Clinical and coronary angiographiccharacteristics of patients with coronary slow flow. Acta Cardiol
Department of Cardiology, Akdeniz University School of Medicine, Antalya, Turkey. Acta cardiologica
(Impact Factor: 0.65).
11/2008; 63(5):579-84. DOI: 10.2143/AC.63.5.2033224
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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- "CSFP is also related to poor outcome in patients treated with percutaneous transluminal coronary angioplasty (PCI) for first acute myocardial infarction (AMI) compared with PCI treated AMI patients without CSFP and in patients solely diagnosed with CSFP compared with patients without CSFP  . The treatment modalities for CSFP are not well established till now due to the limited understanding on the pathogenesis of CSFP  . Although the pathophysiological mechanisms of CSFP remain uncertain , coronary microembolism serves as an important mechanism for the development and progression of CSFP . "
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. Pathomechanism of coronary slow flow phenomenon remains largely unclear now. Present study observed the pathological and angiographic evolution in a pig model of coronary slow flow.
. Coronary slow flow was induced by repeat coronary injection of small doses of 40
m microspheres in 18 male domestic pigs and angiographic and pathological changes were determined at 3 hours, 7 days, and 28 days after microspheres injection.
. Compared to control group treated with coronary saline injection
and baseline level, coronary flow was significantly reduced at 3 hours and 7 days but completely recovered at 28 days after coronary microsphere injection in slow flow group. Despite normal coronary flow at 28 days after microsphere injection, enhanced myocardial cytokine expression, left ventricular dysfunction, adverse remodelling, and ischemia/microembolism related pathological changes still persisted or even progressed from 3 hours to 28 days after coronary microsphere injection.
. Our results show that this large animal slow flow model could partly reflect the chronic angiographic, hemodynamic, and pathological changes of coronary slow flow and could be used to test new therapy strategies against the slow flow phenomenon.
Available from: Muhammad A Chaudhry
- "The presentation of this phenomenon is extremely diverse ranging from stable or unstable angina, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), nonsustained ventricular tachycardia (NSVT), and even vague chest discomfort. Yilmaz et al. found in their study that patients with CSFP had higher total cholesterol level (including higher low-density lipoprotein levels), higher body mass index, and a higher prevalence of metabolic syndrome . Azzarelli et al. showed in a case series that patients with CSFP often present with recurrent chest pain . "
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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.
Available from: PubMed Central
- "The coronary microvessels play a direct and critical role in determining the extent and severity of myocardial ischemia and symptoms, and preservation of cardiac function. Participation of microvessel dysfunction is suspected, but not confirmed, in the slow-flow or no-flow phenomenon associated with percutaneous coronary intervention , Takotsubo cardiomyopathy , peripartum cardiomyopathy , syndrome X , and microvessel angina . "
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ABSTRACT: Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies.
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