Can transthoracic Doppler echocardiography be used to detect coronary slow flow phenomenon？

Background Coronary slow flow phenomenon （CSFP） is an important, angiographic clinical entity but is lacking non-invasive detecting techniques. This study aimed to elucidate the value of transthoracic Doppler echocardiography （TTDE） in the diagnosis and monitoring of coronary slow flow in left anterior descending （LAD） coronary artery.Methods We consecutively enrolled 27 patients with CSFP in LAD detected by coronary arteriography from August 2009 to April 2010. Thirty-eight patients with angiographically normal coronary flow served as control. Corrected thrombolysis in myocardial infarction （TIMI） frame count （CTFC） was used to document coronary flow velocities. All subjects underwent TTDE within 24 hours after coronary angiography. LAD flow was detected and the coronary diastolic peak velocities （DPV） and diastolic mean velocities （DMV） were calculated.Results Sixty of 65 （92.3%） subjects successfully underwent TTDE. Baseline clinical characteristics were similar between the two groups. Coronary DPV and DMV of LAD were significantly lower in the CSFP group than in the control group （（0.228±0.029） m/s vs. （0.302±0.065） m/s, P=0.000; （0.176±0.028） m/s vs. （0.226±0.052） m/s, P=0.000,respectively）. There was a high inverse correlation between CTFC and coronary DPV and DMV （r=-0.727, P=0.000;r=-0.671, P=0.000, respectively）. Receiver operating characteristic （ROC） curve showed that the area under the curve （AUC） was less than one half for coronary DPV （AUC=0.104） and DMV （AUC=0.204）, respectively.Conclusions In patients with CSFP, there is a high inverse correlation between CTFC and coronary diastolic flow velocities in the LAD coronary artery, as measured by TTDE. The value of TTDE in the monitoring and evaluation of coronary flow in patients with CSFP deserves further investigation.

Short-term effects of enhanced external counterpulsation on coronary slow flow and cardiac function in patients with acute myocardial infarction during primary percutaneous coronary intervention

Background Coronary slow flow（CSF） during primary percutaneous coronary intervention（PCI） is closely related to the prognosis of patients with acute myocardial infarction（AMI）. Whether Enhanced External CounterPulsation（EECP） could improve the phenomenon and enhance cardiac function in these patients has not been studied. Methods Seventy-eight AMI patients undergoing primary PCI were enrolled and divided into 2 groups, EECP group and sham group. In EECP group, the patients were treated with EECP for 30 min after coronary artery stent implantation; and in sham group, the patients after coronary artery stent implantation were treated with cuffs wrapped for 30 min. Hemodynamics and corrected TIMI Frame Count（c TFC） were recorded at different time points in both groups. CRP, HCY, NT-pro BNP and Killip class were also detected before operation and after treatment. Results In EECP group, compared to pre-and post-EECP treatment, the systolic blood pressure（SBP） was much lower（P〈0.05）, diastolic blood pressure（DBP） and mean arterial blood pressure（MBP）were much higher（P〈0.05）. The heart rate（HR） was not changed during EECP treatment（P〉0.05）. In sham group, SBP, DBP, MBP and HR were not significantly changed during these period（P〉0.05）. In EECP group,the c TFC of patients with CSF decreased significantly after treatment（P〈0.05）; and there was no difference in sham group（P〉0.05）. Compared with pre-EECP treatment, CRP and HCY were increased in post-EECP treatment of both groups（P〈0.05）, while, they were much lower in EECP group（P〈0.05）. The expression of NTpro BNP was decreased after treatment in both groups（P〈0.05）, and it was much lower in EECP group than in sham group（P〈0.05）. The Killip class was much lower after treatment than before operation in EECP group（P〈0.05）, and there was no change in sham group（P〉0.05）. Conclusions The results suggest that EECP is helpful in a short time to the improvement of CSF and recovery of cardiac function in AMI patients during primary PCI,and that CRP and HCY may be involved in this process.

Assessment of angiographic coronary slow flow phenomenon with intracoronary ultrasound and doppler flow mapping

In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.