| Objective:3.0T cardiac magnetic resonance was used to image CSF(Coronary Slow Flow,CSF)patients to obtain cardiac function parameters,myocardial perfusion parameters and delayed enhancement parameters.To study the coronary microcirculation of CSF patients,evaluate the condition and prognosis of CSF patients,and guide clinical individualized treatment.Methods:A total of 82 patients hospitalized in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from September 1,2019 to January 31,2021 were collected as the study subjects,among which 25 patients whose coronary angiography showed TIMI blood flow level 3,subepicardial coronary stenosis≤30%,and no ST-T changes in dynamic electrocardiogram were selected as the non-coronary slow flow group(NCF group)as the control group;Patients with coronary angiography indicating TIMI flow<level 3 and subepicardial coronary stenosis≤40%were classified as the slow coronary flow group(CSF group).According to the coronary angiography,CSF group was divided into Single coronary slow flow group(group A),double coronary slow flow group(group B),three coronary slow flow group(group C).Patients in the CSF group were followed up,including group D(before treatment)and group E(after treatment).General data and relevant blood test indexes of all patients were collected.All patients underwent cardiac magnetic resonance examination within 14 days after admission,and cardiac function parameters(LVEF,LVEDV,LVESV)and perfuse-related parameters were obtained:Slopemax,Tpeak,RSIPEAK,and area ratio under the perfusion curve(AUC%).According to the characteristics of the perfusion curve,each segment was divided into normal perfusion,decreased perfusion and perfusion defect segments.To investigate the difference of myocardial perfusion parameters between CSF group,NCF group and CSF group before and after treatment;To investigate the myocardial segmental perfusion types of CSF patients with different number of coronary lesions,and to compare whether there is correlation between the number of coronary slow-flow vessels and the segmental myocardial perfusion types.Results:1.The Slopemax at segments 1-16 in the slow coronary flow group(CSF group)was lower than that in the non-coronary slow flow group(NCF),and the difference was statistically significant(P<0.05);Compared with the non-coronary slow flow group(NCF),the TPEAK at segment 1-16 of the slow coronary flow group(CSF)was longer,and the difference was statistically significant(P<0.05);RSIPEAK at segments 1-16 in the slow coronary flow group(CSF group)was lower than that in the non-coronary slow flow group(NCF),and the difference was statistically significant(P<0.05);The AUC%of segment 1-16 in the slow coronary flow group(CSF group)was lower than that in the non-coronary slow flow group(NCF),and the difference was statistically significant(P<0.05);2.Compared with Slopemax of Single coronary slow flow group(group A),double coronary slow flow group(group B),three coronary slow flow group(group C),there were differences in segments 1-16,and the differences were statistically significant(P<0.001);The Slopemax of segments 1,3-5,7-12 and 14-16 in group B was lower than that in group A,and the difference was statistically significant(P<0.05),indicating that compared with the slow flow group of two vessels and the slow flow group of one vessel,the increase rate of contrast medium concentration in this segment was slower,and the differences in other segments were not statistically significant(P>0.05);Slopemax of segments 1-16 in group C was lower than that in group A,and the difference was statistically significant(P<0.05),indicating that compared with the slow flow group of three vessels and the slow flow group of one vessel,the increase rate of contrast medium concentration in this segment was slower.Slopemax of segments 2,6,7,11-13,15 and 16 in group C were lower than those in group B,and the difference was statistically significant(P<0.05),indicating that the contrast medium concentration increased more slowly in this segment compared with that in the slow flow group of three vessels and the slow flow group of two vessels,and the differences in other segments were not statistically significant(P>0.05);3.Compared with the TPEAK of the Single coronary slow flow group(group A),double coronary slow flow group(group B),three coronary slow flow group(group C),,there were differences in segments 1-6 and 8-16,and the differences were statistically significant(P<0.05),the difference in the seventh segment was not statistically significant(P>0.05);The Tpeak of segment 1-6 and 8-16 in group C was longer than that in group A,and the difference was statistically significant(P<0.05),indicating that the local contrast agent inflow time in this segment was longer in the three vessel slow flow group than in the one vessel slow flow group,and the difference in the seventh segment was not statistically significant(P>0.05);The Tpeak in segments 3,4,9,10,12-15 in group C was longer than that in group B,and the difference was statistically significant(P<0.05),indicating that the local contrast agent inflow time in this segment was longer in the three vessels with slow flow group than in the two vessels with slow flow group,and the differences in other segments were not statistically significant(P>0.05);The Tpeak of segment 3,4,12 and 16 in group B was longer than that in group A,and the difference was statistically significant(P<0.05),indicating that the local contrast agent inflow time in this segment was longer than that in the slow flow group of two vessels compared with that in the slow flow group of one vessel,and the differences in other segments were not statistically significant(P>0.05).4.Compared with the RSIPEAK of the Single coronary slow flow group(group A),double coronary slow flow group(group B),three coronary slow flow group(group C),,there were differences in the 2-6,9-16 segments,and the differences were statistically significant(P<0.05),the differences in other segments were not statistically significant(P>0.05);The RSIPEAK of segments 2-6,9-12,15 and 16 in group C was lower than that in group A,and the difference was statistically significant(P<0.05),indicating that the relative peak concentration of contrast medium in this segment was reduced in the slow flow group of three vessels compared with that in the slow flow group of one vessel,and the differences in other segments were not statistically significant(P>0.05);The RSIPEAK of segment 9 in group C was lower than that in group B,and the difference was statistically significant(P<0.05),indicating that the relative peak concentration of contrast medium in this segment was reduced in the three vessels with slow flow group compared with the two vessels with slow flow group,and the differences in other segments were not statistically significant(P>0.05);RSIPEAK in segments 3,6,11,12 and 15 of group B was lower than that of group A,and the difference was statistically significant(P<0.05),indicating that the relative peak concentration of contrast medium in this segment of the slow flow group of two vessels was reduced compared with that of the slow flow group of one vessel,and the differences in other segments were not statistically significant(P>0.05).5.Compared with the AUC%of the Single coronary slow flow group(group A),double coronary slow flow group(group B),three coronary slow flow group(group C),there were differences in segments 1,3-13,15 and 16,and the differences were statistically significant(P<0.05),the differences in other segments were not statistically significant(P>0.05);The AUC%of segments 1,3-7,9-12,15 and 16 in group C was lower than that in group A,and the difference was statistically significant(P<0.05),indicating that compared with the slow flow group of three vessels and the slow flow group of one vessel,the local contrast medium relative accumulation in this segment was reduced,and the differences in other segments were not statistically significant(P>0.05);AUC%of segments 1,3,4,7,8,10,12,13,15 and 16 in group C was lower than that in group B,and the difference was statistically significant(P<0.05),indicating that the local contrast medium relative accumulation in this segment was decreased in the three vessel slow flow group compared with the two vessel slow flow group,and the differences in other segments were not statistically significant(P>0.05);The AUC%of segment 4,5 and 16 in group B was lower than that in group A,and the difference was statistically significant(P<0.05),indicating that compared with the slow flow group of the two vessels,the relative accumulation of contrast agent in this segment was reduced locally compared with one vessel,and the differences in other segments were not statistically significant(P>0.05).6.There were significant differences in smoking,chest tightness,palpitation,shortness of breath,mean platelet volume(MPV),total cholesterol,TG,homocysteine(Hcy)between CSF group before treatment(Group D)and group after treatment(Group E),and the differences were statistically significant(p<0.05);In 8 cases,there were significant differences in SlopEmax at the 1st,3rd,4th,10th and 15th segments between the pre-treatment group and the post-treatment group(p<0.05);There were significant differences in Tpeak in segments 1,7,8,11 and 12(p<0.05);There were significant differences in RSIPEAK at the 21-9 and 12-16 levels(p<0.05);There were differences in AUC%of segments 1,3-16,and the differences were statistically significant(p<0.05).7.There were significant differences in age,BMI,carotid atherosclerosis,mean concentration of HGB,red blood cell distribution width(RDW),triglyceride,LVDD,E,A,E/A ratio between the coronary slow flow group(CSF)group and the non-coronary slow flow group(NCF)(P<0.05).There were no statistically significant differences in ventricular wall motion abnormality,IVST,LVPWT,RVDD,FS,LVEF,LVEDV and LVESV(P>0.05).Conclusion(s):1.In this study,it was observed that in patients with CSF,single vessel involvement accounted for 22.8%,double vessel involvement accounted for 45.6%,and three vessels involvement accounted for 31.6%of CSF;.LAD was the most common coronary slow flow,followed by RCA and LCX.2.CSF patients had coronary microcirculation disturbance compared with NCF group,and the degree of coronary microcirculation disturbance was related to the number of slow coronary blood flow.The more the number of slow coronary blood flow,the more abnormal perfusion segments.The abnormal slow blood perfusion of coronary arteries mainly involved the lateral wall of the left ventricular base and inferior wall,the anterior wall and inferior wall of the middle part,and the anterior wall of the heart apex.The abnormal levels of perfusion were correlated with coronary slow blood flow lesions.3.Some of the myocardial microcirculation disorders in CSF patients can be improved by intensive drug therapy,risk factor control and lifestyle improvement. |
PDF Full Text Request