Abstract
Background: Some patients evaluated for chest pain with angiographically normal coronary arteries show coronary slow flow phenomenon (CSFP) on angiography. Slow flow of dye in epicardial coronary arteries is also not an infrequent finding in patients during routine coronary angiography. The precise pathophysiology of CSFP is not known yet.
Hypothesis: This study investigates the presence of platelet function disorders in patients with CSFP.
Methods: The patient group included 24 patients with CSFP detected by coronary angiography via the TIMI “frame count” method, and a control group included 23 patients with normal coronary flow. Platelet aggregability induced by use of ristocetin, collagen, and adenosine diphosphate (ADP), was measured from all blood samples in both control and patient groups.
Results: The ratio of platelet aggregability increased significantly in patients with CSFP compared with patients with normal coronary flow (ristocetin 57.6 ± 15 vs. 45.4 ± 17.1, collagen 62.9 ± 16.4 vs. 48.9 ± 25.3, ADP 59.4 ± 18 vs. 42.4 ± 15.2, p < 0.05).
Conclusion: Platelet aggregability is increased in patients with CSFP.
Keywords: coronary slow flow, platelet aggregability
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References
- 1. Beltrame JF, Turner SP, Horowitz JD: Persistence of the coronary slow phenomenon. Persistence of the coronary slow flow phenomenon. Am J Cardiol 2001;Oct 15; 88 (8): 938 11676972 [Google Scholar]
- 2. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E: Angina pectoris and slow velocity of dye in coronary arteries: A new angiographic finding. Am Heart J 1972; 84: 66–71 [DOI] [PubMed] [Google Scholar]
- 3. Kemp HG, Elliott W, Gorlin RD: The anginal syndrome with normal coronary arteriography. Trans Assoc Am Physicians 1967; 80: 59–70 [PubMed] [Google Scholar]
- 4. Neill WA, Kassebaum DG, Judkins MP: Myocardial hypoxia as the basis for angina pectoris in a patient with normal coronary arteriograms. N Engl J Med 1968; 279: 789–792 [DOI] [PubMed] [Google Scholar]
- 5. Kurtoǧlu N, Akcay A, Dindar I: Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow. Am J Cardiol 2001; 87: (suppl 8A) 777–779 [DOI] [PubMed] [Google Scholar]
- 6. Mangieri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A, Dell Italia L, Scibilia G, Motta P, Campa P: Slow coronary flow: Clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996; 37: 375–381 [DOI] [PubMed] [Google Scholar]
- 7. Cahill MR, Newland AC: Platelet activation in coronary artery disease. Br J Biomed Sci 1993; 50 (3): 221–234 [PubMed] [Google Scholar]
- 8. Dogan VI, Ovali E, Eti Z, Yayci A, Gögüs FY: The in vitro effect of isoflurane, sevoflurane and propofol on platelet aggregation. Anesth Analg 1999; 88: 432–436 [DOI] [PubMed] [Google Scholar]
- 9. Mehta J, Mehta P: Role of blood platelets and prostaglandins in coronary artery disease. Am J Cardiol 1981; 48 (2): 366–373 [DOI] [PubMed] [Google Scholar]
- 10. Serebruany VL, Cummings CC, Malinin AI, Steinhubl SR, Gurbel PA: Uniform platelet activation exists before coronary stent implantation despite aspirin therapy. Am Heart J 2001; 142 (4): 611–616 [DOI] [PubMed] [Google Scholar]
- 11. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E: TIMI frame count. A quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879–888 [DOI] [PubMed] [Google Scholar]
- 12. Carr ME Jr, Carr SL, Merten SR: Effects of ionic and nonionic contrast media on clot structure, platelet function and thrombolysis mediated by tissue plasminogen activator in plasma clots. Haemostasis 1995; 25: 172–181 [DOI] [PubMed] [Google Scholar]
- 13. Taylor MA, Angello DA, Ayers CR, Gear AR: Radiographic contrast agents and platelet function: A quenched‐flow study. Cathet Cardiovasc Diagn 1991; 22 (4): 295–301 [DOI] [PubMed] [Google Scholar]
- 14. Ramires JA, Decourt LV: Slow blood flow in the coronary arteries: Probable expression of a morbid process. Arq Bras Car diol 1989; 52 (1): 1–3 [PubMed] [Google Scholar]
- 15. Goel PK, Gupta SK, Agarwal A, Kapoor A: Slow coronary flow: A distinct angiographic subgroup in syndrome X. Angiology 2001; 52 (8): 507–514 [DOI] [PubMed] [Google Scholar]
- 16. Burchartt BA, Mukerji V, Alpert MA: Coronary artery slow flow associated with angina pectoris and hypotension: A case report. Angiology 1998; 49 (6): 483–487 [DOI] [PubMed] [Google Scholar]
- 17. Przybojewski JZ, Becker PH: Angina pectoris and acute myocardial infarction due to “slow‐flow phenomenon” in nonatherosclerotic coronary arteries: A case report. Angiology 1986; 37 (10): 751–761 [DOI] [PubMed] [Google Scholar]
- 18. Kapoor A, Pravin KG, Gupta S: Slow coronary flow—a cause for angina with ST‐segment elevation and normal coronary arteries. A case report. Int J Cardiol 1998; 67: 257–261 [DOI] [PubMed] [Google Scholar]
- 19. Greenberg MA, Grose RM, Neuburger N, Silverman R, Strain JE, Cohen MV: Impaired coronary vasodilator responsiveness as a cause of lactate production during pacing‐induced ischemia in patients with angina pectoris and normal coronary arteries. Am Coll Cardiol 1987; 9: 743–751 [DOI] [PubMed] [Google Scholar]
- 20. Cannon RO, Watson RM, Rosing DR, Epstein SE: Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1983; 1: 1359–1373 [DOI] [PubMed] [Google Scholar]
- 21. Cannon RO, Epstein SE: Microvascular angina as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 1988; 61: 1338–1343 [DOI] [PubMed] [Google Scholar]
- 22. Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A: Evidence of impaired endothelium‐dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993; 328: 1659–1664 [DOI] [PubMed] [Google Scholar]
- 23. Van Lierde J, Vrolix M, Sionis D, De Geest H, Piessens J: Lack of evidence for small vessel disease in a patient with “slow dye progression” in the coronary arteries. Cathet Cardiovasc Diagn 1991; 23: 117–122 [DOI] [PubMed] [Google Scholar]
- 24. Friedman HE: Neurobiology of slow coronary flow. Int J Cardiol 1999; 70 (1): 91–92 [DOI] [PubMed] [Google Scholar]
- 25. Lanza GA, Andreotti F, Sestito A, Sciahbasi A, Crea F, Maseri A: Platelet aggregability in cardiac syndrome X. Eur Heart J 2001; 22: 1924–1930 [DOI] [PubMed] [Google Scholar]
- 26. Cesar CAM, Ramires JAF, Serrano CV Jr, Meneghetti JC, Antonelli RH, da‐Luz PL, Pillegi FJ: Slow coronary run‐off in patients with angina pectoris: Clinical significance and thallium‐201 scintigraphic study. Braz J Med Biol Res 1996; 29: 605–613 [PubMed] [Google Scholar]