Dear Editor,

We would like to thank Ertem et al. [1] for their interest in our article [2] and to add two things. First, there was no statistically significant difference between the left ventricular (LV) diastolic functions of the control group and the slow coronary flow (SCF) of the patient group detected by conventional Doppler echocardiography in our study. When we used tissue Doppler echocardiography, LV Sm, Em, Am and Em/Am were similar in both the SCF and the control group; however, isovolumetric relaxation time and the myocardial performance index were higher in the SCF group compared to the control group. Right ventricular (RV) wall Sm, Em, Am, isovolumetric relaxation time and the myocardial performance index were similar in both the SCF and the control group. However, apparently, it is possible to explain our findings based on anatomical and functional aspects [3], different mitochondrial energy metabolism-adaptation mechanisms [4] and distinct calcium kinetics [5] between RV and LV cavities. Second, there were subgroups of RV and LV circulation, where right dominance was present in 31 (89%) patients. In the control group, a correlation analysis of right coronary artery, thrombolysis in myocardial infarction frame count and coronary dominance of 33 (94%) patients showed that there was no statistically significant association with the RV myocardial performance index.

Ertem AG, Koseoglu C, Sivri S, et al: Is coronary circulation the most important parameter for right ventricular functions? Med Princ Pract DOI: 10.1159/000369137.
Altunkas F, Koc F, Ceyhan K, et al: The effect of slow coronary flow on right and left ventricular performance. Med Princ Pract 2014;23:34-39.
Balci MM, Arslan U, Kocaoğlu I, et al: Right ventricular functions in patients with slow coronary flow. Acta Cardiol 2013;68:161-166.
Nouette-Gaulain K, Malgat M, Rocher C, et al: Time course of differential mitochondrial energy metabolism adaptation to chronic hypoxia in right and left ventricles. Cardiovasc Res 2005;66:132-140.
Saari JT, Johnson JA: Calcium kinetics in individual heart segments. Cardiovasc Res 1980;14:731-734.
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