Advances in medical sciences · 2026
Myocardial ischemia detected by SPECT/CT in patients with coronary artery aneurysm or ectasia. Insights from Coronary Artery Ectasia Database - Poland (CARED-POL).
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Podolec Mateusz, Stępień Konrad, Iwańczyk Sylwia, Kościanek Julia, Matrejek Anna, Gutkowska Karolina, Yika Alicia Del Carmen, Matusik Paweł, Holcman Katarzyna, Kostkiewicz Magdalena, Nessler Jadwiga, Zalewski Jarosław
Аннотация
PURPOSE: A high rate of coronary microcirculation dysfunction has been recently demonstrated in coronary artery aneurysm or ectasia (CAAE) in invasive assessment. We sought to analyse the diagnostic value of single-photon emission computed tomography (SPECT/CT) in patients with CAAE and to link it with their angiographic characteristics.
METHODS: We analyzed 79 patients with CAAE without coronary artery disease who underwent coronary angiography assessed with quantitative coronary angiography (QCA). In all patients SPECT/CT with technetium agents was performed to assess the presence of reversible myocardial perfusion defect.
RESULTS: The presence of reversible defect was found in 27 (34.2%) of the included patients. Patients with reversible defect were characterized by more frequent diabetes (55.6 vs 25%, P = 0.007). They were more often treated with insulin (14.8 vs 1.9%, P = 0.026) and non-insulin hypoglycemic drugs (40.7 vs 19.2%, P = 0.043). In patients with reversible defect there was a higher number of multiple CAAE (14.8 vs 5.8%, P = 0.044) without other significant differences in CAAE diameters. The percentage of reversible perfusion defect was inversely associated with distal reference diameter of CAAE (R = -0.342, P = 0.031). In the multivariable analysis, only diabetes was independently associated with presence of reversible perfusion defect (odds ratio [OR] 3.525, 95% confidence interval [CI] 1.240-10.019, P = 0.018).
CONCLUSIONS: As has been shown for the first time in a high percentage of CAAE patients without coronary artery disease, a reversible perfusion defect in SPECT/CT is observed, which may explain their high symptomaticity. Diabetes, but not CAAE diameters, is the independent predictor of reversible perfusion defect.
METHODS: We analyzed 79 patients with CAAE without coronary artery disease who underwent coronary angiography assessed with quantitative coronary angiography (QCA). In all patients SPECT/CT with technetium agents was performed to assess the presence of reversible myocardial perfusion defect.
RESULTS: The presence of reversible defect was found in 27 (34.2%) of the included patients. Patients with reversible defect were characterized by more frequent diabetes (55.6 vs 25%, P = 0.007). They were more often treated with insulin (14.8 vs 1.9%, P = 0.026) and non-insulin hypoglycemic drugs (40.7 vs 19.2%, P = 0.043). In patients with reversible defect there was a higher number of multiple CAAE (14.8 vs 5.8%, P = 0.044) without other significant differences in CAAE diameters. The percentage of reversible perfusion defect was inversely associated with distal reference diameter of CAAE (R = -0.342, P = 0.031). In the multivariable analysis, only diabetes was independently associated with presence of reversible perfusion defect (odds ratio [OR] 3.525, 95% confidence interval [CI] 1.240-10.019, P = 0.018).
CONCLUSIONS: As has been shown for the first time in a high percentage of CAAE patients without coronary artery disease, a reversible perfusion defect in SPECT/CT is observed, which may explain their high symptomaticity. Diabetes, but not CAAE diameters, is the independent predictor of reversible perfusion defect.