Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy

  • Ahmed M. Ismail
  • Mona Rayan
  • Amr Adel
  • Salah Demerdash
  • Mohamed Atef
  • Mohamed Abdallah
  • Wail Nammas
Original Paper


We explored the prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia (CAE), as demonstrated by 99mTc-sestamibi scintigraphy. Prospectively, we enrolled 35 patients with angiographically documented CAE and no significant coronary obstruction, who underwent elective coronary angiography. Patients underwent Stress-rest 99mTc-sestamibi scintigraphy within 4 days of coronary angiography. They were divided into 2 groups: group I: with normal perfusion scan; and group II: with reversible perfusion defects. The mean age was 49.6 ± 6.9 years; 34 (97.1 %) were males. Seventy-nine (75.2 %) arteries were affected by CAE. Among 79 arteries affected by CAE, affection was diffuse in 37 (46.8 %). Thirteen (37.1 %) patients had normal perfusion scan (group I), whereas 22 (62.9 %) had reversible perfusion defects (group II). Among 22 patients with reversible perfusion defects, 20 (90.9 %) had mild and 2 (9.1 %) had moderate ischemia. Among 49 myocardial segments with reversible perfusion defects, 22 (44.9 %) were basal, 18 (36.7 %) mid-, and 9 (18.4 %) apical segments. Diffuse CAE was significantly more prevalent in group II versus group I, in all 3 major coronary arteries (p < 0.05 for all). In patients with isolated CAE who underwent elective coronary angiography, reversible perfusion defects demonstrated by 99mTc-sestamibi scintigraphy were rather prevalent, mostly mild, more likely to affect the basal and mid-segments of the myocardium, and more frequently associated with diffuse ectasia.


Coronary artery ectasia Myocardial perfusion 99mTc-sestamibi scintigraphy 


Conflict of interest

All authors have no conflict of interest to declare.


  1. 1.
    Yetkin E, Waltenberger J (2007) Novel insights into an old controversy: is coronary artery ectasia a variant of coronary atherosclerosis? Clin Res Cardiol 96:331–339PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Krüger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A (1999) Exercise-induced myocardial ischaemia in isolated coronary artery ectasias and aneurysms (‘dilated coronaropathy’). J Am Coll Cardiol 34:1461–1470PubMedCrossRefGoogle Scholar
  3. 3.
    Akyürek O, Berkalp B, Sayin T, Kumbasar D, Kervancioğlu C, Oral D (2003) Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 145:66–72PubMedCrossRefGoogle Scholar
  4. 4.
    Sayin T, Döven O, Berkalp B, Akyürek O, Güleç S, Oral D (2001) Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease. Int J Cardiol 78:143–149PubMedCrossRefGoogle Scholar
  5. 5.
    Altinbas A, Nazli C, Kinay O, Ergene O, Gedikli O, Ozaydin M, Dogan A, Gunay G (2004) Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia. Int J Cardiovasc Imaging 20:3–17PubMedCrossRefGoogle Scholar
  6. 6.
    Huang WH, Luo JF, Zhou YL, Zhao HL, Chen JY (2005) Exercise-induced myocardial ischemia in patients with coronary artery ectasia without significant coronary stenosis. Di Yi Jun Yi Da Xue Xue Bao 25:899–900PubMedGoogle Scholar
  7. 7.
    Krüger D, Stierle U, Potratz J, Diederich KW, Sheikhzadeh A (1996) Detection of stress-induced myocardial ischemia in isolated coronary ectasia and aneurysm (dilatative coronaropathy). Z Kardiol 85:407–417PubMedGoogle Scholar
  8. 8.
    Kim W, Jeong MH, Ahn YK, Cho JG, Park JC, Kang JC (2006) The changes of fractional flow reserve after intracoronary nitrate and Nicorandil injection in coronary artery ectasia. Int J Cardiol 113:250–251PubMedCrossRefGoogle Scholar
  9. 9.
    Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, Mudd JG, Gosselin AJ (1983) Aneurysmal coronary artery disease. Circulation 67:134–138PubMedCrossRefGoogle Scholar
  10. 10.
    Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R (1976) Clinical significance of coronary arterial ectasia. Am J Cardiol 37:217–222PubMedCrossRefGoogle Scholar
  11. 11.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542PubMedCrossRefGoogle Scholar
  12. 12.
    Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, Cohen I, Gerlach J, Waechter PB, Germano G (2004) Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 11:414–423PubMedCrossRefGoogle Scholar
  13. 13.
    Krüger D, ElMokhtari NE, Wieckhorst A, Simon-Herrmann G, Simon R (2010) Intravascular ultrasound study and evidence of pathological coronary flow reserve in patients with isolated coronary artery aneurysms. Clin Res Cardiol 99:157–164PubMedCrossRefGoogle Scholar
  14. 14.
    Krüger D, Al Mokhtari 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 19:249–255PubMedCrossRefGoogle Scholar
  15. 15.
    AbdelDayem TM, El-Mawardy R, Abdel-Dayem MK, Rayan M, El-Mahmoudy A, Shawky G, Nammas W (2010) Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin. Echocardiography 27:1004–1010PubMedCrossRefGoogle Scholar
  16. 16.
    Hossam K, Abdeldayem TM, Gamal M, Ismail M, Nammas W, Abdel-Dayem MK (2011) Effect of intravenous dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia: assessment by transesophageal echocardiography. Echocardiography 28:350–357PubMedCrossRefGoogle Scholar
  17. 17.
    Gadallah S, Thaker KB, Kawanishi D, Mehra A, Lau S, Rashtian M, Chandraratna AN (1998) Comparison of intracoronary Doppler guide wire and transesophageal echocardiography in measurement of flow velocity and coronary flow reserve in the left anterior descending coronary artery. Am Heart J 135:38–42PubMedCrossRefGoogle Scholar
  18. 18.
    Gulec S, Atmaca Y, Kilickap M, Akyürek O, Aras O, Oral D (2003) Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol 91:996–999PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Ahmed M. Ismail
    • 1
  • Mona Rayan
    • 1
  • Amr Adel
    • 1
  • Salah Demerdash
    • 1
  • Mohamed Atef
    • 1
  • Mohamed Abdallah
    • 1
  • Wail Nammas
    • 1
  1. 1.Cardiology Department, Faculty of MedicineAin Shams UniversityAbbassia, CairoEgypt

Personalised recommendations