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

Background: Aetiology, clinical significance and treatment options for coronary artery ectasia/aneurysm is not clear. Objective: We sought to determine whether exercise can induce coronary ischemia in patients with coronary artery ectasia/aneurysm without significant coronary stenosis. Methods: Coronary 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 irregularities with ectatic coronaries but they did not have stenotic lesions >50% with visual assessment of two blinded observers. Patients having coronary 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 performed 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-three patients with coronary artery ectasia/aneurysm (ranging from one to three vessels) but without significant stenosis were derived from 4470 cardiac catheterization procedures between January 1998 and July 2000. In the study group, 17 of the patients had positive treadmill tests with respect to five patients in the control group (P=0.004). In subgroup analysis, diffuse ectasia/aneurysm (involving 2–3 vessels) was found to be strongly related with ischemia (P=0.005) with respect to local disease. Conclusion: Coronary artery ectasia/aneurysm may lead to exercise induced ischemia, especially in the diffuse form.