Effect of Coronary Slow Flow on Intrinsicoid Deflection of QRS Complex
Corresponding Author
Sabri Seyis
Department of Cardiology, Liv Hospital, Istinye University, Istanbul, Turkey istinye.edu.tr
Search for more papers by this authorCorresponding Author
Sabri Seyis
Department of Cardiology, Liv Hospital, Istinye University, Istanbul, Turkey istinye.edu.tr
Search for more papers by this authorAbstract
Coronary slow flow is a rare, clinically important entity observed in acute coronary syndrome. The pathophysiological mechanism is not fully elucidated. We investigated patients with chest pain who had angiographic features consistent with the coronary slow flow. One hundred ten patients were included. Electrocardiography, echocardiography, and angiography results were retrospectively noted. The mean age was 56.4. Fifty-eight were male, and fifty-two were female. The control group consisted of patients with normal angiography. Patients had higher diastolic blood pressure, lower mean ejection fraction, higher average left ventricular end-diastolic diameter, and higher mean left atrial size than the control group (p = 0.009, p = 0.017, p = 0.041, andp < 0.001, resp.). Patients had higher average V1 ID, V6 ID, P wave dispersion, TFC LAD, TFC Cx, TFC RCA, and TFC levels than the control group. A significant linear positive relationship was found between the V1 ID and the TFC LAD, TFC Cx, TFC RCA, and TFC; also between the V6 ID and the TFC LAD, TFC Cx, TFC RCA, and TFC. Angiographic and electrocardiographic features are suggestive and diagnostic for the coronary slow flow syndrome. Although when regarded as a benign condition, coronary slow flow should be diagnosed, followed up, and treated as many of laboratory features suggest ischemic events.
References
- 1 Xia S., Deng S. B., Wang Y. et al., Clinical analysis of the risk factors of slow coronary flow, Heart Vessels. (2011) 26, no. 5, 480–486, https://doi.org/10.1007/s00380-010-0081-5, 2-s2.0-84862833153.
- 2 Singh S., Kothari S. S., and Bahl V. K., Coronary slow phenomenon: an angiographic curiosity, Indian Heart Journal. (2004) 56, no. 6, 613–617.
- 3 Tambe A. A., Demany M. A., Zimmerman H. A., and Mascarenhas E., Anjina pectoris and the slow flow velocity of dye in coronary arteries–a new angiographic finding, American Heart Journal. (1972) 84, no. 1, 66–71, https://doi.org/10.1016/0002-8703(72)90307-9, 2-s2.0-0015362257.
- 4 Leone M. C., Gori T., and Fineschi M., The coronary slow flow phenomenon: a new cardiac “Y” syndrome?, Clinical Hemorheology and Microcirculation. (2008) 39, no. 1–4, 185–190.
- 5 Mosseri M., Yarom R., Gotsman M. S., and Hasin Y., Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries, Circulation. (1986) 74, no. 5, 964–972, https://doi.org/10.1161/01.cir.74.5.964.
- 6 Tanriverdi H., Evrengul H., Kuru O. et al., Cigarette smoking induced oxidative stress may impair endothelial function and coronary blood flow in angiographically normal coronary arteries, Circulation Journal. (2006) 70, no. 5, 593–599, https://doi.org/10.1253/circj.70.593, 2-s2.0-33646077915.
- 7 Sezgin A. T., Sigirci A., Barutcu I. et al., Vascular endothelial function in patients with the slow coronary flow, Coronary Artery Disease. (2003) 14, no. 2, 155–161, https://doi.org/10.1097/00019501-200304000-00008, 2-s2.0-0038746683.
- 8 Yaymaci B., Dagdelen S., Bozbuga N. et al., The response of the myocardial metabolism to atrial pacing in patients with the coronary slow flow, International Journal of Cardiology. (2001) 78, no. 2, 151–156, https://doi.org/10.1016/s0167-5273(01)00366-7, 2-s2.0-0035035054.
- 9 Camsari A., Pekdemir H., Cicek D. et al., Endothelin-1 and nitric oxide concentrations and their response to exercise in patients with slow coronary flow, Circulation Journal. (2003) 67, no. 12, 1022–1028, https://doi.org/10.1253/circj.67.1022, 2-s2.0-0344738771.
- 10 Beltrame J. F., Limaye S. B., Wuttke R. D., and Horowitz J. D., Coronary hemodynamic and metabolic studies of coronary slow flow phenomenon, American Heart Journal. (2003) 146, no. 1, 84–90, https://doi.org/10.1016/s0002-8703(03)00124-8, 2-s2.0-0038499329.
- 11 Ugur M., Yavaş Koroner Akım Fenomeni İle Antiaterojenik Etkili Adipokin Olan Adiponektin Arasındaki İlişki, 2009, Dr. Siyami Ersek Göğüs, Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Istanbul, Turkey, Ph.D. thesis.
- 12 Turkmen M., Barutcu I., Esen A. M. et al., Comparison of exercise QRS amplitude changes in patients with slow coronary flow versus significant coronary stenosis, Japanese Heart Journal. (2004) 45, no. 3, 419–428, https://doi.org/10.1536/jhj.45.419, 2-s2.0-3442892989.
- 13 Beltrame J. F., Limaye S. B., and Horowitz J. D., The coronary slow flow phenomenon–a new coronary microvascular disorder, Cardiology. (2002) 97, no. 4, 197–202, https://doi.org/10.1159/000063121.
- 14 Barutcu I., Sezgin A. T., Gullu H., and Esen A. M., Slow coronary flow phenomenon associated with exercise-induced myocardial ischemia, Turkish Journal of Thoracic and Cardiovascular Surgery. (2005) 13, no. 3, 295–297.
- 15 Cesar L. A., Ramires J. A., Serrana Junior C. V. et al., Slow coronary runoff in patient with angina pectoris: clinical significance and thallium-201 scintigraphic study, Brazilian Journal of Medical and Biological Research. (1996) 29, no. 5, 605–613.
- 16 Demirkol M. O., Yaymaci B., and Mutlu B., Dypridamole myocardial perfusion single photon emission computed tomography in patient with slow coronary flow, Coronary Artery Disease. (2002) 13, no. 4, 223–229, https://doi.org/10.1097/00019501-200206000-00004, 2-s2.0-0036620296.
- 17 Chembers J. and Bass C., Chest pain with normal coronary anatomy: a review of natural history and possible etiological factors, Progress in Cardiovascular Diseases. (1990) 33, no. 3, 161–184, https://doi.org/10.1016/0033-0620(90)90007-o, 2-s2.0-0025145090.
- 18 Voelker W., Euchner U., Dittmann H., and Karsch K. R., Long-term clinical course of patients with anjina and angiographically normal coronary arteries, Clinical Cardiology. (1991) 14, no. 4, 307–311, https://doi.org/10.1002/clc.4960140405, 2-s2.0-0025974959.
- 19 Perez R. A. R., de Abreu L. C., Barbarosa B. R., Nikus K. C., and Baranchuk A., R-peak time: an electrocardiographic parameter with multiple clinical applications, Annals of Noninvasive Electrocardiology. (2016) 21, no. 1, 10–19, https://doi.org/10.1111/anec.12323, 2-s2.0-84957796509.
- 20 Luo C., Wang L., Feng C. et al., Predictive value of coronary blood flow for future cardiovascular events in patients with atrial fibrillation, International Journal of Cardiology. (2014) 177, no. 2, 545–547, https://doi.org/10.1016/j.ijcard.2014.08.102, 2-s2.0-84914142197.
- 21 Gibson C. M., Cannon C. P., Daley W. L. et al., TIMI frame count: a quantitative method of assessing coronary artery flow, Circulation. (1996) 93, no. 5, 879–888, https://doi.org/10.1161/01.cir.93.5.879.
- 22 Luo C., Wu X., Huang Z. et al., Documentation of impaired coronary blood flow by TIMI frame count method in patients with atrial fibrillation, International Journal of Cardiology. (2013) 167, no. 4, 1176–1180, https://doi.org/10.1016/j.ijcard.2012.03.118, 2-s2.0-84881478037.
- 23 Oktay V. and Arat Özkan A., Coronary slow flow, Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology. (2016) 44, no. 3, 193–195, https://doi.org/10.5543/tkda.2016.72429, 2-s2.0-84971450983.
- 24 Turhan H., Saydam G. S., Erbay A. R. et al., Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow, International Journal of Cardiology. (2006) 108, no. 2, 224–230, https://doi.org/10.1016/j.ijcard.2005.05.008, 2-s2.0-33644695573.
- 25
Mangieri E.,
Machiarelli G.,
Ciavolella M. et al., Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries, Catheterization and Cardiovascular Diagnosis. (1996) 37, no. 4, 375–381, https://doi.org/10.1002/(sici)1097-0304(199604)37:4<375::aid-ccd7>3.0.co;2-8.
10.1002/(SICI)1097-0304(199604)37:4<375::AID-CCD7>3.0.CO;2-8 CAS PubMed Web of Science® Google Scholar
- 26 Dagdelen S., Yaymaci B., Izgi A. et al., Assessment of the relationship of slow coronary flow and myocardial ischemia by using TIMI frame count and intracoronary ultrasound, Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology. (2000) 28, no. 12, 747–751.
- 27 Pekdemir H., Cin V. G., Cicek D. et al., Slow coronary flow may be a sign of diffuse atherosclerosis, contribution of FFR and IVUS, Acta Cardiologica. (2004) 59, no. 2, 127–133, https://doi.org/10.2143/ac.59.2.2005166, 2-s2.0-1942472531.
- 28 Cin V. G., Pekdemir H., Camsari A. et al., Diffuse intimal thickening of coronary arteries in slow coronary flow, Japanese Heart Journal. (2003) 44, no. 6, 907–919, https://doi.org/10.1536/jhj.44.907, 2-s2.0-1242286567.
- 29 Pekdemir H., Cicek D., Camsari A. et al., The relationship between plasma endothelin- 1, nitric oxide levels, and heart rate variability in patients with coronary slow flow, Annals of Noninvasive Electrocardiology. (2004) 9, no. 1, 24–33, https://doi.org/10.1111/j.1542-474x.2004.91522.x, 2-s2.0-1242315514.
- 30 Pekdemir H., Polat G., Cin V. G. et al., Elevated plasma endothelin-1 levels in coronary sinus during rapid rate atrial pacing in patients with slow coronary flow, International Journal of Cardiology. (2004) 97, no. 1, 35–41, https://doi.org/10.1016/j.ijcard.2003.06.025, 2-s2.0-4444295628.
- 31 Sezgin A. T., Topal E., Barutçu I. et al., Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study, Angiology. (2005) 56, no. 4, 397–401, https://doi.org/10.1177/000331970505600406, 2-s2.0-22844442031.
- 32 Elsherbiny I. A., Left ventricular function and exercise capacity in patients with the slow coronary flow, Echocardiography. (2012) 29, no. 2, 158–164, https://doi.org/10.1111/j.1540-8175.2011.01552.x, 2-s2.0-84856354790.
- 33 Baykan M., Baykan E. C., Turan S. et al., Assessment of left ventricular function and Tei index by tissue Doppler imaging in patients with slow coronary flow, Echocardiography. (2009) 26, no. 10, 1167–1172, https://doi.org/10.1111/j.1540-8175.2009.00939.x, 2-s2.0-72849129781.
- 34 Boles U., Almuntaser I., and Brown A., Ventricular activation time as a marker for diastolic dysfunction in early hypertension, American Journal of Hypertension. (2010) 23, no. 7, 781–785, https://doi.org/10.1038/ajh.2010.58, 2-s2.0-77953811395.
- 35 Labovitz A. J., Lewen M. K., Kern M. et al., Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty, Journal of the American College of Cardiology. (1987) 10, no. 4, 748–755, https://doi.org/10.1016/s0735-1097(87)80266-8.
- 36 O’Neal W. T., Qureshi W., Navarian S. et al., Electrocardiographic time to intrinsicoid deflection and heart failure: the Multi-Ethnic Study of Atherosclerosis, Clinical Cardiology. (2016) 39, no. 9, https://doi.org/10.1002/clc.22561, 2-s2.0-84992460243.
- 37 Darouian N., Narayanan K., Aro A. L. et al., Delayed intrinsicoid deflection of the QRS complex is associated with sudden cardiac arrest, Heart Rhythm. (2016) 13, no. 4, 927–932, https://doi.org/10.1016/j.hrthm.2015.12.022, 2-s2.0-84957083511.
- 38 Hayano J., Sakakibara Y., Yamada A. et al., Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity, Circulation. (1990) 81, no. 4, 1217–1224, https://doi.org/10.1161/01.cir.81.4.1217.