Coronary slow-flow phenomenon in patients in the absence of a stenotic coronary lesion

INTRODUCTION. Isolated coronary slow-flow phenomenon, being a lesion of the distal microvascular bed, may have an unfavorable prognosis, but usually does not require surgical revascularization. The genesis of delayed coronary flow in patients with symptomatic stenotic coronary lesion requires special attention in terms of surgical tactics, as it is not reversible in all cases.
The OBJECTIVE of the research was to study the coronary slow-flow phenomenon in a model of long-term chronic infection. METHODS AND MATERIALS. 68 patients with pulmonary tuberculosis with clinical or instrumental data of myocardial ischemia, but without coronary artery stenosis were studied. All patients were divided into 2 groups (with and without coronary slow-flow phenomenon). A modified TIMI scale was used to estimate the velocity of the radiopaque substance. The duration of the disease and the extent of the lesion, acute-phase blood parameters, and the presence of cardiotoxic drugs in therapy were evaluated.
RESULTS. Patients in the group with slowing of coronary flow had a longer duration of the disease, were characterized by a large volume of lung damage, however, there were no differences in the degree of increase in acute phase parameters of blood, the factor of bacillus excretion.
CONCLUSION. The presented data indicate the need to take into account the possible presence of a coronary slowflow phenomenon unrelated to the degree of stenosis in the tactics of surgical treatment of patients with a specific inflammatory process with symptomatic stenotic lesions of the coronary arteries.

1. Zhu Q., Wang S., Huang X. et al. Understanding the pathogenesis of coronary slow flow: Recent advances. Trends Cardiovasc Med. 2024;34(3):137–144. https://doi.org/10.1016/j.tcm.2022.12.001. PMID: 36516963.

2. Mikaeilvand A., Hajizadeh R., Bateni A., Yahyapour Z. Long-Term Prognosis in Patients with Coronary Slow Flow. J Tehran Heart Cent. 2022;17(4):202–206. https://doi.org/10.18502/jthc.v17i4.11608. PMID: 37143748; PMCID: PMC10154108.

3. Tomai F., Ghini A. S., Danesi A. Influence of slow coronary blood flow on stenosis morphology. Heart. 2001;86(2):171. https://doi.org/10.1136/ heart.86.2.171. PMID: 11454834; PMCID: PMC1729858.

4. Aparicio A., Cuevas J., Morís C., Martín M. Slow Coronary Blood Flow: Pathogenesis and Clinical Implications. Eur Cardiol. 2022;17:e08. https:// doi.org/10.15420/ecr.2021.46. PMID: 35356630; PMCID: PMC8941644.

5. Leone M. C., Gori T., Fineschi M. The coronary slow flow phenomenon: a new cardiac “Y” syndrome? Clin Hemorheol Microcirc. 2008;39(1– 4):185–90. PMID: 18503124.

6. Beltrame J. F., Limaye S. B., Horowitz J. D. The coronary slow flow phenomenon-a new coronary microvascular disorder. Cardiology. 2002;97(4):197–202. https://doi.org/10.1159/000063121. PMID: 12145474.

7. Goel P. K., Gupta S. K., Agarwal A., Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology. 2001;52(8):507– 14. https://doi.org/10.1177/000331970105200801. PMID: 11512688.

8. Xing Y., Shi J., Yan Y. et al. Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography. Microcirculation. 2019;26(1):e12509. https://doi.org/10.1111/micc.12509. PMID: 30365186.

9. Chalikias G., Tziakas D. Slow Coronary Flow: Pathophysiology, Clinical Implications, and Therapeutic Management. Angiology. 2021;72(9):808– 818. https://doi.org/10.1177/00033197211004390. PMID: 33779300.

10. Leone M. C., Gori T., Fineschi M. The coronary slow flow phenomenon: a new cardiac “Y” syndrome? Clin Hemorheol Microcirc. 2008; 39(1–4):185–90. https://doi.org/10.3233/CH-2008-1079. PMID: 18503124.

11. Gori T., Fineschi M. Two coronary “orphan” diseases in search of clinical consideration: coronary syndromes X and Y. Cardiovasc Ther. 2012;30:e58–e65. https://doi.org/10.1111/j.1755-5922.2010.00232.x.

12. Xing Y., Shi J., Yan Y. et al. Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography. Microcirculation. 2019;26(1):e12509. https://doi.org/10.1111/micc.12509. PMID: 30365186.

13. Li J. J., Zhu C. G., Nan J. L. et al. Elevated circulating inflammatory markers in female patients with cardiac syndrome X. Cytokine. 2007;40(3):172–6. https://doi.org/10.1016/j.cyto.2007.09.005. PMID: 17945505.

14. Gil-Ortega I., Marzoa Rivas R., Ríos Vázquez R., Kaski J. C. Role of inflammation and endothelial dysfunction in the pathogenesis of cardiac syndrome X. Future Cardiol. 2006;2(1):63–73. https://doi.org/10.2217/14796678.2.1.63. PMID: 19804133.

15. Bokov А., Voinov А., Zverev О. et al. Сoronary slow flow phenomenon (syndrome Y) in pulmonary tuberculosis. Medical Alliance. 2024; 12(2):36–37. (In Russ.). https://doi.org/110.36422/23076348-2024-122-33-37.

16. Gibson C. M., Ryan K. A., Kelley M. et al. Methodologic drift in the assessment of TIMI grade 3 flow and its implications with respect to the reporting of angiographic trial results. The TIMI Study Group. Am Heart J. 1999;137(6):1179–84. https://doi.org/10.1016/s0002-8703(99)703807. PMID: 10347349.

17. Kalashnikova М. В., Sarkisyan Н. С. , Kulichenko А. Н. Von Willebrand Factor as a Marker of Inflammation and Haemostasis (Review). Journal of Medical and Biological Research. 2025;13(1):91–103. (In Russ.). https://doi.org/10.37482/2687-1491-Z232.

18. Beliaeva E. L., Koloskov A. V., Gutkin I. M. et al. Comparison of quantitative and qualitative characteristics of the system von Willebrand factor – metalloprotease ADAMTS13 in patients with acute myocardial in farction and is chemic stroke. Russian journal of hematology and transfusiology. 2022;67(3):367–376. (In Russ.). https://doi.org/10.35754/0234-57302022-67-3-367-376.

19. Nazarov P. G. Reactants of acute phase of inflammation. St-Petersburg: Nauka, 2001. 423 p. (In Russ.). EDN TXEJBD.