Myocardial ischemia detected by SPECT/CT in patients with coronary artery aneurysm or ectasia. Insights from Coronary Artery Ectasia Database - Poland (CARED-POL).

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.