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[Delayed filling of the anterior interventricular artery. Apropos of 9 cases]
Insights
Typical angina pectoris can occur without coronary stenosis, often due to slow flow velocity syndrome. This condition involves delayed artery filling and myocardial perfusion defects, even with normal coronary arteries.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Physiology
Background:
- Typical angina pectoris can manifest without significant atheromatous coronary stenosis.
- Alternative causes include coronary spasm, small vessel disease, and metabolic disturbances.
- The "slow flow velocity syndrome" was previously described in patients with angina and normal coronary arteries.
Purpose of the Study:
- To analyze the clinical, electrocardiographic (ECG), and hemodynamic profiles of patients with slow flow velocity syndrome.
- To investigate the characteristics of delayed left anterior descending artery filling in patients with angina and normal coronary arteries.
Main Methods:
- Selective coronary angiography was performed on patients presenting with angina.
- Nine patients with normal coronary arteries but delayed left anterior descending artery filling were identified.
- Stress Thallium myocardial scintigraphy and ergometrine provocation tests were conducted.
Main Results:
- Patients exhibited significantly longer coronary artery filling times compared to controls.
- Delayed filling was observed in strictly normal coronary vessels and was reproducible.
- Myocardial perfusion defects were identified in five patients via stress Thallium scintigraphy.
Conclusions:
- Slow flow velocity syndrome is a distinct cause of angina pectoris in patients with normal coronary arteries.
- This syndrome is characterized by reproducible delayed coronary artery filling and associated perfusion defects.
- Further investigation into the pathophysiology and management of slow flow velocity syndrome is warranted.
Abstract:
Selective coronary angiography has shown that typical angina pectoris may occur in the absence of atheromatous coronary stenosis. Other causes of these attacks of pain have been found: coronary spasm, small vessel disease, abnormal dissociation of haemoglobin or metabolic disturbances of the myocardial cell. Of all the patients undergoing coronary angiography in 1984 at the Centre Cantini, 9 had no classical coronary lesions but delayed filling of the left anterior descending artery. This syndrome was described for the first time in 1972 by Tambe as the "slow flow velocity syndrome". The aim of this study was to analyse the clinical, ECG and haemodynamic profiles of those patients. Five of them also underwent stress Thallium myocardial scintigraphy. An ergometrine provocation test was performed afterwards under ECG control. Delayed filling was appreciated by comparison with the other vessels and also by measuring the filling time which was two or three times longer than in a control series of 9 patients with angina and normal coronary arteries. The difference was statistically significant. These findings were only observed in strictly normal coronary vessels; they were reproducible and unaffected by the administration of nitrate derivatives. In our series all 9 patients were men with an average age of 51.4 years. One patient was asymptomatic and had a history suggestive of myocardial infarction, and 4 others had typical angina of effort: all had abnormal exercise stress tests. The other 3 patients had spontaneous atypical chest pain, normal resting ECG and a negative exercise stress test (impossible in one case). The five stress Thallium scintigraphies showed myocardial perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)
