The present study shows that CSF is significantly and independently associated with male gender and increased TG levels. Mean TFC was calculated by dividing the total TFC by 3. Total TFC was calculated as the sum of TFC in the 3 major epicardial vessels (LAD, LCx and RCA). The LAD TFC was corrected by division by 1.7 because this artery is generally longer than the others. The filming speed was at 15 frames/second, while the standard speed is 30 frames/second, so the frame count was corrected by multiplying by 2. Thrombolysis in myocardial infarction (TIMI) frame count (TFC) was calculated for every major coronary artery to determine CSF as described by Gibson et al. ![]() ![]() Normal CAG was defined as the absence of any obstructive/stenotic lesions in any major epicardial arteries. Angiograms were interpreted by two experienced cardiologists. Multiple views were obtained with visualization of the left anterior descending (LAD) and left circumflex (LCx) coronary arteries in at least 4 projections and the right coronary artery (RCA) in at least 2 projections. Selective CAG was performed to all patients through the femoral or radial approach using the Judkins system for cannulation of the right & left coronary arteries. However, to our knowledge, very few data are available on the relationship between CSF and psychological disorders and that is the aim of this study. Moreover, some studies indicate that patients with CSF have increased psychological distress compared with patients having coronary normal flow (CNF). The pathogenesis of CSF involves mechanisms similar to those linked to anxiety/depression (inflammation, microvascular abnormalities, endothelial dysfunction and anatomical factors of epicardial arteries). It affects young male smokers most commonly and is linked to both CAD (myocardial ischemia symptoms, life-threatening arrhythmias, recurrent acute coronary syndromes and sudden cardiac death) and psychological manifestations (anxiety, depression and psychological distress). ![]() It is seen in 1–7% of patients undergoing CAG which is the only method for diagnosis. This may be seen in a single coronary artery or more. Every 5-point increase in Beck Depression Inventory (BDI) score is associated with a 25–30% increase in the risk of definite CAD or abnormal coronary angiography (CAG) findings.Ĭoronary slow flow (CSF) is defined as the slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels. The proposed pathophysiological mechanisms include: increased sympathetic tone, increased cortisol and catecholamines, endothelial dysfunction, release of inflammatory mediators, platelet activation, decreased heart rate variability, accelerated atherogenesis, and poor platelet adherence. As a risk factor, both psychological stress and depression are as important as smoking and more important than diabetes mellitus (DM) accounting for 32.5% of attributable risk. The incidence of depression is 30%–40% of the general population and 20%–40% of coronary artery disease (CAD) patients and is associated with increased major adverse cardiovascular events (MACE).
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