BACKGROUND: We investigated the possibility that transient coronary slow-flow as assessed during coronary angiography in patients with cardiac syndrome X may impair myocardial perfusion and the effects of this phenomenon on long-term prognosis. METHODS: From 50 consecutive patients with cardiac syndrome X, we prospectively recruited 16 who exhibited coronary slow-flow during angiography. The remaining 34 patients served as controls. The slow-flow phenomenon was invariably worsened by nitrates and reversed by papaverine. During slow-flow, a dose of 99m-Tc-Methoxy-isobutyl-isonitrile (MIBI) was injected in 12 patients and SPECT imaging performed 1 h later. The perfusion study was repeated after 2 days at rest and, in 9 patients, at peak exercise after 10+/-4 days. Patients were then regularly followed-up. RESULTS: All 12 patients had a significant MIBI defect in the regions served by the coronary artery that showed slow-flow just prior MIBI injection. After exercise, MIBI tomograms revealed a perfusion defect in 5 out of the 9 patients who underwent stress scanning. At 14+/-2 years follow-up, 1 patient with slow-flow had died and 4 developed significant coronary artery disease (CAD), while all patients of the control group were alive and none had developed significant CAD. CONCLUSIONS: These results show that the slow-flow phenomenon might be the cause of transient myocardial underperfusion in patients with angina and normal coronary arteries. Apparently, this phenomenon is associated with a worse cardiac prognosis. Therefore, patients with coronary slow-flow should be carefully followed-up.

Fragasso, G., Chierchia, S., Arioli, F., Carandente, O., Gerosa, S., Carlino, M., et al. (2009). Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: Long-term clinical and functional prognosis. INTERNATIONAL JOURNAL OF CARDIOLOGY, 137, 137-144 [10.1016/j.ijcard.2008.06.070].

Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: Long-term clinical and functional prognosis

FAZIO, FERRUCCIO;
2009

Abstract

BACKGROUND: We investigated the possibility that transient coronary slow-flow as assessed during coronary angiography in patients with cardiac syndrome X may impair myocardial perfusion and the effects of this phenomenon on long-term prognosis. METHODS: From 50 consecutive patients with cardiac syndrome X, we prospectively recruited 16 who exhibited coronary slow-flow during angiography. The remaining 34 patients served as controls. The slow-flow phenomenon was invariably worsened by nitrates and reversed by papaverine. During slow-flow, a dose of 99m-Tc-Methoxy-isobutyl-isonitrile (MIBI) was injected in 12 patients and SPECT imaging performed 1 h later. The perfusion study was repeated after 2 days at rest and, in 9 patients, at peak exercise after 10+/-4 days. Patients were then regularly followed-up. RESULTS: All 12 patients had a significant MIBI defect in the regions served by the coronary artery that showed slow-flow just prior MIBI injection. After exercise, MIBI tomograms revealed a perfusion defect in 5 out of the 9 patients who underwent stress scanning. At 14+/-2 years follow-up, 1 patient with slow-flow had died and 4 developed significant coronary artery disease (CAD), while all patients of the control group were alive and none had developed significant CAD. CONCLUSIONS: These results show that the slow-flow phenomenon might be the cause of transient myocardial underperfusion in patients with angina and normal coronary arteries. Apparently, this phenomenon is associated with a worse cardiac prognosis. Therefore, patients with coronary slow-flow should be carefully followed-up.
Articolo in rivista - Articolo scientifico
Cardiac syndrome X; Myocardial ischemia; Myocardial perfusion scintigraphy; Coronary slow-flow; Prognosis
English
2009
137
137
144
none
Fragasso, G., Chierchia, S., Arioli, F., Carandente, O., Gerosa, S., Carlino, M., et al. (2009). Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: Long-term clinical and functional prognosis. INTERNATIONAL JOURNAL OF CARDIOLOGY, 137, 137-144 [10.1016/j.ijcard.2008.06.070].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/26298
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