Background: Coronary slow flow (CSF) phenomenon is characterized by delayed opacification of coronary vessels in a normal coronary angiogram. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully elucidated. In this study, we aimed to evaluate central aortic pressure, aortic stiffness and left ventricular (LV) function in patients with coronary slow flow. Method and Results: The study population consisted of 154 patients who underwent coronary angiography because of typical and quasi-typical symptoms of angina. 81 patients with angiographically proven CSF and 73 cases with normal coronary flow pattern with similar risk profiles were enrolled in the study. Aortic pressures and indexes of elastic properties were evaluated using invasive methods. Aortic pulse pressure (mm Hg) and pulsality index of patients with CSF were found to be significantly higher than those of controls (60.8 ± 13.8 vs. 53.7 ± 14.5, p = 0.002; 0.84 ± 0.22 vs. 0.67 ± 0.18, p = 0.0001, respectively). LV Doppler parameters were deteriorated in patients with CSF. Aortic fractional pulse pressure and pulsality index were significantly correlated with the mean TIMI frame count and LV diastolic parameters in correlation analysis. Conclusion: The present findings allow us to conclude that impaired aortic elasticity in patients with CSF may also be responsible for the impaired LV diastolic parameters.

Keywords:
Aortic stiffness, Coronary slow flow, Diastolic dysfunction, Pulse pressure
1.
Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, et al: Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis 2003;14:155–161.
2.
Tanriverdi H, Evrengul H, Enli Y, Kuru O, Seleci D, Tanriverdi S, Tuzun N, Kaftan HA, Karabulut N: Effect of homocysteine-induced oxidative stress on endothelial function in coronary slow flow. Cardiology 2007;107:313–320.
3.
Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Doven O, et al: Slow coronary flow may be a sign of diffuse atherosclerosis: contribution of FFR and IVUS. Acta Cardiol 2004;59:127–133.
4.
Urschel CW, Covell JW, Sonnenblick EH, Ross J Jr, Braunwald E: Effects of decreased aortic compliance on performance of the left ventricle. Am J Physiol 1968;214:298–304.
5.
Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ: TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879–888.
6.
Mikel DS: Left ventricular diastolic function; in Otto CM (ed): The Practice of Clinical Echocardiography, ed 2. Philadelphia, WB Sounders, 2002.
7.
Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502.
8.
Cakmak M, Tanriverdi H, Cakmak N, Evrengul H, Cetemen S, Kuru O: Simvastatin may improve myocardial perfusion abnormality in slow coronary flow. Cardiology 2008;110:39–44.
9.
Tanriverdi H, Evrengul H, Tanriverdi S, Kuru O, Seleci D, Enli Y, Kaftan A, Kilic M: Carotid intima-media thickness in coronary slow flow: relationship with plasma homocysteine levels. Coron Artery Dis 2006;17:331–337.
10.
Albayrak S, Ordu S, Yuksel H, Ozhan H, Yazgan O, Yazici M: Efficacy of nebivolol on flow-mediated dilation in patients with slow coronary flow. Int Heart J 2009;50:545–553.
11.
Fineschi M, Gori T: Coronary slow flow: description of a new ‘cardiac Y’ syndrome. Int J Cardiol 2009;137:308–310.
12.
Danchin N, Benetos A, Lopez-Sublet M, Demicheli T, Safar M, Mourad JJ; on behalf of the ESCAPP Investigators: Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicenter study. Am J Hypertens 2004;17:129–133.
13.
Jankowski P, Kawecka-Jaszcz K, Czarnecka D, Brzozowska-Kiszka M, Styczkiewicz K, Styczkiewicz M, Posnik-Urbanska A, Bryniarski L, Dudek D: Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis. Atherosclerosis 2004;176:151–155.
14.
Guray U, Guray Y, Yilmaz MB, Caldir V, Cay S, Sasmaz H, Kormaz S: Aortic pulse pressure and aortic pulsatility in patients with coronary slow flow. Cardiology 2007;107:233–238.
15.
Mangieri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A, Dell’Italia LJ, Scibilia G, Motta P, Campa PP: Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996;37:375–381.
16.
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236–1241.
17.
Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, Laurent S: Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002;39:10–15.
18.
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG: Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002;106:2085–2090.
19.
Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, London GM: Aortic pulse wave velocity index and mortality in endstage renal disease. Kidney Int 2003;63:1852–1860.
20.
Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME: Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol 2001;21:2046–2050.
21.
Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, Havlik R, Lakatta EG, Spurgeon H, Kritchevsky S, Pahor M, Bauer D, Newman A: Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005;111:3384–3390.
22.
Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J: Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006;113:664–670.
23.
Arat N, Altay H, Sabah I: Elastic properties of aorta are impaired in patients with slow coronary flow phenomenon. Indian Heart J 2008;60:119–124.
24.
Cay S, Cagirci G, Balbay Y, Atak R, Maden O, Aydogdu S: Effect of aortic pulse and fractional pulse pressures on early patency of sapheneous vein grafts. Coron Artery Dis 2008;19:435–439.
25.
Beltrame JF, Limaye SB, Wuttke RD, et al: Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J 2003;146:84–90.
26.
Sezgin AT, Topal E, Barutcu I, et al: Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study. Angiology 2005;56:397–401.
27.
Baykan M, Baykan EC, Turan S, Gedikli O, Kaplan S, Kiriş A, Durmuş I, Celik S: Assessment of left ventricular function and Tei index by tissue Doppler imaging in patients with slow coronary flow. Echocardiography 2009;26:1167–1172.
28.
Karamitsos TD, Karvounis HI, Didangelos TP, Papadopoulos CE, Kachrimanidou MK, Selvanayagam JB, Parharidis GE: Aortic elastic properties are related to left ventricular diastolic function in patients with type 1 diabetes mellitus. Cardiology 2008;109:99–104.
29.
Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497–1506.
30.
Nishimura RA, Abel MD, Hattle LK, Tajik AJ: Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. 2. Clinical studies. Mayo Clin Proc 1989;64:181–204.
31.
Bouvrain Y, Levy B: ‘Windkessel’ and coronary debit. Arch Mal Coeur Vaiss 1981;74:635–639.
32.
Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y: Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994;24:1406–1414.
33.
Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Decreased aortic compliance aggravates subendocardial ischaemia in dogs with stenosed coronary artery. Cardiovasc Res 1992;26:1212–1218.
34.
Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497–1506.
35.
Wang GH, Hu DY: Effect of pulse wave velocity on coronary flow reserve in patients with essential hypertension. Zhonghua Yi Xue Za Zhi 2005;85:54–57.
36.
Fukuda D, YoshiyamaM, Shimada K, Yamashita H, Ehara S, et al: Relation between aortic stiffness and coronary flow reserve in patients with coronary artery disease. Heart 2006;92:759–762.
37.
Leung MC, Meredith IT, Cameron JD: Aortic stiffness affects the coronary blood flow response to percutaneous coronary intervention. Am J Physiol Heart Circ Physiol 2006;290:624–630.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.