Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease

Background: Aetiology, clinical significance and treatment options for coro nary artery ectasia/aneurysm is not clear. Objective: We sought to determin e whether exercise can induce coronary ischemia in patients with coronary a rtery ectasia/aneurysm without significant coronary stenosis. Methods: Coro nary artery ectasia was defined as 1.5-2-fold, aneurysm as >2-fold luminal dilatation of the adjacent normal segment. The study patients could have ir regularities with ectatic coronaries but they did not have stenotic lesions > 50% with visual assessment of two blinded observers. Patients having cor onary artery ectasia or aneurysm with prior myocardial infarction, dilated cardiomyopathy, valvular heart disease, bundle branch block, significant ST -T changes were excluded. The control group was formed from a well matched population of 32 patients with normal coronary arteries who have not perfor med a treadmill test before coronary angiography. The study group underwent a symptom limited treadmill test if they did not have one before coronary angiogram, all control patients underwent treadmill test. Results: Thirty-t hree patients with coronary artery ectasia/aneurysm (ranging from one to th ree vessels) but without significant stenosis were derived from 4470 cardia c catheterization procedures between January 1998 and July 2000. In the stu dy group, 17 of the patients had positive treadmill tests with respect to f ive patients in the control group (P=0.004). In subgroup analysis, diffuse ectasia/aneurysm (involving 2-3 vessels) was found to be strongly related w ith ischemia (P=0.005) with respect to local disease. Conclusion: Coronary artery ectasia/aneurysm may lead to exercise induced ischemia, especially i n the diffuse form. (C) 2001 Elsevier Science Ireland Ltd. All rights reser ved.