Document Type : Original Article
Authors
1 Associate Professor, Cardiovascular Research Center, Kerman University of Medical Sciences, Kerman, Iran
2 General Physician, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: Slow coronary flow (SCF) is defined as a condition in which in spite of no evidence of coronary occlusion or stenosis in angiography, there is delayed pacification of the vessels after the injection of a contrast agent. There are several studies about electrocardiogram (ECG) changes in these patients, but changes like OLD MI, RBBB, LBBB, LVH and ST-T wave have not been evaluated in them and sample sizes in these studies have been also small. The aim of this study was to evaluate electrocardiogram changes in patients with slow coronary flow referred to Shafa Hospital affiliated to Kerman University of Medical Sciences, Kerman, Iran.
Methods: In this descriptive-analytical study, 3000 patients with probable diagnosis of coronary occlusion referred to Shafa hospital affiliated to Kerman University of Medical Sciences were screened. Elective coronary angiography was performed for all patients using Judkinz standard method and the findings were analyzed by two cardiologists. Also, standard 12-lead electrocardiogram was recorded for the patients. Finally, 57 patients with normal coronary flow and 105 patients with slow coronary flow were included in this study.
Results: Frequency of SCF was 3.5%. The electrocardiogram (ECG) changes in patients with SCF were evaluated and it was revealed that greatest changes were related to T wave and the most frequent form was inverted T wave (57.1%). There was no significant difference in these changes between SCF group and NCF group (P=0.279). The other electrocardiogram changes in the two groups did not reveal any statistically significant difference.
Conclusion: According to the findings of this study, CSF can be diagnosed on the basis of angiographic findings, while electrocardiogram changes are non- specific findings in these patients.
Keywords
- Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. A new angiographic finding. Am Heart J1972; 84(1): 66-71.
- Karakaya O, Kocer A, Esen A M, Kargin R, BarutcuI. Impaired cerebral circulation in patients with slow coronary flow. Tohoku J Exp Med 2011; 225(1): 13-16.
- YetkinE, Turhan H, Ebay AR, Aksoy Y, Senen K. Increased thrombolysis in myocardial infarction frame count in patient with myocardial infarction and normal coronary arteriogram : a possible link between slow coronary flow and myocardial infarction Atherosclerosis .2005; 181(1): 193-199.
- Li JJ, Wu YJ, Qin XW. Should slow coronary flow be considered as Angina pectoris and slow flow velocity of dye in coronary arteries a coronary syndrom? Med Hypotheses2006; 66(5): 953-956.
- Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X.Angiology2001; 52(8): 507-14.
- Hawkins BM, Stavrakis S, Rousan TA Abu-Fadel M, Schechter E. Coronary slow flow: Prevalence and clinical correlations. Circ J2012; 76(4):936-42.
- Mosseri M, Yarom R, Gotsman Ms, Hasin Y. Histologic evidence for small-vessel coronary artery disease in patient with angina pectoris and patient large coronary arteries circulation. 1986; 74(5): 964-72.
- Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J2003; 146(1): 84-90.
- Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, et al.Vascular endothelial function in patients withslow coronary flow. Coron Artery Dis2003; 14(2):155-161.
- Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Do¨ven O, Parmaksiz HT. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol2004; 59(2):127-33.
- Camsari A, Ozcan T, Ozer C, Akcay B. Carotid artery intima-media thickness correlates with intravascular ultrasound parameters in patients with slow coronary flow. Atherosclerosis2008; 200(2):310-14.
- Selcuk H, Selcuk MT, Temizhan A, Maden O, Saydam GS, Ulupinar H, et al. Decreased plasma concentrations of adiponectin in patients withslow coronary flow. Heart Vessels2009; 24(1):1-7.
- Cin VG, Pekdemir H, Camsar A, Ciçek D, Akkus MN, Parmaksýz T, et al. Diffuse intimal thickening of coronary arteries in slow coronary flow. Jpn Heart J2003; 44(6): 907-19.
- Natalie C, Christopher Z, Angela MK, John FB.ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon. International Jounal of cardiology 2011; 146(3): 457-58.
- Turkmen M, Barutca I, Esen AM, Karakaya O, Esen O, Basaran Y. Effect of slow coronary flow on P wave duration and dispersion. Angiology2007; 58(5):408-12.
- Biceroglu S, Yildiz A, Bayata S, Yesil M, Postaci N. Is there an association between left bundle block branch and coronary slow flow in patients with normal coronary arteries? Angiology 2007Dec-2008 Jan; 58(6): 685-88.
- Moazenzadeh MD, Abbaszadeh Mohammad MD, Rashidinezhad Hamid Reza MD, Sarvar Azimzadeh Behzad MD. Comparison of plasma level of hs-CRP in subjects with Slow Coronary Flow and Normal Coronary Flow. Iranian Heart Jornal 2012; 13(1):17-22.
- Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: aquantitative method of assessing coronary artery flow. Circulation. 1996; 93(5):879-888.
- Burchartt BA, Mukeriji V, Alpert MA. Coronary artery slow flow associated with angina pectoris and hypertension: a case report.Angiology1998; 49(6): 483-87.
- Mohmmad Ali Sadr-Ameli, Sedigheh Saedi, Tahereh Saedi, Mohsen Madani, Behshid Ghardoost. Coronary Slow Flow: Benign or ominous? Anadolu Kardiyol Derg 2015; 15 (0)
)