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Slow coronary flow and stress myocardial perfusion imaging. Different patterns in acute patients

Mangieri, Enrico; Tanzilli, Gaetano; Vincentis, Giuseppe De; Barillà, Francesco; Remediani, Silvia; Acconcia, Maria Cristina; Comito, Cosimo; Gaudio, Carlo; Scopinaro, Francesco; Puddu, Paolo Emilio; Critelli, Giuseppe

Journal of Cardiovascular Medicine: May 2006 - Volume 7 - Issue 5 - p 322–327
doi: 10.2459/01.JCM.0000223253.16686.4d
Original articles
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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.

aSecond Division of Cardiology, Department of Heart and Great Vessels “Attilio Reale”, Rome, Italy

bDepartment of Experimental Medicine, “La Sapienza” University of Rome, Rome, Italy

Received 13 May, 2005

Revised 26 July, 2005

Accepted 1 August, 2005

Correspondence and requests for reprints to Dr Enrico Mangieri, Via Parenzo 1, 00198 Rome, Italy E-mail: enrico.mangieri@uniroma1.it

© 2006 Italian Federation of Cardiology. All rights reserved.