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Intravascular ultrasound study and evidence of pathological coronary flow reserve in patients with isolated coronary artery aneurysms

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Abstract

Objectives

Isolated coronary artery aneurysms (CA) are defined as non-obstructive lesions with luminal dilation ≥2-fold of normal coronary diameters.

Methods

A coronary sinus study with incremental atrial pacing was performed in 19 patients with bilateral fusiform CA to investigate myocardial ischemia. Intravascular ultrasound was performed to characterize the lesions morphology. The average peak velocity in the aneurysmatic segment of the left anterior descending artery was simultaneously measured by a Doppler flow wire. Coronary flow volumes, vascular resistances and flow reserve after administration of papaverin were calculated. Ten patients without heart disease served as a control group (CG).

Results

Intravascular ultrasound revealed large true CA with a cross-sectional area of 34.2 ± 4.1 mm² and only slight atherosclerosis. Exercise-induced myocardial ischemia was found in CA presenting with a cardiac lactate production and an only 1.6-fold increase in coronary blood flow. A significant smaller coronary flow reserve of 1.51 was revealed in CA when compared with CG (2.86, P < 0.02) corresponding to a coronary vascular resistance of 0.59 versus 0.35 (P < 0.03) mmHg (ml/min) after papaverin.

Conclusions

Coronary artery aneurysms were unequivocally identified as an entity of ischemic non-obstructive coronary artery disease with a markedly reduced flow reserve.

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References

  1. Hartnell GG, Parnell BM, Pridie RB (1985) Coronary artery ectasia, its prevalence and clinical significance in 4993 patients. Br Heart J 54:392–395

    Article  CAS  PubMed  Google Scholar 

  2. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R (1976) Clinical significance of coronary artery ectasia. Am J Cardiol 37:217–222

    Article  CAS  PubMed  Google Scholar 

  3. Befeler B, Aranda JM, Embi A, Mullin FL, El-Sherif N, Lazzara R (1977) Coronary artery aneurysms study of their etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 62:597–607

    Article  CAS  PubMed  Google Scholar 

  4. Akyürek O, Berkalp B, Sayin T, Kumbasar D, Kervancioglu C, Oral D (2003) Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 145:66–72

    Article  PubMed  Google Scholar 

  5. Krüger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A (1999) Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms (‘dilated coronaropathy’). J Am Coll Cardiol 34:1461–1470

    Article  PubMed  Google Scholar 

  6. Krüger D, ElMokhtari NE, Wieckhorst A, Rausche T, Simon-Herrmann G, Simon R (2008) Evidence of pathological coronary flow patterns in patients with isolated coronary artery aneurysms. Coron Artery Dis 19:249–255

    Article  PubMed  Google Scholar 

  7. Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamapoulou E, Foussas SG, Cokkinos DV (1997) The natural history of aneurysmal coronary artery disease. Heart 78:136–141

    CAS  PubMed  Google Scholar 

  8. Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, Mudd JG, Gosselin AJ (1983) Aneurysmal coronary artery disease. Circulation 67:134–138

    CAS  PubMed  Google Scholar 

  9. Oliveros RA, Falsetti HL, Carroll RJ, Heinle RA, Ryan GF (1974) Arteriosclerotic coronary artery aneurysm. Report of five cases and a review of the literature. Arch Intern Med 134:1072–1076

    Article  CAS  PubMed  Google Scholar 

  10. Al-Harthi SS, Nouh MS, Arafa M, Al-Nozha M (1991) Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance. Int J Cardiol 30:184–191

    Article  Google Scholar 

  11. Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 21:28–40

    Article  CAS  PubMed  Google Scholar 

  12. Cross SJ, Lee HS, Kenmure AF, Jennings KP (1993) Coronary artery ectasia, is it associated with myocardial ischemia and infarction? Scott Med J 38:28–29

    CAS  PubMed  Google Scholar 

  13. Park SH, Kim SE, Ryu SK (2001) Left main coronary artery aneurysm with chronic total occlusion of both left coronary arteries in a young athlete. Heart 85:E1

    Article  CAS  PubMed  Google Scholar 

  14. Rath S, Har-Zahav Y, Battler A, Agranat O, Rotstein Z, Rabinowitz B, Neufeld HN (1985) Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J 109:785–791

    Article  CAS  PubMed  Google Scholar 

  15. Aboud A, Bossert T, Sigusch HH, Gummert J (2007) Surgical treatment of multiple atherosclerotic coronary artery aneurysms in a patient presenting with acute myocardial infarction. Clin Res Cardiol 96(1):45–48

    Article  PubMed  Google Scholar 

  16. Komatsu S, Achenbach S, Ropers D, Daniel WG, Ueda Y, Pflederer T, Kuhlmann A, Wechsel M, Hirayama A, Kodama K (2007) Occlusion of coronary aneurysms demonstrated by multidetector-row computed tomography. Clin Res Cardiol 96(8):575–578

    Article  PubMed  Google Scholar 

  17. Hertting K, Reimers J, Kuck KH (2007) A 21-year-old male with reduced left ventricular function. Clin Res Cardiol. 96(8):579–581

    Article  PubMed  Google Scholar 

  18. Tambe AA, Demany MA, Zimmerman Mascarenhas E (1972) Angina pectoris and slow flow velocity of dye in coronary arteries—a new angiographic finding. Am Heart J 84:66–71

    Article  CAS  PubMed  Google Scholar 

  19. Falsetti HL, Carroll RJ (1976) Coronary artery aneurysm. Chest 69:630–636

    Article  CAS  PubMed  Google Scholar 

  20. Reiber JHC, van den Zweet PMJ, Koning G (1993) Accuracy and precision of quantitative digital coronary angiography, observer as well as short- and medium-term variabilities. Cath Cardiovasc Diagn 28:187–198

    CAS  Google Scholar 

  21. Serruys PW, DiMario C, Kern MJ (1994) Intracoronary Doppler. In: Topol EJ (ed) Textbook of interventional cardiology. Saunders, Philadelphia, pp 1069–1121

    Google Scholar 

  22. Ofili EO, Labovitz AA, Kern MJ (1993) Coronary flow velocity dynamics in normal and diseased arteries. Am J Cardiol 71:3D–9D

    Article  CAS  PubMed  Google Scholar 

  23. DiMario C, Meneveau N, Gil R, De Jaegere P, De Feyter PJ, Slager CJ, Roelandt JR (1993) Maximal blood flow velocity in severe coronary stenoses measured with a Doppler guidewire. Am J Cardiol 17:54D–61D

    Article  Google Scholar 

  24. Hasdai D, Holmes DR, Higano ST, Lerman A (1998) Effect of basal epicardial tone on endothelium-independent coronary flow reserve measurement. Cathet Cardiovasc Diagn 44:392–396

    Article  CAS  PubMed  Google Scholar 

  25. Zucker IR, Rothfeld EL, Bernstein A (1965) A new multipurpose cardiac catheter. Am J Cardiol 15:45–47

    Article  CAS  PubMed  Google Scholar 

  26. Jackson G, Atkinson L, Clark M, Crook B, Armstrong P, Oram S (1978) Diagnosis of coronary artery disease by estimation of coronary sinus lactate. Br Heart J 40:979–983

    Article  CAS  PubMed  Google Scholar 

  27. Opie LH, Owen P, Thomas M, Samson R (1973) Coronary sinus lactate measurement in assessment of myocardial ischemia. Am J Cardiol 32:295–305

    Article  CAS  PubMed  Google Scholar 

  28. Markham RV, Winniford MD, Firth BG, Hillis LD (1983) Symptomatic, electrocardiographic, metabolic, and hemodynamic alteration during pacing-induced myocardial ischemia. Am J Cardiol 51:1589–1594

    Article  PubMed  Google Scholar 

  29. Simon R (1990) Coronary circulation. In: Lentner C (ed) Geigy scientific tables, heart and circulation, vol 5. Ciba-Geigy Limited, Basel, pp 173–181

  30. Maehara A, Mintz GS, Ahmed JM, Fuchs S, Castagna MT, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ (2001) An intravascular ultrasound classification of angiographic coronary artery aneurysms. Am J Cardiol 15:365–370

    Article  Google Scholar 

  31. König A, Bleie O, Rieber J, Jung P, Schiele TM, Sohn HY, Leibig M, Siebert U, Klauss V (2009) Intravascular ultrasound radiofrequency analysis of the lesion segment profile in ACS patients. Clin Res Cardiol 2009 [Epub ahead of print]

  32. Swanton RH, Lea-Thomas M, Coltarte DJ, Jenkins BS, Webb-Peploe MM, Williams BT (1978) Coronary artery ectasia, a variant of occlusive coronary arteriosclerosis. Br Heart J 40:393–399

    Article  CAS  PubMed  Google Scholar 

  33. Mueller F, Knirsch W, Harpes P, Pretre R, Valsangiacomo Buechel E, Kretschmar O (2009) Long-term follow-up of acute changes in coronary artery diameter cause by Kawasaki disease: risk factors for development of stenotic lesions. Clin Res Cardiol 98(8):501–507

    Article  PubMed  Google Scholar 

  34. Kurokawa H, Kondo T, Shiga P, Nomura M, Mizuno Y, Ashiwara M, Torigai K, Hattori Y, Ozawa K, Sugimuri S (1986) Myocardial infarction due to thrombi in coronary aneurysms in a young woman with systemic lupus erythematosus. J Cardiography 16:249–258

    CAS  Google Scholar 

  35. DiMaria C, Zanchetta M, Maiolini P (1988) Coronary artery aneurysm in a case of Ehlers–Danlos syndrome. Jpn Heart J 29:491–496

    Google Scholar 

  36. McKusick VA (1955) Cardiovascular aspects of Marfan′s syndrome: hereditable disorder of connective tissue. Circulation 11:321–332

    CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 12, 24105, Kiel, Germany

    Dietmar Krüger, Nour Eddine ElMokhtari, Arne Wieckhorst, Gunhild Simon-Herrmann & Rüdiger Simon

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  1. Dietmar Krüger
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  2. Nour Eddine ElMokhtari
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  3. Arne Wieckhorst
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  4. Gunhild Simon-Herrmann
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Correspondence to Dietmar Krüger.

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Krüger, D., ElMokhtari, N.E., Wieckhorst, A. et al. Intravascular ultrasound study and evidence of pathological coronary flow reserve in patients with isolated coronary artery aneurysms. Clin Res Cardiol 99, 157–164 (2010). https://doi.org/10.1007/s00392-009-0100-7

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  • DOI: https://doi.org/10.1007/s00392-009-0100-7

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