Reversible perfusion defect in myocardial scintigraphy in coronary artery aneurysm or ectasia

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Abstract Background Coronary artery aneurysm or ectasia are a rare vascular pathology. Recently, a high rate of coronary microcirculation dysfunction has been demonstrated in coronary artery aneurysm or ectasia in invasive assessment. However, there is no studies regarding the myocardial perfusion scintigraphy - single-photon emission computed tomography, nuclear imaging technique, in coronary artery aneurysm or ectasia patients. Purpose We aim to assess the presence of reversible perfusion defect in myocardial scintigraphy in coronary artery aneurysm or ectasia Methods We analyzed 79 patients with coronary artery aneurysm or ectasia without coronary artery disease who underwent coronary angiography. All patients were included in Coronary Artery Ectasia Database – Poland (CARED-POL) Registry, a multicenter, observational nationwide registry. The detailed characteristics included demographic and anthropometric data, as well as cardiovascular risk factors, comorbidities, pharmacological treatment, echocardiographic parameters, laboratory results, all collected during the index hospitalization. Coronary angiography was reviewed by an experienced interventional cardiologist using quantitative coronary angiography to perform a detailed coronary artery aneurysm or ectasia assessment. In all patients single-photon emission computed tomography with technetium agents was performed in accordance with current standards 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 direct oral anticoagulants (40.7 vs 19.2%, P= 0.043), 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 higher number of multiple CAAE (14.8 vs 5.8%, P=0.044) without differences in their location in particular arteries as well as their dimensions. Moreover, the percentage of reversible perfusion defect was inversely associated with distal reference diameter of coronary artery aneurysm or ectasia (R=-0.342, P=0.031). In the multivariable analysis diabetes, multiple coronary artery aneurysm or ectasia and lower coronary artery aneurysm or ectasia distal reference diameter were independently associated with percentage of reversible perfusion defect (in all P<0.001). Conclusions As has been shown for the first time in a high percentage of coronary artery aneurysm or ectasia patients without coronary artery disease a reversible perfusion defect in single-photon emission computed tomography is observed, which may explain their high symptomaticity. Diabetes, multiple coronary artery aneurysm or ectasia and lower coronary artery aneurysm or ectasia distal reference diameter are the independent predictors of reversible perfusion defect.

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