The effect of coronary slow flow on left atrial structure and function

Abstract

The coronary slow flow phenomenon (CSFP) is common in coronary angiography, however its impact on left atrial (LA) function is still controversial. This study aims to evaluate the LA structure and function of patients with CSFP using two-dimensional speckle tracking echocardiography (2D-STE). Consecutive patients scheduled for coronary angiography from January 2016 to September 2017 were enrolled in this study. Patients’ demographic data, clinical histories, laboratory and angiographic findings were collected and recorded. Diagnostic criteria for CSFP is based on Beltrame et al. proposed in 2012. Meanwhile 139 patients who have no significant stenosis (≤ 40%) and normal blood flow were selected as control. All patients received an echocardiographic examination 24 h before coronary angiography. LA structure and function were measured with echocardiography and 2D-STE. Our results showed that among the 1,954 patients who had received coronary angiography, 512 patients were included in the analysis after the exclusion criteria was implemented. Of those, 101 patients met the CSFP criteria (5.5%). CSFP is mainly seen in LAD (~ 70%). There was no statistical difference in baseline characteristics between the CSFP group and control group, except for a higher proportion of smokers in the CSFP group (P = 0.001). The percentage of monocytes is an independent risk factor for the occurrence of CSFP (P = 0.036) after binary logistic regression analysis. The LA global longitudinal strain (LA-GLS, represents reservoir functions) decreased and LA strain rate at late diastole (LA-SRa, represents booster function) increased in patients with CSFP compared to the control group (P < 0.05). Correlation test of continuous variables by Pearson test suggested that LA-GLS was negatively correlated with TIMI frame count (TFC). We concluded that the percentage of monocytes is an independent risk factor for the CSFP; the LA reservoir and booster functions were impaired in patients with CSFP; LA-GLS is negatively correlated with TFC.

Left Atrial Dysfunction in Patients with Coronary Slow Flow

“…However, in another study with 1:1 patient-control matching design for age, sex, hypertension, diabetes mellitus, and the LV function by Fallah [38], the authors did not find significant differences regarding triphasic LA functions assessed through 2D-STE between the CSFP group and control group. In our study [30], we found that minimum left atrial volume index (LAVImin) increased and left atrial ejection fraction (LA-EF) decreased in the CSFP group compared with the control group, although no statistically significant differences were found in the LA size (i.e., antero-posterior diameter, lateral diameter, and LA length) and maximum left atrium volume index (LAVIm) between the two groups. Meanwhile, we found that patients with CSF have lower LA-mLGS and higher late diastolic strain rate (LA-mSRa), suggesting an impairment of left atrial reservoir function and booster function in patients with CSFP.…”

“…In our recent study [30], we found that the percentage of monocytes has significant difference between the CSF group and the normal control group, it was an independent risk factor for the occurrence of CSFP by regression analysis, indicating monocytes may play an important role in the development of CSFP. As we know, monocytes involve in the occurrence and development of atherosclerosis, which precipitates the progression of atherosclerotic plaques from a stable state to an unstable state [31,32].…”

Evaluation of cardiac chamber functions by speckle‐tracking echocardiography in the presence of coronary artery flow disturbances other than stenosis: A review

“…Three studies evaluated 2D‐STE‐derived deformation markers in patients with CSFP 31,36,42 . Two reported no difference regarding Sr between the control and CSFP groups, 31,36 while the other revealed a decrease in this marker in patients with CSFP 42 . One of the 3 studies revealed decreased Scd in patients with CSFP, 31 contrary to the findings of another one of these investigations 36 .…”

“…Three studies evaluated 2D‐STE‐derived deformation markers in patients with CSFP 31,36,42 . Two reported no difference regarding Sr between the control and CSFP groups, 31,36 while the other revealed a decrease in this marker in patients with CSFP 42 .…”

Application and clinical significance of tissue ultrasound for assessment of right ventricular diastolic function in patients with coronary slow flow

“…Coronary slow-flow phenomenon (CSFP) is an angiographic phenomenon where dye passage is slow in coronary angiography in the absence of significant arterial lesions or other causes. 1 Despite considerable number of studies published since its discovery in 1972, the etiology and pathogenesis of CSFP remains unclear. CSFP is likely to lead to angina pectoris and myocardial infarction, possibly due to the impairment of coronary endothelial function, coronary microvascular lesions, early atherosclerosis, and myocardial infarction.…”