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

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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.

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Ethical standard

Our study has been approved by the ethics committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons involved in our study gave their informed consent prior to their inclusion in the study. All co-authors have seen and agreed with the contents of the manuscript and there are no financial or other conflicts of interest to report.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, China

    Yuling Li, Dalin Jia & Yan Lv

  2. Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, 110001, China

    Yonghuai Wang, Yan Zhang, Zhengyu Guan & Chunyan Ma

Authors
  1. Yuling Li
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  2. Yonghuai Wang
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  3. Dalin Jia
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  4. Yan Lv
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  5. Yan Zhang
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Corresponding author

Correspondence to Dalin Jia.

Electronic supplementary material

Below is the link to the electronic supplementary material.

380_2014_606_MOESM1_ESM.mpg

Supplementary material 1 (MPG 1112 kb) Assessment of TFC value in a patient with slow coronary flow (Images acquired at 15 frames/s)

380_2014_606_MOESM2_ESM.mpg

Supplementary material 2 (MPG 1286 kb) The first frame count of the LAD was 14, the last frame count of the LAD was 95. The TFC of LAD was calculated as 95

380_2014_606_MOESM3_ESM.mpg

Supplementary material 3 (MPG 926 kb) The first frame count of the LCX was 11, the last frame count of the LCX was 26. The TFC of LCX was calculated as 30

380_2014_606_MOESM4_ESM.mpg

Supplementary material 4 (MPG 1792 kb) The first frame count of the RCA was 1, the last frame count of the RCA was 14. The TFC of RCA was calculated as 26

380_2014_606_MOESM5_ESM.mpg

Supplementary material 5 (MPG 1394 kb) Slow coronary flow occured in LAD and LCX coronaries. Mean TIMI frame count for this patient was 50.4

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Li, Y., Wang, Y., Jia, D. et al. Assessment of risk factors and left ventricular function in patients with slow coronary flow. Heart Vessels 31, 288–297 (2016). https://doi.org/10.1007/s00380-014-0606-4

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  • DOI: https://doi.org/10.1007/s00380-014-0606-4

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