Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Abstract

Slow coronary flow (SCF) is characterized by delayed opacification of coronary arteries during coronary angiography and is associated with myocardial perfusion abnormalities, ischemia or myocardial infarction. We hypothesized that SCF could be a part of systemic circulatory abnormalities. Therefore, the present study was conducted to investigate whether cerebral blood flow velocity is altered in patients with SCF. The study included 16 patients suffering from chest pain with angiographically proven SCF and 16 subjects suffering from atypical chest pain with angiographically normal coronary flow. All study subjects were selected among those who undergone routine cardiac catheterization. SCF was defined based on thrombolysis in myocardial infarction frame count that reflects coronary artery flow. Thrombolysis in myocardial infarction frame count was significantly higher in patients with SCF than those with normal coronary flow. The average peak systolic, end diastolic and mean flow velocities of the middle cerebral artery were measured and recorded in both groups by transcranial Doppler ultrasonography. Baseline demographic properties were similar in both groups. Echocardiographic parameters were also similar in patients with SCF and those with normal coronary flow. In contrast, both right and left middle cerebral artery peak systolic, end diastolic and mean flow velocities were significantly lower in patients with SCF than those with normal coronary flow. We conclude that cerebral blood flow velocity is significantly lower in patients with SCF. SCF phenomenon may reflect a part of impaired systemic circulation.Keywords: cerebral blood flow; coronary angiography; slow coronary flow; thrombolysis in myocardial infarction frame count; transcranial Doppler Tohoku J. Exp. Med., 2011, 225 (1), 13-16. © 2011 Tohoku University Medical Press Slow coronary flow (SCF), characterized by slow antegrade progression of dye in the absence of obstructive coronary disease, has been noted in the coronary arteries during routine angiographic study, but its precise mechanism has not been well documented. SCF was first defined by Tambe at al. (1972) on six patients with chest pain. However, the exact etiology, pathogenesis and long term outcome of SCF patients is still unknown although endothelial, vasomotor and microvascular dysfunction and occlusive disease of small coronary arteries were suggested in its etiology (Moserri et al. 1986;Mangieri et al. 1996;Sezgin et al. 2003). It is also unknown whether SCF phenomenon is a disorder limited to the coronary artery or it involves cerebral circulation as well.Transcranial Doppler ultrasonography (TCD) is a noninvasive method that provides reliable information about the hemodynamic status of the cerebral circulation. TCD is relatively cheap, can be performed bedside, and allows monitoring both in acute emergency settings as well as for prolonged periods with a high temporal resolution making it ideal for studying dynamic cerebrovascular responses. Also, systolic upstroke, velocity, pulsat...

Relationship of serum salusin beta levels with coronary slow flow

“…In previous studies, it was also found that there might be concomitant slow flow in the cerebral circulation in patients with CSF. This suggests that slow flow is not a specific disease to myocardium, and it is also a systemic disease (21). In our study, CRP was found not to be associated with mean TFC and salusin-β.…”

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

“…Patients with CSF often present with recurrent unstable angina pectoris, arrhythmias, and cardiovascular and cerebrovascular events, and they generally have a poor prognosis ( 6 , 34 ). Therefore, early identification of patients with high risk of CSF is crucial for defining preventive treatment strategies and improving the quality of life and survival prognosis for these individuals.…”

Non-Dipper Blood Pressure Impact on Coronary Slow Flow in Hypertensive Patients With Normal Coronary Arteries

“…In cardiovascular and cerebrovascular patients, decreased endothelium-dependent vasodilation due to a reduction in nitric oxide release in the microvascular arteries is a risk factor [ 14 ]. Karakaya et al observed that the velocity of cerebral blood flow was greatly reduced in individuals with CSF [ 15 ]. Endothelial irregularity appears to be a systemic condition that affects both the coronary and peripheral arteries.…”