The coronary slow flow phenomenon (CSFP) is associated with coronary microvascular dysfunction although the responsible mechanisms are unknown. This study compared endothelial function assessed by changes in augmentation index (AIx) following endothelium-independent (glyceryl trinitrate, GTN) and endothelium-dependent vasodilators (salbutamol), in 40 stable CSFP patients and 23 age-matched healthy controls. Plasma concentrations of inflammatory proteins (myeloperoxidase and high-sensitivity C-reactive protein), oxidative stress biomarkers (malondialdehyde and homocysteine), and asymmetric dimethylarginine levels were also determined. There were no differences between CSFP and controls in response to salbutamol (AIx: –2.28 ± 0.88% vs. –3.22 ± 0.70%, p = 0.4) or GTN (AIx: –11.30 ± 0.75% vs. –13.30 ± 1.00%, p = 0.12). Similarly, there were no differences in the measured biomarkers. Thus, alternate mechanisms to the assessed endothelial function, inflammatory and oxidative stress processes should be explored to explain the microvascular dysfunction in CSFP patients.

Beltrame JF, Limaye SB, Horowitz JD: The coronary slow flow phenomenon – a new coronary microvascular disorder. Cardiology 2002;97:197–202.
Mosseri M, Yarom R, Gotsman MS, Hasin Y: Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986;74:964–972.
Mangieri E, Macchiarelli G, Ciavolella M, et al: Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996;37:375–381.
Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD: Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J 2003;146:84–90.
Sezgin AT, Sigirci A, Barutcu I, et al: Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis 2003;14:155–161.
Turhan H, Saydam GS, Erbay AR, et al: Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow. Int J Cardiol 2006;108:224–230.
Barutcu I, Sezgin AT, Sezgin N, et al: Elevated plasma homocysteine level in slow coronary flow. Int J Cardiol 2005;101:143–145.
Shirani S, Darabian S, Jozaghi S, Hamidian R: Correlation between endothelial dysfunction in normal coronary patients with slow flow and aortic ectasia: the first report. Cardiol J 2009;16:146–150.
Wilkinson IB, Hall IR, MacCallum H, et al: Pulse-wave analysis: clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol 2002;22:147–152.
Karamanoglu M, O’Rourke MF, Avolio AP, Kelly RP: An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J 1993;14:160–167.
Tewari PC, Zhang B, Bluestein BI: Analytical and clinical evaluation of the Bayer ADVIA Centaur homocysteine assay. Clin Chim Acta 2004;342:171–178.
Marie Dupuy A, Boutet A, Paul Cristol J: Evaluation of the high-sensitivity, full-range Olympus CRP OSR6199 application on the Olympus AU640. Clin Chem Lab Med 2007;45:402–406.
Heresztyn T, Worthley MI, Horowitz JD: Determination of l-arginine and NG, NG – and NG, NG’ -dimethyl-L-arginine in plasma by liquid chromatography as AccQ-Fluor fluorescent derivatives. J Chromatogr B Analyt Technol Biomed Life Sci 2004;805:325–329.
Arstall MA, Yang J, Stafford I, Betts WH, Horowitz JD: N-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction. Safety and biochemical effects. Circulation 1995;92:2855–2862.
Evrengul H, Tanriverdi H, Kuru O, et al: Elevated homocysteine levels in patients with slow coronary flow: relationship with Helicobacter pylori infection. Helicobacter 2007;12:298–305.
Tanriverdi H, Evrengul H, Enli Y, et al: Effect of homocysteine-induced oxidative stress on endothelial function in coronary slow-flow. Cardiology 2007;107:313–320.
Riza Erbay A, Turhan H, Yasar AS, et al: Elevated level of plasma homocysteine in patients with slow coronary flow. Int J Cardiol 2005;102:419–423.
Li JJ, Qin XW, Li ZC, et al: Increased plasma C-reactive protein and interleukin-6 concentrations in patients with slow coronary flow. Clin Chim Acta 2007;385:43–47.
Yazici M, Aksakal E, Demircan S, Sahin M, Sagkan O: Is slow coronary flow related with inflammation and procoagulant state? (article in Turkish). Anadolu Kardiyol Derg 2005;5:3–7.
Kopetz VA, Penno MA, Hoffmann P, Wilson DP, Beltrame JF: Potential mechanisms of the acute coronary syndrome presentation in patients with the coronary slow flow phenomenon – insight from a plasma proteomic approach. Int J Cardiol 2011;5:84–91.
Selcuk MT, Selcuk H, Temizhan A, et al: Asymmetric dimethylarginine plasma concentrations and L-arginine/asymmetric dimethylarginine ratio in patients with slow coronary flow. Coron Artery Dis 2007;18:545–551.
Bae SW, Stuhlinger MC, Yoo HS, et al: Plasma asymmetric dimethylarginine concentrations in newly diagnosed patients with acute myocardial infarction or unstable angina pectoris during two weeks of medical treatment. Am J Cardiol 2005;95:729–733.
Cao Y, Yang K, Zhang Z, Ouyang M, Xiao L: Correlation between plasma asymmetric dimethylarginine and different types of coronary heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2010;35:301–306.
Shimokawa H: Hydrogen peroxide as an endothelium-derived hyperpolarizing factor. Pflugers Arch 2010;459:915–922.
Liu Y, Bubolz AH, Mendoza S, Zhang DX, Gutterman DD: H2O2 is the transferrable factor mediating flow-induced dilation in human coronary arterioles. Circ Res 2011;108:566–573.
Larkin SW, Clarke JG, Keogh BE, et al: Intracoronary endothelin induces myocardial ischemia by small vessel constriction in the dog. Am J Cardiol 1989;64:956–958.
Godfraind T: Evidence for heterogeneity of endothelin receptor distribution in human coronary artery. Br J Pharmacol 1993;110:1201–1205.
Pekdemir H, Polat G, Cin VG, et al: Elevated plasma endothelin-1 levels in coronary sinus during rapid right atrial pacing in patients with slow coronary flow. Int J Cardiol 2004;97:35–41.
Sen N, Basar N, Maden O, et al: Increased mean platelet volume in patients with slow coronary flow. Platelets 2009;20:23–28.
Beltrame JF, Turner SP, Leslie SL, Solomon P, Freedman SB, Horowitz JD: The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. J Am Coll Cardiol. 2004;44:57–62.
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