الفهرس 
Introduction
Coronary slow flow phenomenonOnly 14 pages are availabe for public view
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Abstract
Patients present with clinical evidence of typical anginal pain and positive objective evidence for ischemia in whom coronary angiography reveals patent coronary vessels with coronary slow flow phenomenon constitute a challenging scenario that we face daily. Although this phenomenon has been recognized for many decades, there is still no firm or convincible pathophysiologic explanation.
Retinal microvascular vessels are easily accessible with noninvasive
Procedures and appear to share the same physiological and anatomical characteristics as cerebral and coronary microvascular vessels .
The present study was performed to evaluate the correlation between coronary and retinal circulation in patients with CSF and obstructive CAD with sharing endothelial function evaluation with comparison to control persons.
This study was carried out from October 2011 to October 2015, included 105 subjects , 30 patients with obstructive CAD , 30 patients with CSF , 30 subjects as first control group without cardiac catheterization and 15 subjects as second control group with previous cardiac catheterization that revealed normal coronary angiograms and they were collected in retrospective manner.
Subjects were subjected to full history taking, clinical examination, resting ECG, echocardiography, stress ECG, endothelial function by FMD, Fluorescein angiography and ophthalmic artery Doppler.
After statistical analysis we found that.
Patient with CSFP showed slow flow in retinal circulation (microcirculation) that presented by prolonged AVP and prolonged systemic circulation that presented by measuring the time of circulation between the antecubital vein and the retina ( ART) by using retinal fluorescein angiography in comparison to patients with obstructive CAD and control groups.
Patients in group (II) had significantly higher weight yet none of them was obese as per inclusion protocol when compared to other groups .
Patients with obstructive CAD had significantly prolonged arm to retinal time( ART) in comparison to control groups but no significant difference regarding AVP.
Patients with CSF and patients with obstructive CAD had significantly decreased FMD and increased vascular resistance indices PI & RI in ophthalmic artery Doppler in comparison to control groups and without significant difference in between them.
There is significant positive correlation between TFC in all subjects with all of indices of vascular resistance in ophthalmic artery Doppler, BMI and fluorescein angiography times (ART& AVP).
There is significant negative correlation between FMD in all subjects and all of Duke Score, exercise duration and indices of vascular resistance of ophthalmic artery (PI & RI) but no significant correlation between FMD and total TFC.
Patients with obstructive CAD there was significant positive correlation between Syntax score , Gensini score and Duke score but no significant correlation was found between These scores and FMD.
Based on the results of this study, we can conclude that patients with coronary slow flow also suffer from slow flow in retinal circulation and may lead to ischemic retinal complications and this need long follow up study .
Retinal micro circulation may represent coronary micro circulation, so can be used as mirror image for coronary circulation for diagnosis, risk stratification and follow up of changes in coronary circulation..
Patients with CSF and patients with obstructive CAD displayed reduced FMD and increase indices of vascular resistance in ophthalmic artery Doppler.
We can use peripheral endothelial function test (FMD) as surrogate for coronary endothelial function test in patient with CSF or CAD.