Coronary slow flow or syndrome Y: Dysfunction at rest, preserved reactivity of the peripheral endothelium

Neuropeptide Y-induced coronary microvascular dysfunction: A significant contributor to the adverse outcomes in stress cardiomyopathy?

“…in SCM is still largely unknown, severe coronary microvascular dysfunction may be considered as a potential trigger in some patients. Endothelial dysfunction [4] and increased serum NPY (a vasoconstrictor hormone) [5] levels are well known to play the central role in the pathogenesis of coronary microvascular syndromes. Among these syndromes, coronary syndrome Y (characterized by coronary slow flow (CSF)) is associated with enhanced coronary resistance, and may present with the clinical picture of acute coronary syndrome (ACS) along with an increased proclivity to cardiac arrhythmias [4].…”

“…Endothelial dysfunction [4] and increased serum NPY (a vasoconstrictor hormone) [5] levels are well known to play the central role in the pathogenesis of coronary microvascular syndromes. Among these syndromes, coronary syndrome Y (characterized by coronary slow flow (CSF)) is associated with enhanced coronary resistance, and may present with the clinical picture of acute coronary syndrome (ACS) along with an increased proclivity to cardiac arrhythmias [4]. Similarly, in the setting of SCM, severe and transient coronary microvascular dysfunction induced by excessive levels of NPY may be associated with adverse clinical outcomes including ischemic malign arrhythmic events and sudden cardiac death (SCD), etc.…”

Renal dysfunction in syndrome Y

“…We thank Dr Yalta et al for their interest in our case report [1] and for their contribution in the definition of what we believe is a poorly understood condition [2]. Beyond endothelial dysfunction (or rather in the context of endothelial dysfunction), renal insufficiency is often associated with coronary calcifications and hemorheological abnormalities which provide a likely background for their observations [3].…”

Pharmacological Management of Cardiac Syndrome Y: A Focused Review

“…Controversy still exist however, for an endothelial cell dysfunction as the cause of the CSFP, since other reports observed intact endothelial cell function in patients with CSY [20]. The unique clinical characteristics of the CSFP warranted the call for a separate classification within the microvascular coronary artery disorders [5,9,12,[21][22][23][24][25][26][27], the name cardiac syndrome Y has been suggested due to the possible role of Neuropeptide Y in the pathophysiology of the CSFP [24,26]. The corrected TIMI frame count has been adopted as a standard method to quantify the slow flow, a TIMI frame count of 27 or more has been considered an acceptable angiographic definition of slow flow [28], which in the setting of a typical history and clinical presentation, strongly favors a diagnosis of CSY.…”