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In summary, CSFP is an angiographic phenomenon which was first described more than 30 years ago but until recently has been largely considered an angiographic curiosity and thus frequently neglected. Table III summarizes our current knowledge of this disorder.

Although initially diagnosed on the basis of an angio-graphic observation, pathophysiological investigations have demonstrated that it is a coronary microvascular disorder with an increased resting coronary resistance due to both structural and functional abnormalities. Potential biologic mechanisms include the autacoids, endothelin, and neu-ropeptide Y.

Further Reading

Beltrame, J. F., Limaye, S. B., Wuttke, R., and Horowitz, J. D. (2003). Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am. Heart J. 146, 84-90. This paper identifies important pathophysiological features of the coronary slow flow phenomenon.

Beltrame, J. F., Turner, S. P., and Horowitz, J. D. (2001). Persistence of the coronary slow flow phenomenon. Am. J. Cardiol. 88, 938.

Ciavolella, M., Avella, A., Bellagamba, S., Mangieri, E., Nigri, A., and Reale, A. (1994). Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at long-term follow-up. Coron. Artery Dis. 5(6), 493-499.

Demirkol, M. O., Yaymaci, B., and Mutlu, B. (2002). Dipyridamole myocardial perfusion single photon emission computed tomography in patients with slow coronary flow. Coronary Artery Dis. 13, 223-229.

Goel, P. K., Gupta, S. K., Agarwal, A., and Kapoor, A. (2001). Slow coronary flow: A distinct angiographic subgroup in syndrome X. Angiology 52, 507-514.

Kurtoglu, N., Akcay, A., and Dindar, I. (2001). Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow. Am. J. Cardiol. 87, 777-779.

Mangieri, E., Macchiarelli, G., Ciavolella, M., Barilla, F., Avella, A., Martinotti, A., Dell'Italia, L. J., Scibilia, G., Motta, P., and Campa, P. (1996). Slow coronary flow: Clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet.

Cardiovasc. Diagn. 137, 375-381. This important study describes the structural abnormalities associated with the coronary slow flow phenomenon and provides evidence for functional abnormalities of the coronary microvasculature.

Maseri, A. (1995). Syndrome X and microvascular angina. In Ischemic Heart Disease. A Rational Basis for Clinical Practice and Clinical Research, pp. 507-532. New York: Churchill Livingstone.

Mosseri, M., Yarom, R., Gotsman, M. S., and Hasin, Y. (1986). Histologic evidence for small-vessel coronary artery disease in patients with angina and patent large coronary arteries. Circulation 74, 964-972. Yaymaci, B., Dagdelen, S., Bozbuga, N., Demirkol, O., Say, B., Guzelmeric, F., and Dindar, I. (2001). The response of the myocardial metabolism to atrial pacing in patients with coronary slow flow. Int. J. Cardiol. 78,151-156.

Capsule Biography

Dr. Beltrame is a Senior Lecturer in Medicine at the University of Adelaide, The Queen Elizabeth Hospital Campus. He has a strong interest in coronary vasomotor reactivity disorders and been researching the coronary slow flow phenomenon for the past 10 years.

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