Evaluation of exercise on left ventricular function in patients with slow coronary flow by excercise‐stress echocardiography / 中华超声影像学杂志

Objective To evaluate the role of treadmill exercise‐stress echocardiography in the assessment of left ventricular ( LV ) function in patients with slow coronary flow ( SCF ) ,and discuss the possible mechanism of SCF . Methods Forty‐six patients with diagnosis of SCF were enrolled as SCF group . Forty age and sex matched adults were included as control group . All subjects had underwent clinical evaluation and exercise stress echocardiography . LV diastolic and systolic functions were assessed by conventional echocardiography , tissue Doppler imaging and two‐dimensional speckle tracking echocardiography at rest and during exercise . Results ①LV function in patients with SCF at rest :LV peak systolic longitudinal strain ( LS) was lower in patients with SCF than that in controls ( P ＜0 .05) . T here was no difference of LV ejection fraction ( LVEF) between the two group( P＞0 .05) . Early diastolic mitral annulus velocity ( M itral e′) and the ratio between the early mitral inflow velocity and Mitral e′( M itral E/e′) were significantly decreased in SCF group( all P＜0 .01 ) . ②LV function during exercise :LVEF ,LS and M itral e′were significant increased in two groups ( all P ＜0 .05 ) than those at rest ,but there was no significant difference of LVEF ,LS ,M itral e′ and M itral E/e′ between the two groups ( all P ＞ 0 .05 ) . Compared with control group ,ΔLS and ΔM itral e′were significantly higher in SCF group ( all P＜0 .05 ) . Conclusions LV systolic and diastolic function in patients with SCF are impaired at rest . LV systolic and diastolic function recover in patients with SCF during exercise .

The risk factors and clinical follow-up of 236 patients with slow coronary flow / 中华急诊医学杂志

Objective To investigate the risk factors of slow coronary flow (SCF) phenomenon; To study the prognosis of SCF patients and analyze the high risk factors of adverse events by follow-up.Methods 17930 patients were analyzed retrospectively who had undergone routine coronary angiography because of suspected coronary artery disease at TEDA International Cardiovascular Hospital from January 2006 to December 2010.By Thrombolysis in myocardial infarction Frame Count method,236 patients with normal coronary artery but slow coronary flow were enrolled in the SCF group and 240 patients with normal coronary artery and normal coronary flow (40-50patients per year) were enrolled in the control group.After that,the risk factors leading to SCF were analyzed by the multivariate logistic regression analysis and all patients were followed up from March 2012 to April 2012 to know about the incidence of adverse events (acute coronary syndrome,malignant arrhythmia and sudden cardiac death) and the high risk factors leading to the adverse events.Results (1) Compared to the patients in the control group,the patients in SCF group have higher percentage of male (76.69％ vs.42.08％,P =0.000) 、rate of smokers (58.48％ vs.27.50％,P =0.000) 、BMI (26.78 ±3.75 vs.26.13 ±3.20,P =0.043) 、serum uric acid (344.90 ± 86.18 vs.304.43 ±76.44,P =0.000) 、serum creatinine (68.27 ± 15.10 vs.60.92 ± 13.17,P =0.000)、triglyceride (1.85 ± 1.23 vs.1.65 ± 0.81,P =0.037) but younger age and lower high density lipoprotein cholesterol (1.14 ± 0.28 vs.1.19 ± 0.30,P =0.048).(2) By multivariate logistic regression analysis,male,smoking status,hiah BMI and serum uric acid are all independent factors for SCF.(3) The SCF phenomenon noted in lvessel,2 vessels and 3 vessels accounted for 7.29％,26.04％,66.67％,respectively.(4) During the follow-up,2 patients with malignant arrhythmia and 1 patients with ACS were found in SCF group,no sudden cardiac death took place.None of the adverse events happened in the control group.Conclusions Younger male smokers are prone to have SCF,high BMI and serum uric acid are also independent factors for SCF; The SCF phenomenon is most common in three coronary arteries.Both malignant arrhythmia and acute coronary syndrome took place in the SCF group in the follow-up.

Increased red cell distribution width in patients with slow coronary flow syndrome

OBJECTIVE: An elevated red cell distribution width has been recognized as a predictor of various cardiovascular diseases. Slow coronary flow syndrome is an important angiographic clinical entity with an unknown etiology. This study aimed to examine the relationship between red cell distribution width and the presence of slow coronary flow syndrome. METHODS: In total, 185 patients with slow coronary flow syndrome and 183 age- and gender-matched subjects with normal coronary flow (controls) were prospectively enrolled in this study. Red cell distribution width and C-reactive protein were measured upon admission, and the results were compared between the patients with slow coronary flow syndrome and normal controls. RESULTS: Red cell distribution width levels were significantly higher in the patients with slow coronary flow syndrome than the normal controls. Moreover, the data showed that the plasma C-reactive protein levels were also higher in the patients with slow coronary flow syndrome than in the normal controls. In addition, a multivariate analysis indicated that C-reactive protein and red cell distribution width were the independent variables most strongly associated with slow coronary flow syndrome. Finally, the red cell distribution width was positively correlated with C-reactive protein and mean thrombosis in the myocardial infarction frame counts of the patients with slow coronary flow syndrome. CONCLUSION: The data demonstrated that red cell distribution width levels are significantly higher and strongly positively correlated with both C-reactive protein and thrombosis in the myocardial infarction frame counts of patients with slow coronary flow syndrome. These findings suggest that red cell distribution width may be a useful marker for patients with slow coronary flow syndrome. .

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

BACKGROUND AND OBJECTIVES: Slow 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 METHODS: We 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. RESULTS: Fifteen 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. CONCLUSION: SCF may reflect early atherosclerotic changes in the coronary artery microvasculature.

Transmural myocardial ischemia due to slow coronary flow / 老年心脏病学杂志（英文版）

Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Only limited studies have been focused on the etiologies, clinical manifestations and treatment of this unique angiographic phenomenon. In our case report, we described an 85-year-old man who came with significant ST segment elevation in leads V1-V4 and V3R-V5R without increase in myocardial enzyme. The patient also developed respiratory failure requiring intubation and mechanical ventilation. Coronary angiography revealed only mild atherosclerosis without spasm or thromboembolic occlusion. Slow flow was seen in all coronary arteries, especially in the left anterior descending and right coronary arteries. This case speculated that transmural myocardial ischemia with ST segment elevation might be resulted from slow coronary flow. Transmural myocardial ischemia can occur owing to abnormalities of the coronary microcirculation.