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International Journal of Cardiology and Cardiovascular Diseases

ISSN: 2768-5640

Short Communication Open Access

Spectrum of congenital coronary artery anomalies in hypertrophic cardiomyopathy: a systematic review

Luke Miller1,*, Matthew Shelly1, Katelyn Graver1, Nicholas Roma2, Brett Cohen3, Jamshid Shirani1,2
  • 1Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
  • 2Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA 18015, USA
  • 3Division of Internal Medicine, St. Luke’s University Health Network, Bethlehem, PA 18015, USA
+ Affiliations - Affiliations

Corresponding Author

Luke Miller; lukecmill@gmail.com

Received Date: November 28, 2025

Accepted Date: March 13, 2026

Citation:

Miller L, Shelly M, Graver K, Roma N, Cohen B, Shirani J. Spectrum of congenital coronary artery anomalies in hypertrophic cardiomyopathy: a systematic review. Int J Cardiol Cardiovasc Dis. 2026;6(1):24-29.


Copyright: © 2026 Miller L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Myocardial ischemia is a frequent finding in hypertrophic cardiomyopathy (HCM) potentially resulting from microvascular dysfunction, extravascular compression, reduced coronary flow reserve, hemodynamic abnormalities, or concomitant atherosclerotic coronary artery disease (CAD). From June 1991 to October 2024, 40 congenital coronary artery anomalies (CCAA) were reported in 30 adults with HCM [age 18–87 (47.6 ± 19.7); 60% male; 37% obstructive; 20% apical variant]. Clinical data on ischemia, therapy, and outcomes were reviewed. Coronary anatomy was categorized by number of ostia: single (n=12; 40%), two (n=13; 43%), three (n=4; 13%), or four (n=1; 4%). The anomalous vessel was the left main (20%), left anterior descending (25%), left circumflex (18%), right coronary artery (35%), or ramus intermedius (2%). Two patients (7%) with apical HCM also had coronary fistulae. Myocardial ischemia was present in 13 patients (43%), including 5 with anomalous vessels coursing between the great vessels. Two of five patients with sudden cardiac arrest had a high-risk anomaly. Pharmacologic therapy was provided to 13 (43%), coronary surgery to 3 (10%), and septal reduction to 8 (27%). Among 15 patients with follow-up, all reported symptomatic improvement. CCAA may occur in HCM and contribute to ischemia; management should be guided by anomaly type and objective evidence of ischemia.

Keywords

Hypertrophic cardiomyopathy, HCM, Coronary artery, Coronary anomalies, Myocardial ischemia

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