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Abstract
Coronary slow flow (CSF) is an important angiographic entity that is characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. Elevated levels of ADMA cause the induction of endothelial dysfunction and thus promote atherosclerosis. This study was aimed at determining the role of ADMA in the development of CSF. One hundred twenty-nine subjects who fulfilled the inclusion criteria were enrolled in this study. According to coronary angiography results, these subjects were divided into five groups. The serum concentration of ADMA was measured in these subjects. In this study, there was no significant correlation between serum concentrations of ADMA and mean corrected TIMI frame count (CTFC) (P > 0.05). However, the ADMA level was significantly correlated with CTFC in the left anterior descending (LAD) coronary artery in patients with CSF (r = −0.381, P = 0.045). Also, plasma ADMA levels were significantly higher in patients with CSF and without CAD compared to patients without CSF and with CAD (50-90%) (P = 0.034). Besides, serum concentrations of ADMA were significantly higher in subjects with BMI < 25 kg/m2 compared with those having BMI > 30 kg/m2 (P = 0.003). It was also shown that the levels of ADMA were significantly higher in subjects with age as a cardiovascular risk factor compared with those without this risk factor (P = 0.024). Further studies with larger population sizes are needed to confirm the present findings on the association between the serum concentrations of ADMA and CSF.
Highlights
Patients who have chest pain without coronary artery disease (CAD) present a diagnostic and therapeutic challenge and impose high costs on society and the medical system
Coronary slow flow phenomenon (CSFP) is an important clinical, angiographic finding because it can result in angina during rest or exercise, acute myocardial infarction, and hypertension in some patients [9]
Asymmetric dimethylarginine (ADMA) is a competitive nitric oxide synthase inhibitor, which is associated with peripheral atherosclerosis and cardiovascular events in patients with CAD [6, 8]
Summary
Patients who have chest pain without coronary artery disease (CAD) present a diagnostic and therapeutic challenge and impose high costs on society and the medical system. At least 10-30% of patients with angina lack significant CAD in coronary angiography. 50-65% of these patients, who have chest pain without obstructive CAD, have coronary microvascular disorders, often known as microvascular angina. Coronary slow flow phenomenon (CSFP) is an angiographic finding that is diagnosed by delayed terminal vascular filling in the absence of significant epicardial CAD [2]. The exact etiology is still unknown [3] It is diagnosed through angiographic findings of difference in corrected thrombolysis in myocardial infarction (TIMI) frame count of more than two standard deviations of the normal range in the absence of coronary artery obstruction [4]. Corrected TIMI frame count (CTFC) is a quantitative and repeatable index of coronary artery flow. The normal TIMI frame count of the LAD vessel (36:2 ± 2:6) is 1.7 times longer than the left circumflex artery (LCX) (22:4 ± 2:1) and the right coronary artery (RCA) (20:3 ± 4) vessels [2]
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