Evaluation of the Relationship Between Semaphorin 4D Levels and the Coronary Slow Flow Phenomenon

Background: Coronary slow flow (CSF) is a frequently observed angiographic and clinical condition linked to various complications, including stable and unstableangina pectoris, acute coronary syndromes, hypertension, and potentially fatal arrhythmias.Semaphorin 4D (Sema4D), a recently identified type 1 transmembrane glycoprotein, has been implicated in processes such as inflammation, oxidative stress, atherosclerosis, and angiogenesis.Elevated Sema4D levels have been documented in individuals with atrial fibrillation, acute coronary syndrome, and heart failure.Aim: This study aimed to assess the association between Sema4D levels and both the presence and severity of CSF.Study Design: Cross-sectional observational study. Methods:The study comprised 79 patients diagnosed with CSF and 81 healthy control subjects.Serum levels of Sema4D were measured, and coronary flow was assessed using the thrombolysis in myocardial infarction frame count (TFC) method.Results: Sema4D concentrations were significantly higher in the CSF group compared to the control group (p<0.001).Notably, Serum4D levels showed a positive correlation with high-sensitivity C-reactive protein (r=073, p<0.001), mean TFC (r=088, p<0.001), and the neutrophil-to-lymphocyte ratio (r=0.37,p<0.001). Conclusion:Sema4D may serve as a biomarker associated with CSF and could aid in identifying patients with CSF-related unstable angina.