Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia
Ahmet Altinbas1, Cem Nazli, Ozan Kinay
1Department of Cardiology, Sevket Demirel Heart Center, Suleyman Demirel University Medical School, Isparta, Turkey.
Insights
The extent of coronary ectasia and specific angiographic findings like backflow in the left anterior descending artery predict exercise-induced ischemia in patients with coronary ectasia. This helps identify at-risk individuals.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Biology
Background:
- Coronary ectasia, a dilation of coronary arteries, can affect blood flow.
- Predicting exercise-induced ischemia in these patients is crucial for risk stratification.
Purpose of the Study:
- To identify angiographic predictors of exercise-induced ischemia in patients with isolated coronary ectasia.
- To evaluate the correlation between specific coronary angiogram findings and ischemia.
Main Methods:
- Prospective analysis of coronary angiograms from 1521 patients.
- Focused on 46 patients with isolated coronary ectasia.
- Assessed 'slow flow', 'backflow phenomenon', and stasis; developed an ectasia-jeopardy score.
Main Results:
- Exercise-induced ischemia occurred in 52% of patients.
- Diffuse ectasia (70% abnormal exercise tests) was a stronger predictor than segmental ectasia (26%).
- Backflow phenomenon in the left anterior descending artery (LAD) and the ectasia-jeopardy score strongly correlated with ischemia.
Conclusions:
- The extent of coronary ectasia, diffuse ectasia, and LAD backflow are key predictors of exercise-induced ischemia.
- An ectasia-jeopardy score >= 4 accurately identifies patients at risk.
- These findings aid in managing patients with coronary 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.
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