Korean Circ J.  2011 Nov;41(11):666-670. 10.4070/kcj.2011.41.11.666.

Slow Coronary Flow is Related to Increased Carotid Intima-Media Thickness but Not Pulse Wave Velocity

• Kim BS
• Kim HJ
• Han SW
• Kim SH
• Suh SY
• Chung SM
• Ryu KH

• KMID: 2225075
• DOI: http://doi.org/10.4070/kcj.2011.41.11.666

Abstract

BACKGROUND AND OBJECTIVES
Slow coronary flow (SCF) is characterized by delayed contrast dye opacification without significant stenosis of epicardial coronary arteries. However, the pathophysiology and clinical implications of SCF are not fully understood. Some reports have suggested that SCF might be caused by atherosclerosis in the coronary artery microvasculature. Measuring carotid intima-media thickness (IMT) and pulse wave velocity (PWV), which are non-invasive and simple diagnostic tools, was developed to detect subclinical atherosclerosis. Thus, we determined IMT and PWV, and their possible relationship in a SCF group and a normal coronary flow (NCF) group of patients.
SUBJECTS AND METHODS
We included 101 patients who complained of chest pain but had a normal coronary angiogram. Thrombolysis in Myocardial Infarction frame count (TIMI frame count, TFC) was evaluated in the left and right coronary arteries. We defined SCF as a TFC of more than 25. Carotid IMT was measured by ultrasonography in both common carotid arteries. PWV was calculated from pulse transit time between the brachial and ankle arteries.
RESULTS
Fifteen patients were included in the SCF group and 86 patients in the NCF group. Male patients (n=11, 73.3%) were significantly more common in the SCF group than in the NCF group (n=37, 43.0%, p<0.05). The TFC of the SCF and NCF groups were 28.8+/-3.5 and 15.7+/-4.5, respectively. The carotid IMT in the SCF group increased significantly compared to that in the NCF group (1.2+/-0.3 mm vs. 0.8+/-0.1 mm, p<0.01). However, no significant difference in PWV was observed between the two groups.
CONCLUSION
SCF may reflect early atherosclerotic changes in the coronary artery microvasculature.

Keyword

Microcirculation; Slow coronary flow; Carotid intima-media thickness

MeSH Terms

Animals
Ankle
Atherosclerosis
Carotid Artery, Common
Carotid Intima-Media Thickness
Chest Pain
Constriction, Pathologic
Coronary Vessels
Humans
Male
Microcirculation
Microvessels
Myocardial Infarction
Pulse Wave Analysis

Figure

• 

  Fig. 1 TFC for each clinical diagnosis. TFC increased significantly in the microvascular angina group compared to other clinical diagnoses (p<0.05 by analysis of variance). AMI: acute myocardial infarction, CHF: chronic heart failure, MA: microvascular angina, NC: non-cardiac chest pain, TFC: Thrombolysis in Myocardial Infarction frame count, UA: unstable angina.

• 

  Fig. 2 A: a positive correlation was observed between carotid intima-media thickness (IMT) and the Thrombolysis in Myocardial Infarction frame count (TFC) (r=0.40, p<0.001). B: no significant correlation was found between pulse wave velocity (PWV) and the TFC. NS: not significant.

• 

  Fig. 3 Comparison of the carotid intima-media thickness (IMT) and pulse wave velocity (PWV) between the normal coronary flow (NCF) and slow coronary flow (SCF) groups. A: carotid IMT increased significantly in the SCF group compared to that in the NCF group. B: no difference in the PWV between the SCF and NCF groups. NS: not significant.

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