| The coronary slow flow phenomenon is an angiographic observation characterized by angiographically normal or near-normal coronary arteries with delayed opacification of the distal vasculature.Coronary slow flow phenomenon was first reported and defined by Tambe in1972, However, since that time, only a limited number of studies have focused on the etiology of CSF. Although the pathophysiological mechanisms of CSF remain uncertain, there are a few hypotheses have been suggested. Occlusive disease of small coronary arteries has been suggested as an etiology of CSF. based on this hypothesis, CSFP may be a form of early phase of atherosclerosis in some patients. Although atheros- clerosis has been considered to be multifactorial disease in which genetic, environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation. as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease. As we know, assess the extent of atherosclerotic lesions is not on the atherosclerotic plaque caused by vascular lumen stenosis, but rather the stability of atherosclerotic plaque. Matrix metalloproteinases (MMPs) are proteolytic enzymes involving in turnover of extracellular matrix (ECM) proteins. Of the MMP family, MMP-9 may play a role in chronic inflammation. The enzyme induces migration of inflammatory cells such as eosinophils, neutrophils, and lymphocytes across basement membrane. A lot of studies confirm that, MMP-9 can be used as the stability of atherosclerotic plaque were independent predictors. So we made this experimental study in order to investigate the pathophysiological and its mechanisms of CSF, so as to provide assistance for clinical analysis, disease risk assessment and treatment.Objective: To explore the pathophysiology of CSF from observe the patients with coronary slow flow changed in Plasma levels of MMP-9.Materials and Methods:Patients who hospitalized with the compain of chest pain, therefore underwent coronary angiography (CAG) from March 2008 to December 2009 were enrolled in this study.The patients were divided into 2 groups according to their coronary angiography results, i.e.20patients in CSF group, 19patients in normal coronary flow (NCF) group.Coronary flow patterns of the cases were determined by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) method. Blood samples of both patients with slow coronary flow and control subjects for measuring MMP-9 levels were drawn from radial artery with 3ml blood .Plasma was immediately obtained by centrifugation of the blood at 4000 r/min for 15 minutes and then stored in several aliquots at -70℃until assayed.Plasma soluble MMP-9 levels were measured in all patients and control subjects using commercially available ELISA kits. Results:(1) Blood cell count, HCT, fibrinogen had no significant differences in the two groups (P>0.05).(2) The CTFC of each coronary artery had significant differences in the two groups(P<0.01).(3) MMP-9 levels had significant differences in the slow blood flow and normal coronary group (P<0.01).Conclusion:(1) Serum MMP-9 levels increased degradation of extracellular matrix, leading to plaque instability and CSF increased the incidence of cardiac events.(2) Chronic inflammation may be one pathophysiology of in coronary slow flow .(3) Levels of The serum MMP-9 levels was increased in CSF, MMP-9 can degrade extracellular matrix, leading to atherosclerotic plaque instability, occur the risk of myocardial ischemia and acute coronary syndrome are increased. |
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