| Background and 0bjectiveNowadays, coronary atherosclerotic heart disease(coronary heart disease, CHD) is a serious threat to people's health and quality of life in the western developed countries, and is also a primary cause of death. With the advancement of people's living standard, the prevalence, However, is increasing year by year in our country. People are also gradually deepening the research levels and understanding of the types of coronary heart disease, etiology and pathophysiologic mechanisms. In recent years, with the development and popularization of coronary angiography(CAG), coronary slow flow phenomenon(CSFP) is gradually recognized by interventional cardiologists. Reported firstly by Tambe[1] in 1972. CSFP is an angiographic clinical entity, characterized by delayed distal vessel opacification in the absence of significant epicardial coronary stenosis in patients with sweating, tachycardia, chest pain or chest tightness, who underwent coronary angiography, but the patents who have medical stories of coronary angioplasty, the treatment of intracoronary thrombolysis, coronary dilatation or spasm, coronary gas embolism, cardiomyopathy, connective tissue disease, hyperthyroidism and heart valve disease etc, which may lead to slowing down the velocity of the coronary blood flow were excluded. CSFP is a frequent angiographic observation, with a reported incidence of 1% [2] in patients undergoing diagnostic angiography according to some surveys. For years, with the progress of science and technology and the further study of CSFP, we find that CSFP is not only a coronary angiography phenomenon, but also has a considerably important clinical significance. It has been associated with angina pectoris [3],acute myocardial infarction[4], benign and life-threatening arrhythmias[5], hypertension and sudden cardiac death[6] etc. At present, although several mechanisms such as inflammation, resistance vascular and microvascular endothelial cells dysfunction, the imbalance of secretion of vasoactive substances, the early performance of coronary artery atherosclerosis, metabolic abnormality, anatomic structure and blood component abnormalities have been proposed for the etiology of CSFP, the underlying etiology and physiopathological mechanisms are not understood completely, What is more, it is not very well patients who are diagnosed as CSFP in relieving symptoms with conventional treatment measures of coronary heart disease.Nowadays, with the research development of vasculitis disease caused by cystatin C(CysC), the CysC has been recognized as a risk factor, and its roles in pathogenesis for cardiovascular disease have been awared. Does it have an effect on CSFP with the changes of its serum levels? If so, what is the magnitude of the impact? Whether it can be used as an effective predictor of CSFP or not? We do not know about this, moreover, there are few reports about these roles. Therefore, this study aims to observe the correlation between the serum levels of CysC and CSFP, and to investigate the mechanism of serum CysC in the occurrence of CSFP and its predictive value for CSFP, so that it can provide theoretical principles for guidances of clinical diagnosis and treatment to the disease. Materials and MethodsFrom December 1,2013 to December 31,2015,we enrolled 78 patients, 41 males and 39 females, who came to the Second Affiliated Hospital of Zhengzhou University because of sweating, tachycardia, chest pain or chest tightness and so on, received CAG successfully, but the results showed that there were no significant stenosis in epicardial coronary. Standard selective coronary angiography with at least 4 views of the left coronary system and 2 views of the right coronary artery was performed using the Judkins technique. Coronary flow rates of all subjects were determined by the TFC method as described by Gibson et al. TFC was evaluated for each coronary vessel by two trained cardiologist. And we defined the average blood frames of coronary greater than 27 as CSFP. According to results,the subjects were divided into two groups: CSFP group(n=37), 21 males and 16 females, and NCF group(n=41), 21 males and 16 females. General data and related physical examination data were collected, the serum level of CysC was measured by immunoturbidimetry. The test results were conducted by professional staffs the Second Affiliated Hospital of Zhengzhou University. SPSS20.0 statistical software was used for all statistical calculations. A p value of <?0.05 was considered as statistically significant. Results(1) There were no significant differences between two groups regarding sex, age, prevalence of hypertension, prevalence of diabetes, blood lipids, transaminase, urea, creatinine(P>0.05).(2) Serum CysC levels in patients with CSFP group were significantly higher than those in NCF group [(1.16±0.35)mg /L VS(0.83 ± 0.16) mg/L, P<0.05]; Additionally, serum CysC levels were positively correlated with mean TFC in patients with CSF(r=0.19,p<0.01).(3) Single vascular lesion is common in patients with CSFP in this study(56.75%, n=21), especially the right coronary artery(45.76%,n=27).(4) Logistic regression analysis was performed to estimate the effects of serum CysC level on the presence of CSF, and it showed that its level was an independent risk factor for CSFP(OR=2.38,P=0.04).(5) Receiver–operating characteristic(ROC) curve was generated for the area under the curves(AUCs) of serum CysC levels, The diagnostic value by the AUC for serum CysC in discriminating patients with CSF was 0.704, which suggested that a higher level of serum CysC may have a certain value to predict the patient with CSFP. Conclusions(1)The levels of serum CysC are higher in patients with CSFP.(2) The CSFP most occurs in the right coronary artery, the mean TFC is positively correlated with levels of serum CysC in patients with CSF, CysC is a risk factor for CSFP and plays a certain role in the pathogenesis of CSFP.(3) To examine the levels of serum CysC has certain clinical application value in the prediction and diagnosis and treatment of patients with CSFP. |
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