Clinical and coronary angiographic characteristics of patients with coronary slow flow.
ABSTRACT The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease, and is an important clinical entity because it may be the cause of angina at rest or during exercise, acute myocardial infarction, and hypertension. The pathophysiological mechanisms of the coronary slow flow phenomenon remain undetermined. Endothelial dysfunction and microvascular dysfunction have been suggested as underlying mechanisms. The slow coronary flow (SCF) phenomenon is considered to be a form of early phase atherosclerosis in some studies.A study of patients with SCF was conducted to determine the associated clinical and angiographic properties.
Eighty-five patients with SCF and 85 control subjects without SCF were included in the study. All subjects had angiographically proven normal coronary arteries. Coronary flow patterns of the latter were determined by the thrombolysis in myocardial infarction frame count method. Clinical and angiographic characteristics of the patients were obtained from case records.
Patients with SCF had higher total cholesterol, and LDL-C levels. Body mass index (BMI) was higher and metabolic syndrome was more frequent in SCF compared to control subjects. Patients with SCF were more symptomatic than the control group, and hospital admissions were also more frequent. BMI correlated statistically significantly, but weakly, with mean TIMI frame count for the 3 coronary arteries.
In this study we demonstrated that patients with SCF had a significant metabolic disarrangement compared to the control group. Patients with SCF have a high incidence of metabolic syndrome which leads to development of coronary microvascular dysfunction via several mechanisms.
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ABSTRACT: OBJECTIVE: Increasing evidence suggests a relationship between vitamin D (VD) insufficiency and cardiovascular disease. The present study evaluated the effect of VD insufficiency on epicardial coronary flow rate, subclinical atherosclerosis, and endothelial function. METHODS: The present study was cross-sectional and observational. We enrolled 222 consecutive patients who had undergone coronary angiography for suspected ischemic heart disease and were found to have normal or near-normal coronary arteries. Thereafter, 25(OH)D3 levels were measured and the coronary flow rate was assessed using the thrombolysis in myocardial infarction frame count. Slow coronary flow (SCF) was defined as a thrombolysis in myocardial infarction frame count greater than 27/frame. Endothelial function was assessed by brachial artery flow-mediated dilatation. Carotid intima-media thickness, an indicator of subclinical atherosclerosis, was measured using B-mode ultrasonography. RESULTS: The mean level of 25(OH)D3 was 31.8 ng/ml, and 47% (n=106) of the patients had insufficient 25(OH)D levels (<30 ng/ml). Baseline characteristics were similar between VD-insufficient and VD-sufficient groups. The incidence of SCF was significantly higher in the VD-insufficient group than in patients with sufficient VD (relative risk=3.5, 95% confidence interval=1.1-10.5, P=0.01). After adjusting for cardiovascular disease risk factors, VD insufficiency was independently associated with SCF. The linear regression analysis showed that VD insufficiency was correlated independently with % flow-mediated dilatation (β=0.424, P<0.001) and carotid intima-media thickness (β=0.43, P<0.001). CONCLUSION: A strong association was found between VD insufficiency and the SCF phenomenon. In addition, VD insufficiency was associated with endothelial dysfunction and subclinical atherosclerosis. We believe that further studies are required to clarify the role of VD in patients with SCF.Coronary artery disease 05/2013; · 1.56 Impact Factor
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ABSTRACT: The coronary slow flow phenomenon (CSFP) is an important, angiographic entity characterized by delayed progression of the injected contrast medium through the coronary tree. It is a frequent finding, typically observed in patients presenting with acute coronary syndromes. Although it is well known to interventional cardiologists for approximately four decades, the pathogenic mechanisms remain unclear. The clinical implications are significant, with over 80% of patients experiencing recurrent chest pain, resulting in considerable impairment in quality of life. This article will address in detail the characteristics, possible mechanisms, and clinical implications of this entity to provide further insight into its clinical significance and management strategies.Cardiovascular diagnosis and therapy. 12/2011; 1(1):37-43.
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ABSTRACT: The coronary slow flow phenomenon (CSFP) is the delayed opacification of coronary arteries in the absence of significant stenosis. The pathogenesis of CSFP has not been completely understood yet. There are several proposed mechanisms such as the structural and functional abnormalities in coronary microcirculation. Nail fold capillaroscopy is a simple, noninvasive examination of the microvasculature and suggested to be a useful technique for analysis in various inflammatory and autoimmune diseases. In this study; we hypothesized that; CSFP is a part of systemic vascular entity rather than a problem confined to coronary vasculature and our aim was to investigate the nail fold capillaries of the patients with CSFP and compare to those with normal coronary flow (NCF). The study was designed as a case-control study and total 25 patients (10 male, mean age 55 ± 9 years) with documented CSFP, and 24 patients (15 male, mean age 55 ± 11 years) with NCF were recruited. Nail fold capillaroscopy examinations were performed by video dermatoscopy in all patients and results were compared between two groups. The demographic and clinical characteristics were similar between patients of CSFP and NCF groups. Nail fold capillary abnormalities including dilatation, tortuosity and microhemorrhage were present in 15 (60%) patients in CSFP group and 5 (21%) patients in NCF group (p < 0.05 OR: 5.7 95% C.I 1.602-20.279). In this study, we found that the abnormalities in nail fold capillaries suggesting the presence of inflammation and anatomical changes were significantly higher in patients with CSFP.International Journal of Clinical and Experimental Medicine 01/2014; 7(4):1052-8. · 1.42 Impact Factor