Coronary slow flow phenomenon: more than just an angiographic curiosity

Finley, John; Savage, Michael P.

doi:10.2217/ica.12.23

Cited by 10 publications

(9 citation statements)

References 57 publications

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“… 14 Other exclusions include left ventricular myocardial dysfunction, severe hypotension, sudden increases in intracavitary pressure, valvular heart disease, air embolism, or connective tissue disorders. 6 , 15 …”

Section: Discussionmentioning

confidence: 99%

“…Left and right ventricular myocardial biopsy specimens from patients with CSFP have demonstrated the presence of coronary microvascular disease. 6 Small vessel disease, cell edema, capillary damage, subclinical atherosclerosis, inflammation, fibromuscular hypertrophy, and degeneration of endothelial cells with resultant microvascular luminal narrowing have been reported as existing in association with CSFP. 6 , 16 - 18 On the molecular level, endothelin-1 and neuropeptide Y (another reason for the label “syndrome Y”) have been implicated as possible mediators of the microvascular constriction response.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 16 - 18 On the molecular level, endothelin-1 and neuropeptide Y (another reason for the label “syndrome Y”) have been implicated as possible mediators of the microvascular constriction response. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 2 , 4 , 5 Regarding the coronary vasculature, the left anterior descending (LAD) artery, even when corrected for length, is most often involved (50% to 90% of the time), followed by the right coronary artery (28% to 45%) and the left circumflex (-20%). 6 , 7 Coronary angiograms in patients with CSFP are often referred to as “normal” or “mild nonobstructive disease,” which lends itself into classifying these phenotypical patients as having “chest pain with a negative cardiac catheterization.” Perhaps due to the lack of a fully understood pathophysiology, CSFP is frequently not identified as a root cause of abnormal ischemic testing and recurrent chest pain symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review

Alvarez

Siu

2018

Journal of Investigative Medicine High Impact Case Reports

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Background. Coronary slow-flow phenomenon (CSFP) is characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis. CSFP has been reported as a cause of chest pain and abnormal noninvasive ischemic tests and is often underrecognized. Material and Methods. Charts and angiographic records from our institution were reviewed to identify 15 consecutive patients who were diagnosed with CSFP from January 2016 to January 2017. Results. Of the 15 patients (4 females and 11 males) studied, the mean age was 59.1 years (range = 45-86 years); all had left ventricular ejection fraction >45% and without significant valvular stenosis/regurgitation. The indication for coronary angiography for all 15 patients was chest pain with abnormal noninvasive tests. Of the 11 patients who underwent previous coronary angiograms, all revealed prior evidence of CSFP. None of these patients were on calcium channel blockers (CCBs) or long-acting nitroglycerin agents before angiography. Intracoronary CCBs were effectively utilized to alleviate the angiographic finding (improvement in Thrombolysis in Myocardial Infarction frame count) in all 15 patients. Oral CCBs were started with subsequent improvement in all 15 patients (mean follow-up time = 13.6 months). Conclusion. Coronary slow-flow should be a diagnostic consideration in patients presenting with chest pain and abnormal noninvasive ischemic testing with nonobstructive epicardial vessels. CSFP remains underrecognized, and the specific standard of care for treatment has not been established. In each of the 15 cases, intracoronary nifedipine resolved the angiographic manifestation of coronary slow-flow. Furthermore, in follow-up, all patients improved symptomatically from their chest pain after oral CCBs were initiated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review

Alvarez

Siu

2018

Journal of Investigative Medicine High Impact Case Reports

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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 [ 5 , 6 ]. The treatment modalities for CSFP are not well established till now due to the limited understanding on the pathogenesis of CSFP [ 4 , 7 ]. Although the pathophysiological mechanisms of CSFP remain uncertain [ 8 ], coronary microembolism serves as an important mechanism for the development and progression of CSFP [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Evolution of Coronary Flow in an Experimental Slow Flow Model in Swines: Angiographic and Pathological Insights

Bai

et al. 2015

BioMed Research International

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Objective. 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. Methods. Coronary slow flow was induced by repeat coronary injection of small doses of 40 µm microspheres in 18 male domestic pigs and angiographic and pathological changes were determined at 3 hours, 7 days, and 28 days after microspheres injection. Results. Compared to control group treated with coronary saline injection (n = 6) 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. Conclusions. 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.

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Association Between Orthostatic Hypotension With Coronary Slow Flow in Patients With Chest Pain: A Single Center Experience

Han,

Li,

Xie

et al. 2024

Clinical Cardiology

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BackgroundOrthostatic hypotension (OH) is associated with different cardiovascular diseases, however, the association between OH and coronary slow flow (CSF) has never been evaluated before.Materials and MethodsChest pain patients who underwent coronary angiography (CAG) and with normal coronary arteries in our department from January 1st, 2022 to August 31st, 2023 were retrospectively enrolled. Patients were divided into the CSF group and the normal blood flow (NBF) group. Relative clinical information, laboratory test results as well as the results of CAG were collected and analyzed. Both uni‐variable and multi‐variable logistic regression analyses were used to evaluate the association between OH and CSF in these patients.ResultsFour thousand six hundred and twenty‐seven patients underwent CAG and 655 patients had normal coronary arteries. In which, sixty‐nine patients were diagnosed with CSF while 586 patients were diagnosed with NBF. Uni‐variable analysis revealed that higher body weight index, faster heart rate in sitting position, accompanied with chronic kidney disease, did not take Antidiabetic therapy, higher level of aspartate transaminase, uric acid, triglyceride, total cholesterol, ApoB1, low‐density lipoprotein cholesterol, homocysteine, B‐type natriuretic peptide as well as OH are the risk factors for CSF in these patients. Multi‐variable logistic regressing analysis further demonstrated that OH was the independent risk factor for predicting CSF in these patients.ConclusionsOur finding suggests OH might be a useful predictor for CSF in patients with chest pain but normal coronary arteries.

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Coronary slow flow phenomenon: more than just an angiographic curiosity

Cited by 10 publications

References 57 publications

Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review

Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review

Evolution of Coronary Flow in an Experimental Slow Flow Model in Swines: Angiographic and Pathological Insights

Association Between Orthostatic Hypotension With Coronary Slow Flow in Patients With Chest Pain: A Single Center Experience

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