Sex-specific assessment of reduced coronary sinus flow in non-hypertensive patients with coronary artery disease at rest

Abstract

BackgroundAccess to data on the coronary flow in the coronary sinus (CS) can aid in the diagnosis of coronary artery disease (CAD). We tested the hypothesis that assessing the CS flow by transthoracic Doppler echocardiography (TTE) at rest can detect coronary artery stenosis in non-hypertensive patients.MethodsThe antegrade phase of coronary flow in the CS was analyzed and compared in 140 male and 135 female non-hypertensive subjects who had all undergone coronary angiography.ResultsThere were statistically significant differences noted between males and females for the CS flow both in normal subjects and patients with CAD. Compared with normal subjects, patients with CAD had significantly lower blood flow in the CS both in males (196.6±174.31 vs. 367.65±168.04 ml/min, P<0.01) and females (183.04±65.46 vs. 244.13±135.43 ml/min P<0.01). For males, the diagnostic sensitivity, specificity, and accuracy of the cutoff value of the CS flow (206 ml/min) for predicting a significant coronary artery stenosis (>70%) were 91.67%, 81.25%, and 85.71%, respectively. For females, those of the cutoff value of the CS flow (195 ml/min) were 85.71%, 75%, and 80%, respectively.ConclusionTTE can effectively detect coronary hemodynamically significant stenosis in non-hypertensive male and female patients at different cutoff values.

Coronary sinus fow measured by pulsed Doppler ultrasound is a powerful indicator of coronary blood supply – a pig heart in vitro study.

“…They are all in vivo studies using transesophageal and transthoracic Doppler echocardiography [10][11][12][13][14]17,18], and none of these studies provided the precise correlation between the coronary sinus flow and the coronary infusion. Compared with in vivo studies, our study had some possible advantages.…”

“…Over the last decade, the coronary flow reserve in the coronary sinus has been used to diagnose severe coronary artery stenosis by transesophageal Doppler echocardiography due to inadequate visualization of the coronary arteries [10][11][12]. Recently, our studies showed that coronary sinus flow depicted by transthoracic Doppler echocardiography at rest can detect coronary artery stenosis in non-hypertensive [13], hypertensive [14], and diabetic hypertensive patients. These studies including transesophageal and transthoracic Doppler echocardiography still just depicted the coronary sinus flow (reserve) in the case of angiographically proven normal or stenotic coronary artery, but the exact relationship between coronary perfusion and coronary sinus flow remains unknown.…”

Coronary Sinus Flow Is Reduced and Recovered With Time in Viral Myocarditis Mimicking Acute Coronary Syndrome

“…[6][7][8][9][10] First, the parasternal right ventricular inflow tract view was obtained. The transducer was manipulated to visualize the mouth of the coronary sinus.…”

“…The velocity time integral was determined from digitized Doppler spectral envelopes. Third, the coronary sinus flow per minute (flow) was calculated according to the following formula [6][7][8][9][10][11] : Flow (mL/min) = π × D 2 /4 × velocity time integral × heart rate, where π is the ratio of the circumference of a circle to its diameter, and D is the diameter of the coronary sinus ( Figure 1). The average value of 3 spectral and planimetric envelopes was used.…”

“…[6][7][8][9][10][11] In this study, we aimed to assess the changes in coronary sinus flow at the onset and follow-up of myocarditis mimicking acute coronary syndrome using TTE.…”