Slow coronary flow and stress myocardial perfusion imaging. Different patterns in acute patients.
OBJECTIVE
We investigated myocardial perfusion in acute patients with slow coronary flow (SCF) at angiography. Whether impaired myocardial perfusion occurs in acute patients with SCF is unknown.


METHODS
We enrolled 28 consecutive patients with SCF in the epicardial coronary arteries with no evidence of significant stenosis. SCF affected a single coronary artery in 14 patients (group A) and all three coronary vessels in 14 others (group B). Coronary angiography was repeated after dipyridamole infusion and single photon emission computed tomography was performed using dipyridamole as the stress agent. The Thrombolysis in Myocardial Infarction frame count was measured in SCF vessels at baseline and after dipyridamole infusion.


RESULTS
Mean Thrombolysis in Myocardial Infarction frame count significantly decreased after dipyridamole in both groups. At baseline, mean values of the single photon emission computed tomography score were 31.5 +/- 1.6 and 25.1 +/- 2.1 in groups A and B, respectively. After dipyridamole, they increased from 31.5 +/- 1.6 to 37.8 +/- 1.4 (P < 0.001) in group A, whereas a further decrease to 15.0 +/- 1.2 (P < 0.005) was observed in group B.


CONCLUSIONS
An opposite behavior of myocardial perfusion was observed after dipyridamole infusion: a normal response in patients with SCF affecting one single coronary artery versus an ischemic-like response in those with CSF affecting all three coronary arteries.
Mangieri
Enrico
E
Second Division of Cardiology, Department of Heart and Great Vessels Attilio Reale, Rome, Italy. enrico.mangieri@uniroma1.it
Tanzilli
Gaetano
G
De Vincentis
Giuseppe
G
Barillà
Francesco
F
Remediani
Silvia
S
Acconcia
Maria Cristina
MC
Comito
Cosimo
C
Gaudio
Carlo
C
Scopinaro
Francesco
F
Puddu
Paolo Emilio
PE
Critelli
Giuseppe
G
D000208:Acute Disease; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004176:Dipyridamole; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000378:metabolism; D005996:Nitroglycerin; D010496:Pericardium / Q000000981:diagnostic imaging / Q000503:physiopathology; D019275:Radiopharmaceuticals / Q000378:metabolism; D013577:Syndrome; D017256:Technetium Tc 99m Sestamibi / Q000378:metabolism; D015899:Tomography, Emission-Computed, Single-Photon; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi; D005996:Nitroglycerin