent of the ectasia within the coronary tree, diffuse ectasia and backflow-phenomenon in LAD were identified as the most important predictors of exercise induced ischemia.

Left Ventricular Twist Mechanics Are Impaired in Patients with Coronary Slow Flow

“…5). [29][30][31] The presence of reversible perfusion defects was described in myocardial scintigraphy. 25 Previous studies have shown that anterior wall abnormalities in particular are strongly associated with impaired LV twist.…”

“…5). [29][30][31] The presence of reversible perfusion defects was described in myocardial scintigraphy. 27 Furthermore, decreased coronary flow reserves, in spite of having a patent coronary anatomy, were also observed in patients with CSF.…”

Copeptin Level in Isolated Coronary Artery Ectasia

“…However, interestingly, it has been found that diabetes, which is considered to be equivalent to CAD, does not increase the frequency of CAE (17) . In histopathologic evaluation of CAE specimens, varying degrees of atrophy and destruction have been observed in the muscoelastic components of the muscularis media, and it has been found that the etiology is predominantly atherosclerosis in autopsy series (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) .…”

“…These findings suggest disruption in microvascular perfusion in myocardial segments supplied by ectatic arteries. It is thought that disruption of physiological coronary flow in ectasic segments increases thrombogenicity in this area and that distal embolization of the thrombi formed are significant causes of disruption in microvascular perfusion in patients with CAE (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) .…”

Coronary artery ectasia current concepts and interventions

“…Patients with CAE without stenosis had positive results during myocardial perfusion scintigraphic evaluation and treadmill exercise tests (37,78). In patients with isolated CAE, the extent of the ectasia, diffuse ectasia and backflow-phenomenon in an ectatic left anterior descending artery were identified as the most important angiographic predictors of ischemia on exercise testing (79).…”