Slow coronary flow may be a sign o diffuse atherosclerosis

Pekdemir, Haşan; Cin, Veli Gökhan; Cicek, Dilek; Çamsarı, Ahmet; Akkuş, Necdet; Döven, Oben; Parmaksiz, H. Tuncay

doi:10.2143/ac.59.2.2005166

Cited by 114 publications

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“…Our findings on the presence of relation between Hs-CRP and TIMI frame count, may have emerged from the contribution Hs-CRP as inflammation marker to the atherosclerotic process and related coronary flow pattern (18). Slevin et al (19) have shown the importance of CRP within the angiogenic microvessels from diseased tissues.…”

Section: Discussionmentioning

confidence: 53%

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Acute phase reactants in patients with coronary slow flow phenomenon

Madak¹,

Nazlı²,

Mergen³

et al. 2010

Anadolu Kardiyol Derg

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Acute phase reactants in patients with coronary slow flow phenomenonKoroner yavaş akım fenomeni olan hastalarda akut faz reaktanları 416ABSTRACT Objective: In this study, we sought to investigate the serum levels of high sensitivity C-reactive protein (Hs-CRP), N-terminal pro-brain natriuretic peptide (NT proBNP), erythrocyte sedimentation rate, leukocyte, thyroid hormone and fibrinogen levels in patients with coronary slow flow phenomenon (CSFP). Methods: A total of 82 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (45 males and 37 females, mean age 59±11 years) and 34 patients with normal coronary arteries and normal coronary flow (19 males and 15 females, mean age 56±10 years) with similar risk profiles were included in this cross-sectional observational study. Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction (TIMI) frame count, serum level of Hs-CRP, NT proBNP, sedimentation, leukocyte, free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) and fibrinogen levels were measured. Statistical analysis was performed using t test for independent samples, Chi-square test and Pearson correlation analysis.Results: Hs-CRP (0.88±0.86 vs 0.36±0.35 mg/L, p<0.001) and NT proBNP (117.83±163.2 vs 47.33±30.6 ng/ml, p<0.01) were found to be significantly higher in patients with coronary slow flow compared with normal control group. There were no significant differences regarding thyroid hormones, fibrinogen, sedimentation rate and leukocyte count between two groups. The mean TIMI frame counts were positively correlated (r=0.454, p=0.001 and r=0.554, p=0.001, respectively) with plasma Hs-CRP levels and NT-proBNP levels.

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Section: Discussionmentioning

confidence: 53%

“…Plasma concentration of interleukin-6 and CRP levels were found to be increased in patient with slow coronary flow. Pekdemir et al (18) found that the levels of CRP and TIMI frame count had no significant relationship in patients with CSFP. In this study, we assessed the levels of Hs-CRP, which is highly specific compared to CRP.…”

Section: Discussionmentioning

confidence: 99%

Acute phase reactants in patients with coronary slow flow phenomenon

Madak¹,

Nazlı²,

Mergen³

et al. 2010

Anadolu Kardiyol Derg

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“…On the other hand, Mosseri et al (1986) suggested that occlusive disease of small coronary arteries might be etiology of SCF phenomenon. Many intravascular ultrasound studies suggested the evidence of diffuse atherosclerosis in SCF phenomenon (Cin et al 2003;Pekdemir et al 2004;Camsari et al 2008). Erdogan et al (2007) suggested that the coronary flow reserve (CFR) is impaired in patients with SCF.…”

Section: Discussionmentioning

confidence: 99%

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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“…12 On the other hand, intravascular ultrasonography (IVUS) studies demonstrated that increased TIMI frame count might reflect diffuse atherosclerotic involvement. 13 Hence, not only impaired function of coronary arteries but also diffuse atherosclerotic involvement of them might be the reason for the increased TIMI frame count in this population.…”

Section: Discussionmentioning

confidence: 89%

Coronary Flow Slows as Renal Function Worsens

Yilmaz

Yalta

2009

Clinical Cardiology

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Background: Slow coronary flow in patients without obstructive coronary artery disease is an angiographic finding that could easily be detected by thrombolysis in myocardial infarction (TIMI) frame counts. On the other hand, impaired renal function is a frequent problem. We searched the association between the 2 entities. Hypothesis: We evaluated the impact of impaired renal function on slow coronary flow. Methods: In this study, 105 patients with normal coronary arteries and impaired renal function in the form of a calculated glomerular filtration rate (GFR) <90 mL/min/1.73 m 2 were enrolled and compared with 102 ageand sex-matched controls who had normal a GFR. Results: Calculated GFR was found to be negatively correlated with TIMI frame count in LAD (r = −0.579, p<0.001), in CX (r = −0.499, p<0.001), and in RCA (r = −0.491, p<0.001) in patients with impaired renal function. After adjusting for systolic and diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, multiple regression analysis demonstrated a statistically significant and independent relationship between TIMI frame count for 3 vessels and calculated GFR. Conclusions: Impaired renal function seems to denote slower coronary flow in patients with normal coronary arteries compared with those with normal renal function, and there seems to be an independent association between GFR and TIMI frame count in those with impaired renal function. IntroductionNormal or near-normal coronary angiograms are found in approximately 15%-20% of patients undergoing coronary angiography because of clinical suspicion of angina pectoris. 1 In a subset of these patients, coronary angiography may show coronary slow flow (CSF) characterized by the slow progression of contrast dye in the absence of obstructive coronary artery disease. It has been suggested that a higher thrombolysis in myocardial infarction (TIMI) frame count, a simple clinical tool for assessing quantitative indexes of coronary blood flow, 2 may reflect vascular dysfunction. 3 Normal endothelium plays a vital role in the regulation of vascular tone through the production and release of various factors. 4 Nitric oxide, the major endogenous relaxing factor of the endothelium, is the crucial determinant of normal endothelial function. 5,6 On the other hand, the association between end-stage renal disease (ESRD) and endothelial dysfunction, which could yield a poor prognosis, is well established and could be the result of asymmetric dimethyl arginine (ADMA). 7,8 In the present study, we aimed to show whether there was any association between coronary blood flow by TIMI frame count and glomerular filtration rate in patients with impaired renal function (those with calculated glomerular filtration rate <90 mL/min/1.73 m 2 ) who had angiographically proven normal coronary arteries and to compare them with those with normal renal function and coronary arteries.

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Slow coronary flow may be a sign o diffuse atherosclerosis

Abstract: We have demonstrated the decreased FFR in the patients with SCF. Decreased FFR levels have been attributed to increased resistance in the epicardial coronary arteries due to diffuse atherosclerotic disease which has been demonstrated by IVUS.

Cited by 114 publications

References 0 publications

Acute phase reactants in patients with coronary slow flow phenomenon

Acute phase reactants in patients with coronary slow flow phenomenon

Impaired Cerebral Circulation in Patients with Slow Coronary Flow

Coronary Flow Slows as Renal Function Worsens

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