Assessment of risk factors and left ventricular function in patients with slow coronary flow

Abstract

Slow coronary flow (SCF) is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Life-threatening arrhythmias and sudden cardiac death can occur; however, the pathological mechanism and influence on left ventricular function remain undetermined. We aimed to assess the risk factors and left ventricular (LV) function in SCF and evaluate the relationships between thrombolysis in myocardial infarction frame count (TFC) and the number of involved coronary arteries with LV function in patients with SCF. We included 124 patients who underwent coronary angiography because of symptoms of angina; 71 patients with angiographically proven SCF and 53 cases with normal coronary flow pattern. SCF was diagnosed as TFC >27 in at least one coronary artery. Complete blood count and biochemical parameters were compared between the two groups. Conventional echocardiography and tissue Doppler imaging were used to assess LV systolic and diastolic function. Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery mean TFC (mTFC) (r = 0.514, P < 0.001) and the number of coronary arteries with SCF (r = 0.628, P < 0.001). Early diastolic mitral inflow velocity (E) (0.66 ± 0.15 vs. 0.74 ± 0.17, P = 0.008), ratio of early to late diastolic mitral inflow velocity (E/A) (0.95 ± 0.29 vs. 1.15 ± 0.35, P = 0.002), global myocardial peak early diastolic velocity (gVe) (4.41 ± 1.25 vs. 4.96 ± 1.45, P = 0.037), and ratio of global myocardial peak early to late diastolic velocity (gVe/gVa: 1.09 ± 0.45 vs. 1.36 ± 0.58, P = 0.006) were decreased in patients with SCF compared with controls. gVe (3 vs. 0 branches, 4.08 ± 1.14 vs. 4.97 ± 1.45, respectively, P = 0.008) deteriorated significantly in patients with SCF involving three coronary arteries. mTFC negatively correlated with E and E/A (r = -0.22, P = 0.02; r = -0.20, P = 0.04, respectively). The number of coronary arteries with SCF negatively correlated with E, E/A, gVe and gVe/gVa (r = -0.23, P = 0.02; r = -0.25, P = 0.009; r = -0.25, P = 0.008; r = -0.21, P = 0.03, respectively). Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery TFC and the number of affected coronary arteries. Left ventricular global and regional diastolic function was impaired in SCF patients. Furthermore, the number of coronary arteries involved rather than coronary artery TFC determined the severity of left ventricular dysfunction in patients with SCF.

Is dipyridamole useful in improving left ventricular systolic and diastolic function in patients with coronary slow flow?

“…Conventional Doppler imaging (CDI) is commonly used to evaluate LV diastolic function . Previously, it was shown that CSF is related to LV diastolic dysfunction . Similar to these studies, we showed decreased E velocity, increased A velocity, a decreased E/A ratio, and a prolonged IVRT and isovolumic contraction time in CSF patients using CDI.…”

Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow?

“…20,27 Coronary slow flow is a condition characterized by the slowing down of coronary artery flow rate, and is defined as delay in the filling of epicardial coronary arteries with contrast agent without the existence of stenosis. 30 The underlying mechanisms and aetiology remain unknown, however, studies have shown that endothelial dysfunction, vasomotor dysfunction, microvascular disease and generalized atherosclerosis may play a role in aetiopathogenesis. [31][32][33][34] In patients with coronary slow flow, studies have identified lengthwise extensive calcification without narrowing the lumen, diffuse intimal thickening, and atheroma plaques in the vessel wall.…”

Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

“…These data collectively confirm a strong relationship between LVEF impairment and the risk of slow flow after RA. Previous studies have indeed indicated that coronary flow is closely related to both systolic and diastolic LV function and that slow coronary flow is more frequent in patients with LV dysfunction [20, 21]. It is worth noting that the operators in our study did not react with glycoprotein IIb/IIIa inhibitors to slow-flow events possibly because of concomitant higher bleeding risks in the cohort with bad ventricular function.…”