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Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms ("dilated coronaropathy")

Dietmar Krüger, MD^*, Ulrich Stierle, MD, Gunhild Herrmann, MD^*, R.üdiger Simon, MD, FACC, FESC^* and Abdolhamid Sheikhzadeh, MD, FACC, FESC

^* University Hospital Lübeck, Lübeck, Germany
University Hospital Kiel, Kiel, Germany

View larger version (119K): [in a new window]   Figure 1 Coronary angiography of the left coronary artery of a 52-year-old man (7 F Judkins coronary catheter, 30° right anterior oblique projection). (A) Large fusiform aneurysms affecting the proximal and middle segment of the LAD and LCX are depicted. (B) After five cardiac cycles, a delayed antegrade filling and drainage in the LCX ("slow flow") and a local deposition of dye ("stasis") in the middle segment of the LAD are documented.

View larger version (73K): [in a new window]   Figure 2 Coronary sinus lactate study with incremental atrial pacing in CEA. The rates of CLM (mean ± SD) without premedication (open bars) and after the administration of 0.8 mg NTG (solid bars) are depicted on the ordinate. The time of blood sampling appears on the abscissa: baseline (BL) and every 3 min during incremental atrial pacing at 100, 120, 140 and three times 160 beats/min, 1, 3 and 5 min after cessation of pacing. Within the bars, the number of patients is indicated in whom pacing had to be stopped prematurely because of angina pectoris. (A) All patients of the study group (n = 42). (B) Patients with frank cardiac lactate production (subgroup I, n = 18). (C) Patients with moderate myocardial ischemia (subgroup II, n = 14). (D) Patients without metabolic evidence of cardiac ischemia (subgroup III, n = 10).

View larger version (17K): [in a new window]   Figure 3 Influence of the extent of luminal enlargement on the CLM in CEA. Depicted are the coronary artery diameters of every patient’s proximal LAD segment on the abscissa and the maximum rate of CLM under atrial pacing on the ordinate. A significant correlation was found (p < 0.001, r = 0.87) between the diameters of the subgroups I (solid triangle), II (open circles) and III (x) and the severity of CI due to the CLM.