冠状动脉慢血流35例临床分析

冠状动脉慢血流现象（coronary slow flow phenomenon，CSFP）是指排除冠状动脉狭窄、溶栓治疗后、冠状动脉成形术后、冠状动脉痉挛、冠状动脉扩张、心肌病、瓣膜病、结缔组织病等因素后，在冠状动脉造影中没有发现冠状动脉存在明显病变，而远端血流灌注延迟的现象。Mangieri等报道7％怀疑有冠心病的患者进行冠状动脉造影有慢血流现象发生，由此可见CSFP发生率较高，应引起临床的足够重视。     

冠状动脉慢血流现象研究进展

冠状动脉（冠脉）慢血流现象是在冠脉造影过程中发现的冠脉血流灌注延迟现象,但没有结构性的冠脉疾病作为基础,因其预后的不确定性,近几年来越来越引起介入医生的关注,而其病因、发病机制、临床诊治、疾病预后等尚缺少大量研究的支持,本文将就该现象的相关研究现状作综述。     

冠状动脉慢血流药物治疗研究进展

在冠状动脉造影检查中,无阻塞性冠状动脉（冠脉）性疾病存在末端冠状动脉血管延迟显影的现象称为冠状动脉慢血流（CSF）。其临床以反复胸痛为主要表现,心电图或负荷心电图常有心肌缺血征象。尽管冠状动脉造影显示冠状动脉无狭窄,但仍有反复心血管事件发生。目前CSF治疗仅以药物为主,尚无标准化治疗措施。本文以CSF的可能发病机制为依据,对治疗CSF的药物进展进行综述。     

冠状动脉慢血流现象的研究进展

<正>随着生活水平提高,冠心病患者人数在逐年攀升,冠状动脉造影检查已成为诊断冠心病的金标准。在冠状动脉造影检查中,存在一种血管形态几乎正常却出现血流灌注延迟的现象,Tambe等~([1])于1972年初次发现,并命名为冠状动脉慢血流现象。但由于对该现象相关研究较少,目前仍没有形成系统定论。研究表明慢血流现象发生率约为7%。本文将针对慢血流现象从概念、诊断标准、临床特点、病理机制、危险因素、治疗方案等方面进行综合分析。     

冠状动脉慢血流现象的临床特点分析

目的探讨冠状动脉慢血流现象(CSFP)的临床意义。方法入选病例分两组:冠脉慢血流现象组(39例)和冠状动脉血流正常组(27例),所有病例均行冠脉造影检查,并除外心肌病、瓣膜病及其他类型心脏病,在行冠脉造影检查时发现慢血流,均于冠脉内注射硝酸甘油0.2mg,测量注射前后的血流速度,入选病例均行运动负荷试验及静息心电图检查。结果冠状动脉慢血流现象组注射硝酸甘油后血流速度明显增快,P<0.05;冠脉慢血流组无心绞痛发作时,静息心电图异常发生与血流正常组无差异,P>0.05,心绞痛发作时,静息心电图异常发生高于冠脉血流正常组,P<0.05,运动负荷阳性率高于冠脉血流正常组,P<0.05。结论冠状动脉慢血流现象在冠脉造影中比较常见,可能是一种缺血性心脏病新的发病机制,有待进一步验证。     

冠状动脉慢血流现象研究进展

<正>冠状动脉慢血流(coronary slow flow,CSF)现象是指除外溶栓治疗后、冠状动脉成形术后、冠状动脉痉挛、冠状动脉扩张、心肌病、瓣膜病等因素,且冠状动脉造影中没有发现明显病变,却发生血流灌注延迟的现象。有人为了更好地区分X综合征而把这种现象称为Y综合征[1]。随着冠状动脉造     

冠状动脉慢血流现象研究的进展

冠状动脉慢血流（coronary slow flow，CSF）现象是指在冠状动脉造影（CAG）时正常的冠状动脉远端血流灌注延迟的现象。尽管这种现象早在1972年就已经被报道，但直到目前为止无论是对CSF的发病机理还是治疗都还不十分清楚。随着CAG的普及，CSF越来越受到心血管界的重视，已经成为国内、外学者研究的热门课题，本文就近年来对CSF的研究作一综述。     

冠状动脉慢血流现象的研究进展

冠状动脉慢血流现象的病因及病理机制尚不明确,近年来的研究认为,吸烟、高同型半胱氨酸等与冠状动脉慢血流现象的发生密切相关,内皮功能损伤和炎性反应可能参与病理生理机制并发挥重要作用。冠状动脉慢血流现象可引起心肌缺血,临床上可表现为心绞痛或急性冠状动脉综合征,甚至猝死。小样本随访研究也表明,冠状动脉慢血流现象预后较差。现就冠状动脉慢血流现象的病因、病理生理机制、临床特点、诊治和预后综述如下。     

双嘧达莫治疗冠状动脉慢血流临床观察

冠状动脉（下称冠脉）慢血流现象（CSFP）是指冠脉造影未发现冠脉病变而远端血流灌注延迟的现象。2003年8月～2005年12月，我们采用双嘧达莫治疗CSFP患者28例，效果显著。现报告如下。     

冠状动脉慢血流现象研究进展

冠状动脉（冠脉）慢血流现象是冠脉造影和介入治疗时的常见现象。心肌微循环障碍、冠脉循环前向阻力增加、内皮功能障碍、血管舒缩因子分泌失调、炎症和冠脉弹性改变等诸多因素与冠脉慢血流密切相关。     

Coronary slow flow phenomenon caused by contrast-induced microvascular spasm

Coronary slow flow phenomenon is not an infrequent finding and is often associated with chest pain, but the mechanism has not been fully elucidated. We report a case of coronary slow flow phenomenon induced after contrast injection which was resolved by nicorandil administration. Therefore, the microvascular spasm might be an important factor in coronary slow flow phenomenon and contrast medium can be a trigger.     

Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon

Background

The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by Thrombolysis in Myocardial Infarction (TIMI)-2 flow in the absence of significant large vessel coronary disease. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully elucidated. This study investigates the persistence of the phenomenon on serial angiographic studies, coronary hemodynamic findings at rest and during provocative stimuli, and biochemical evidence of inducible myocardial ischemia.

Methods

Twelve patients with CSFP underwent repeat angiography and coronary sinus canulation that allowed for the assessment of coronary blood flow, transmyocardial lactate, and oxygen extraction. Parameters were assessed at rest and during rapid atrial pacing, cold pressor stimulation, and acetylcholine infusion. Angiographic and coronary hemodynamic findings were compared with 47 patients who underwent angiography and 8 patients who were hemodynamic control subjects, respectively.

Results

Persistent TIMI-2 flow was demonstrated with repeat angiography in only 4 of the patients. However, the corrected TIMI frame count remained delayed compared with that in control subjects. Furthermore, resting coronary sinus oxygen saturation was low compared with control subjects (23% ± 4% vs 31% ± 4%; P <.01), reflecting an increased basal coronary vasomotor tone. The coronary vasodilatory response to atrial pacing was similar to that in control subjects; however, several patients exhibited abnormal vasomotor responsiveness to cold pressor and acetylcholine stimuli. There was no evidence of nett myocardial lactate production with atrial pacing.

Conclusion

The CSFP is associated with a chronically elevated resting coronary microvascular tone, even when symptoms are relatively quiescent.     

冠状动脉慢血流现象研究进展

冠状动脉（冠脉）慢血流现象是冠脉造影和介入治疗时的常见现象。心肌微循环障碍、冠脉循环前向阻力增加、内皮功能障碍、血管舒缩因子分泌失调、炎症和冠脉弹性改变等诸多因素与冠脉慢血流密切相关。     

炎症与冠状动脉慢血流现象

目的探讨炎症在冠状动脉慢血流（CSF）现象形成中的病理生理作用。方法经冠状动脉造影（CAG）诊断为CSF患者38例,CAG显示无管腔狭窄且无慢血流者25例为对照组,使用校正的TIMI血流分级（CTFC）方法评价冠状动脉血流速度。两组均采用ELIA法测定高敏C反应蛋白（hs—CRP）及白细胞介素6（IL-6）浓度,比较两组间hs—CRP及IL-6的差异,分析冠状动脉血流速度与hs—CRP及IL-6的相关性。Logistic多因素分析评价CSF发生的影响因素。结果CSF组hs—CRP和IL-6浓度明显高于对照组。冠状动脉平均血流速度与hs—CRP及IL-6浓度呈正相关。Logistic多因素分析显示hs—CRP和IL-6与CSF的发生相关（P=0．004,0．001）。结论炎症参与CSF的形成。     

Coronary slow flow phenomenon: description of three cases evaluated with myocardial perfusion scintigraphy.

The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of the epicardial coronary arteries in the absence of significant stenosis, spasm, dissection or thrombus. Although this poorly understood phenomenon received little attention, patients with CSFP at coronary angiography often suffer from recurrent episodes of chest pain, sometimes occurring during an acute coronary syndrome. We describe 3 cases of patients with CSFP who complained of recurrent chest pain; in one of them an episode of chest pain was so severe as to bring the patient to the emergency department. Indeed, in all our 3 cases myocardial ischemia was evaluated on the basis of a positive myocardial scintigraphy result. In conclusion, it is suggested that CSFP may be an acute and recurrent perturbation of microvascular function with an often severe impairment of quality of life. Myocardial perfusion scintigraphy might help for an accurate assessment of myocardial ischemia in such patients.     

冠状动脉慢血流现象的临床意义

目的:探讨冠状动脉慢血流现象的临床及近期预后价值。方法:通过矫正的TIMI血流分级方法,评价冠状动脉血流速度和远端血流灌注。对37例正常血流者和35例无冠状动脉狭窄性病变而冠状动脉慢血流者行次级量平板运动试验及心脏超声左室射血分数(LVEF)测定,并随访1年,观察近期预后。结果:冠状动脉慢血流组平板运动试验阳性率明显高于正常血流组(71.4%∶13.5%,P<0.01),而平板运动耐量时间明显低于正常血流组[(5.32±4.38)∶(10.58±5.67)min,P<0.01)];2组LVEF差异无统计学意义;随访1年发现冠状动脉慢血流组中10例反复心绞痛发作、1例发生急性下壁心肌梗死,无心脏性猝死发生。结论:冠状动脉慢血流现象与运动耐量降低、心绞痛发作有关,应引起临床重视。