Research Article
The Relationship Between Coronary Slow Flow and Myocardial Ischaemia Evaluated with Timi Frame Count and Myocardial Perfusion Scintigraphy
Abstract
Objective: Coronary slow flow (CSF) is known as a form or early stage of common atherosclerotic disease. Myocardial perfusion scintigraphy (MPS) is a valuable technique in the diagnosis of coronary artery disease and prediction of prognosis. The aim of this study was to investigate the relationship between the myocardial defect score and ischaemia in patients with CSF.
Methods: A total of 168 patients who applied with the complaint of angina pectoris and underwent SPECT as a non-invasive test followed by coronary angiography were included in this retrospective study. 9 patient was excluded from the study for various reasons. The study population comprised determined with CSF and no obstructive stricture in the coronary arteries and with normal flow. The mean age of the patients was 56±12 years. The scores obtained from Quantitative Perfusion SPECT (QPS) and Quantitative Gated SPECT (QGS) software were used in the myocardial perfusion evaluation. The TIMI frame counts were compared with the myocardial defect and ischaemia scores. The TIMI frame count method was used in the determination of CSF.
Results: In patients with slow flow in the circumflex (Cx) coronary artery, the stress total perfusion defect Cx (sTPD-Cx) was found to be 0.1 (range, 0.0-1.3), and in those with normal flow, it was 0.0 (range, 0.0-0.28) (p=0.002). The stress score Cx (sscore-Cx) was found to be 1.0 (range, 0.0-3.0) in patients with slow flow and 0.0 (range, 0.0-2.0) in those with normal flow (p=0.031). A linear correlation was determined between the Cx TIMI frame count and the sTPD-Cx and sscore-Cx values (r=0.207, p=0.009; r=0.159, p=0.045). No relationship was found between slow flow and the defect and ischemia scores in other myocardial regions.
Conclusion: In patients with slow flow in the Cx coronary artery, the sTPD-Cx and the sscore-Cx values were found to be significantly high. Although at a weak level, a linear correlation was found between the Cx TIMI frame count and the sTPD-Cx and the sscore-Cx values
References
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- 26. Sellke FW, Myers PR, Bates JN, Harrison DG. Influence of vessel size on the sensitivity of porcine coronary microvessels to nitroglycerin. Am J Physiol 258:H51S-H520, 1990.
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- 29. James TN. Small arteries of the heart. Circulation 1977; 56: 2-14.
- 30. Ratcliffe HL, Redfield E. Atherosclerotic stenosis of the extramural and intramural coronary arteries of man. Related lesions. Virchows Arch A Pathol Pathol Anat 1972; 357: 1-10.
- 31. Nakatani S, Yamagishi M, Tamai J, Goto Y, Umeno T, Kawaguchi A, et al. Assessment of coronary artery distensibility by intravascular ultrasound. Application of simultaneous measurements of luminal area and pressure. Circulation. 1995 Jun 15;91(12):2904-10.
- 32. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001 Jun5;103(22):270510
Year 2023,
Volume: 9 Issue: 1, 1 - 12, 28.02.2023
Abstract
References
- 1. Kemp HG, Vokoanas PS, Cohn PF, Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six-year experience. Am J Med 1973; 54: 735-42.
- 2. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slowflow velocity of dye in coronary arteries-A new angiografic finding. Am Heart J 1972; 84 66-71.
- 3. Sezgin AT, Sigirci M, Barutcu I. Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis 2003; 14: 155-161. Mosseri M, Yorom R, Gotsman MS, Hasin Y. Histologic evidence for small vessel coronary artery disease in patients with angina pectoris and patent large coronay arteries. Circulation 1986; 7: 964-972.
- 4. Mangieri M, Machiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A, et al. Slow coronary flow: Clinical and histopatological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diag 1996; 37: 375-381.
- 5. Kurtoğlu N, Akcay A, Dindar I. Usefulness of oral dypridamole therapy for angiographic slow coronary artery flow. Am J Cardiol 2001; 87(Suppl 8A): 777-779.
- 6. Pekdemir H, Polat G, Cin VG, Camsari A, Cicek D, Akkus MN, Doven O, Katircibasi MT, Muslu N. Elevated plasma endothelin-1 levels in coronary sinus during rapid rate atrial pacing in patients with coronary slow flow. İnt J Cardiol 2004;97(1):35-41.
- 7. Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus MN, Doven O, Parmaksiz HT. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol 2004; 59(2):127-33
- 8. Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus MN, Doven O, Parmaksiz HT. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol 2004; 59(2):127-33.
- 9. Cin VG, Pekdemir H, Camsari A, Cicek D, Akkus MN, Parmaksiz HT, Katircibasi MT, Doven O. Diffuse İntimal Thickening of Coronary Arteries in Slow Coronary Flow. Japan Heart J. 2003; 44: 907,919
- 10. Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: A distinct angiographic subgroup in Syndrome X. Angiology. 2001; 52(8): 507-14.
- 11. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med. 1985 Apr 4;312(14):932-6.
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- 14. Turhan H, Sezgin AT, Yetkin O, Senen K, Đleri M, Sahin O, Karabal O, Yetkin E, Kutuk E, Demirkan D. Effects of slow coronary artery flow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol 8(2):107-111, 2003
- 15. Koç S, Ozin B, Altın C, Altan Yaycıoğlu R, Aydınalp A, Müderrisoglu H. Evaluation of circulation disorder in coronary slow flow by fundus fluorescein angiography. Am J Cardiol. 2013; 111:1552-6.
- 16. Wang X, Geng LL, Nie SP. Coronary slow flow phenomenon: A local or systemic disease? Med Hypotheses. 2010; 75:334-7
- 17. Hawkins BM, Stavrakis S, Rousan TA, Mazen Abu-Fadel, Eliot Schecther. Coronary slow flow prevalence and clinical correlations. Circ J 2012;76(4):936-42
- 18. Ayhan E, Uyarel H, Isık T, Ergelen M, Cicek G, Altay S et al. Slow coronary flow in patients undergoing urgent coronary angiography for ST elevation myocardial infarction. Int J Cardiol. 2012; 156:106–8
- 19. Sen T. Coronary slow flow phenomenon leads to ST elevation myocardial infarction. Korean Circ J. 2013; 43:196–8.
- 20. Cesar LA, Ramires JA, Serrano Junior CV, Meneghetti JC, Antonelli RH, da-Luz PL, Pıgellı FC. Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study. Braz J Med Biol Res. 1996 May;29(5):605-13.
- 21. Yaymacı B, Dagdelen S, Bozbuga N, Demirkol O, Say B, Guzelmeric F, Dindar I. The response of the myocardial metabolism to atrial pacing in patients with coronary slow flow. Int J Cardiol. 2001 Apr;78(2):151-6
- 22. Erdoğan D, Çalışkan M, Güllü H, Sezgin AT, Yıldırır A, Müderrisoğlu H. Coronary flow reserve is impaired in patients with slow coronary flow. Atherosclerosis. 2007 Mar;191(1):168-74.
- 23. Cesar LA, Ramires JA, Serrano Junior CV, Meneghetti JC, Antonelli RH, da-Luz PL, et al. Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study. Braz J Med Biol Res. 1996 May;29(5):605-13.
- 24. Demirkol MO, Yaymaci B, Mutlu B. Dipyridamole myocardial perfusion single photon emission computed tomography in patients with slow coronary flow. Coron Artery Dis 13(4):223-229, 2002.
- 25. Dağdelen S, Yaymacı B, İzgi A. Evaluation of the relationship between coronary slow flow and myocardial ischemia with TIMI frame count and intracoronary ultrasound measurements. Turkish Cardiol Association Research 2000:28: 747-51.
- 26. Sellke FW, Myers PR, Bates JN, Harrison DG. Influence of vessel size on the sensitivity of porcine coronary microvessels to nitroglycerin. Am J Physiol 258:H51S-H520, 1990.
- 27. Van Lierde J, Vrolix M, Sionis D, De Geest H, Piessens J. Lack of evidence for small vessel disease in a patient with "slow dye progression" in the coronary arteries. Cathet Cardiovasc Diagn. 1991 Jun;23(2):117-20.
- 28. De Bruyne B, Hersbach F, Pijls NH, Bartunek J, Bech JW, Heyndrickx GR, Gould KL, Wijns W. Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but "Normal" coronary angiography. Circulation. 2001 Nov 13;104(20):2401-6.
- 29. James TN. Small arteries of the heart. Circulation 1977; 56: 2-14.
- 30. Ratcliffe HL, Redfield E. Atherosclerotic stenosis of the extramural and intramural coronary arteries of man. Related lesions. Virchows Arch A Pathol Pathol Anat 1972; 357: 1-10.
- 31. Nakatani S, Yamagishi M, Tamai J, Goto Y, Umeno T, Kawaguchi A, et al. Assessment of coronary artery distensibility by intravascular ultrasound. Application of simultaneous measurements of luminal area and pressure. Circulation. 1995 Jun 15;91(12):2904-10.
- 32. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001 Jun5;103(22):270510
There are 32 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research articles |
| Authors | |
| Publication Date | February 28, 2023 |
| Published in Issue | Year 2023 Volume: 9 Issue: 1 |
e-ISSN 2149-7796