ABC | Volume 114, Nº3, March 2020

Short Editorial Carvalho & Azevedo Coronary Slow Flow Phenomenon - adding myocardial fibrosis to the equation Arq Bras Cardiol. 2020; 114(3):552-553 using delayed enhancement imaging is a powerful prognostic tool in multiple cardiomyopathies, both ischemic and nonischemic. Although small in size, this study by Candemir et al. 8 opens up new research possibilities to answer whether there is causality in the association between CSFP and myocardial fibrosis and if the presence of myocardial fibrosis in these patients have any prognostic implication or, for instance, is associated with a higher likelihood of malignant arrhythmias. Conversely, future research using novel CMR techniques for tissue characterization, including T1 and T2 mapping, may also help shed light into this still poorly understood condition. 1. Tambe AA, DemanyMA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries—A new angiographic finding. AmHeart J . 1972;84(1):66-71. 2. Wang X, Nie S-P. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther . 2011;1(1):37-43. 3. Fineschi M, Gori T. Coronary Slow-Flow Phenomenon or Syndrome Y. J Am Coll Cardiol . 2010;56(3):239-40. 4. Beltrame JF, Limaye SB, Horowitz JD. The Coronary SlowFlowPhenomenon – A New Coronary Microvascular Disorder. Cardiology . 2002;97(4):197- 202. 5. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary Slow Flow Phenomenon and Risk for Sudden Cardiac Death Due to Ventricular Arrhythmias: A Case Report and Review of Literature. Clin Cardiol . 2008;31(8):352-5. 6. Yurtda M, Özcan IT, Çamsari A, Cice KD, Tamer L, Cin VC. NT-pro-BNP levels and their response to exercise in patients with slow coronary flow. Arq Bras Cardiol . 2012;99(6):1115-22. 7. Fineschi M, Bravi A, Gori T. The “slow coronary flow” phenomenon: Evidence of preserved coronary flow reserve despite increased resting microvascular resistances. Int J Cardiol . 2008;127(3):358-61. 8. Candemir M, Sahinarslan A, Yazol M, Oner YA, Boyaci B. Determinação do tecido cicatricial do miocádio no fenômeno de fluxo coronário lento e a relação entre quantidade de tecido cicatricial e o Nt-Pro Bnp. Arq Bras Cardiol. 2020; 114(3):540-551 9. Sara L, Szarf G, Tachibana A,Shiozaki AA, Villa AV, Oliveira AC, et al. II Diretriz de Ressonância Magnética e Tomografia computadorizada Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia. Arq Bras Cardiol . 2014;103(6):1-86. 10. Wu KC, Kim RJ, Bluemke D, Rochitte CE, Zerhouni EA, Becker LC, et al. Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol. 1998;32(6):1756-64. 11. Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction. Current and Emerging Applications. J Am Coll Cardiol . 2009;55(1):1-16. 12. Azevedo CF, Nigri M, Higuchi ML, Pomerantzeff PMA, Spina G, Sampaio R, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56(4):278-87. 13. Azevedo Filho CF de, Hadlich M, Petriz JLF, Mendonça LA, Moll Filho JN, Rochitte CE. Quantificação damassa infartada do ventrículo esquerdo pela ressonânciamagnéticacardíaca:comparaçãoentreaplanimetriaeométodo de escore visual semi-quantitativo. Arq Bras Cardiol . 2004;83(2):111-7. 14. Carvalho FP de, Erthal F, Azevedo CF. The Role of CardiacMR Imaging in the Assessment of Patients with Cardiac Amyloidosis. Magn Reson Imaging Clin N Am . 2019;27(3):453-63. 15. de Carvalho FP, AzevedoCF. Comprehensive Assessment of Endomyocardial Fibrosis with Cardiac MRI: Morphology, Function, and Tissue Characterization. RadioGraphics . Jan. 2020:190148. 16. Haaf P, Balmelli C, Reichlin T, Twerenbold R, Reiter M, Meissner J,et al. N-terminal Pro B-type Natriuretic Peptide in the Early Evaluation of Suspected Acute Myocardial Infarction. Am J Med . 2011;124(8):731-9. References This is an open-access article distributed under the terms of the Creative Commons Attribution License 553