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: Coronary slow flow phenomenon (CSFP) is defined as delayed coronary opacification in the absence of obstructive coronary artery disease. In the present study, we sought to define its prevalence and clinical features. The 1,741 consecutive patients who underwent coronary angiography (CAG) were identified. Those with normal left ventricular ejection fraction and normal coronary arteries were included in the study (n=158). TIMI frame counts were calculated, and data on demographics, comorbidities, and medication use were collected. CSFP was defined as frame count > 27. Multivariate logistic regression analysis was used to identify independent predictors of CSFP. CSFP was identified in 96 (5.5%) subjects referred for CAG. Subjects with CSFP were more obese (body mass index [BMI] 33.9 vs. 29.8 kg/m², P=0.003) and had lower high-density lipoprotein levels (39.7 vs. 45.7 mg/dl, P=0.04). In the CSFP group, total cholesterol, low-density lipoprotein and frame counts increased significantly with increasing vessel involvement (1-, vs. 2-, vs. 3-vessel involvement; P<0.05 for each variable). By multivariate analysis, male sex (odds ratio 3.36, 95% confidence interval 1.17-8.61, P=0.02) and higher BMI independently predicted the presence of CSFP (odds ratio 1.09, 95% confidence interval 1.03-1.15, P=0.003). CSFP is associated with male sex and obesity. Multivessel involvement may be a marker of more severe, diffuse disease. Further studies are needed to investigate this hypothesis.Circulation Journal 02/2012; 76(4):936-42. · 3.58 Impact Factor
- Circulation Journal 02/2012; 76(4):818-20. · 3.58 Impact Factor
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ABSTRACT: The coronary slow flow phenomenon (CSFP) is a disease entity characterized by slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels. CSFP has a diverse presentation from mild chest discomfort to ST-segment elevation myocardial infarction. It can also have severe morbidity and mortality implications and can significantly hamper the quality of life of those affected. In this paper we present two patients with CSFP highlighting the diverse spectrum of presentation. A concise review of the literature is also provided emphasizing the epidemiology, pathogenesis, diagnostic parameters, treatment modalities, and clinical significance of this phenomenon.Cardiology research and practice. 01/2012; 2012:383181.