Slow Coronary Flow is Associated with Carotid Artery Dilatation

Yiğit, Fatma; Sezgin, Alpay Turan; Demircan, Şenol; Tekin, Göknur; Erol, Tansel; Müderrisoğlu, Haldun

doi:10.1620/tjem.209.41

Cited by 11 publications

(10 citation statements)

References 33 publications

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“…They also found that TIMI frame counts were positively correlated with carotid intima-media thickness and coronary intimal thickness and concluded that SCF might be the results of coronary atherosclerosis, which was the part of systemic involvement. In contrast, Yigit et al (2006) found no difference between the patients with NCF and SCF in terms of carotid intimamedia thickness. They also found that carotid and coronary artery diameters are increased in patients with SCF when compared to those of normal coronary flow and concluded that carotid artery dilatation could be used as an early marker of SCF.…”

Section: Discussioncontrasting

confidence: 63%

Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Karakaya

Koçer

Esen

et al. 2011

Tohoku J. Exp. Med.

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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...

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Section: Discussioncontrasting

confidence: 63%

Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Karakaya

Koçer

Esen

et al. 2011

Tohoku J. Exp. Med.

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“…This is extreme SCF compared to previous studies 9)13)14). IMT of the carotid arteries in the SCF group increased greater in our results than those of other reports 13)14)20). These findings indicate that our subjects were more severe cases of SCF.…”

Section: Discussioncontrasting

confidence: 62%

Slow Coronary Flow is Related to Increased Carotid Intima-Media Thickness but Not Pulse Wave Velocity

Kim

Han

et al. 2011

Korean Circ J

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Background and ObjectivesSlow coronary flow (SCF) is characterized by delayed contrast dye opacification without significant stenosis of epicardial coronary arteries. However, the pathophysiology and clinical implications of SCF are not fully understood. Some reports have suggested that SCF might be caused by atherosclerosis in the coronary artery microvasculature. Measuring carotid intima-media thickness (IMT) and pulse wave velocity (PWV), which are non-invasive and simple diagnostic tools, was developed to detect subclinical atherosclerosis. Thus, we determined IMT and PWV, and their possible relationship in a SCF group and a normal coronary flow (NCF) group of patients.Subjects and MethodsWe included 101 patients who complained of chest pain but had a normal coronary angiogram. Thrombolysis in Myocardial Infarction frame count (TIMI frame count, TFC) was evaluated in the left and right coronary arteries. We defined SCF as a TFC of more than 25. Carotid IMT was measured by ultrasonography in both common carotid arteries. PWV was calculated from pulse transit time between the brachial and ankle arteries.ResultsFifteen patients were included in the SCF group and 86 patients in the NCF group. Male patients (n=11, 73.3%) were significantly more common in the SCF group than in the NCF group (n=37, 43.0%, p<0.05). The TFC of the SCF and NCF groups were 28.8±3.5 and 15.7±4.5, respectively. The carotid IMT in the SCF group increased significantly compared to that in the NCF group (1.2±0.3 mm vs. 0.8±0.1 mm, p<0.01). However, no significant difference in PWV was observed between the two groups.ConclusionSCF may reflect early atherosclerotic changes in the coronary artery microvasculature.

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“…However, serum neopterin levels did not correlate with the extent of coronary artery ectasia (number of ectatic coronary vessels). Yiğit et al (23) showed that carotid and coronary artery diameters were increased in patients with SCF (without coronary ectasia) as compared to those with normal coronary arteries. Papadakis et al (24) have demonstrated that coronary artery ectasia was associated with diminished coronary flow velocity.…”

Section: Discussionmentioning

confidence: 99%

Increased neopterin levels and its association with angiographic variables in patients with slow coronary flow: an observational study

Varol¹,

Gulcan²,

Aylak³

et al. 2011

Anadolu Kardiyol Derg

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Objective: Although various inflammatory markers have been studied in patients with slow coronary flow (SCF), serum neopterin levels have not been studied previously. We investigated the serum neopterin and high sensitivity C-reactive protein (hs-CRP) levels and the relationship between neopterin and hs-CRP levels and TIMI flow in patients with SCF. Methods: The study group consisted of 51 patients with SCF. An age and gender matched control group was composed of 40 subjects. Coronary flow rates of all patients and control subjects were documented by Thrombolysis in Myocardial Infarction (TIMI) frame count. We measured serum neopterin and hs-CRP levels at the same time in patients with SCF and control subjects in this cross-sectional observational study. Chi-square, Mann-Whitney U and unpaired t tests, Pearson correlation and linear regression analyses were used for statistical analysis. Results: The TIMI frame counts for all coronary arteries and the mean TIMI frame count were significantly higher in the SCF group than controls. Serum neopterin levels were significantly higher among patients with SCF when compared with control group (2.13±1.03 vs. 1.60±0.50 ng/ml; p=0.004). Serum hs-CRP levels were significantly higher among patients with SCF when compared with control group (2.06±1.32 vs. 0.74±0.40 mg/L respectively; p<0.001). There was a significant association of serum neopterin levels (β=0.60, 95% CI: 4.93-9.06, p<0.001) and serum hs-CRP levels (β=0.29, 95%CI: 0.84-4.33, p=0.004) with mean TIMI frame count independent of potential confounders such as age, gender, body mass index, smoking, glucose and cholesterol levels. Conclusion: We have shown that serum neopterin and hs-CRP levels were significantly elevated in patients with SCF when compared with control subjects. Serum neopterin and hs-CRP levels were correlated with mean TIMI frame count in patients with SCF. (Anadolu Kardiyol Derg 2011; 11: 692-7) Key words: Slow coronary flow, neopterin, high-sensitive C-reactive protein, regression analysis 692 ÖZET Amaç: Her ne kadar yavaş koroner akım (YKA)'lı hastalarda çeşitli enflamasyon göstergeleri çalışılmış olsa da, serum neopterin seviyeleri çalışılmamıştır. Yavaş koroner akım (YKA)'lı hastalarda serum neopterin ve yüksek duyarlı C-reaktif protein (hs-CRP) düzeylerini ve serum neopterin ve hs-CRP düzeyleriyle TIMI kare sayısı arasındaki ilişkiyi araştırdık. Yöntemler: Çalışma grubu 52 YKA hastasından, yaş ve cinsiyet açısından eşitlenmiş kontrol grubu 40 kişiden oluşmaktaydı. Hastaların ve kontrol grubunun koroner akım hızları (Thrombolysis In Myocardial Infarction) TIMI kare sayısı yöntemi ile ölçüldü. Bu enine-kesitli gözlemsel çalışma-da, YKA ve kontrol grubunda serum neopterin ve hs-CRP düzeylerini ölçtük. İstatistiksel analizde Ki-kare, Mann-Whitney U ve esleştirilmemiş t testleri, Pearson korelasyon ve doğrusal regresyon analizleri kullanıldı. Bulgular: Bütün koroner arterlerin TIMI kare sayıları ve ortalama TIMI kare sayısı YKA hastalarında normal koroner arter grubundan daha yüksekti. Seru...

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Slow Coronary Flow is Associated with Carotid Artery Dilatation

Cited by 11 publications

References 33 publications

Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Slow Coronary Flow is Related to Increased Carotid Intima-Media Thickness but Not Pulse Wave Velocity

Increased neopterin levels and its association with angiographic variables in patients with slow coronary flow: an observational study

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