PO006 Comparison of Myocardial Deformation Between Normal Coronary Artery and Coronary Slow Flow Patients

Background: The coronary slow flow phenomenon has been revealed to be associated with life-threatening arrhythmias and sudden cardiac death. Currently, clinical features and risk factors of patients with the coronary slow flow phenomenon are incompletely understood. The present study aimed to evaluate the prevalence, clinical presentation, risk factors and evidence of ischemia in patients with coronary slow flow.Methods: This observational study was conducted at a tertiary-care center in India between February 2013 and August 2014. A total of 60 consecutive patients whose coronary angiogram revealed coronary slow flow were included in the study. According to the number of blood vessels involved, patients were divided into group-1 (29 patients with single-vessel disease), group-2 (22 patients with double-vessel disease), and group-3 (9 patients with triple-vessel disease). Clinical presentation and risk factors were compared among groups.Results: Prevalence of coronary slow flow was 2.97% with greater prevalence amongst male patients (p=0.030). Unstable angina was the most common presentation (p=0.030). Among the traditional risk factors, there was a significantly higher prevalence of smoking (p=0.036), family history of coronary artery disease (p=0.049) and dyslipidemia (p=0.045) in group-3 patients compared to other groups. Among all groups, triglycerides (p=0.020), low-density lipoprotein cholesterol (p=0.046), highly sensitive C-reactive protein (p=0.007) levels, homocysteine (p=0.481), and patterns of ECG abnormalities were significantly different between the three groups. In addition, mean frame counts with coronary slow flow phenomenon in left anterior descending artery (p<0.001), left circumflex artery (p<0.001) and right coronary artery (p=0.005) increased significantly with increase in number of vessels involved.Conclusions: Coronary slow flow was relatively common among patients who presented with unstable angina. Male sex, smoking, and dyslipidemia can be considered as independent risk factors for this phenomenon.

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Comparison of Tumor Necrosis Factor-α Level in Coronary Artery Disease and Coronary Slow Flow of Thrombolysis in Myocardial Infarction

The Indonesian Biomedical Journal ◽

10.18585/inabj.v11i3.826 ◽

2019 ◽

Vol 11 (3) ◽

pp. 299-303

Author(s):

Muhammad Diah ◽

Rahmawati Rahmawati ◽

Aznan Lelo ◽

Zulfikri Muhktar ◽

Dharma Lindarto ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Healthy Subjects ◽

Slow Flow ◽

Timi Frame Count ◽

Tnf Α ◽

Significant Difference ◽

Coronary Slow Flow ◽

Artery Disease ◽

Α Level

BACKGROUND: Tumor necrosis factor (TNF)-α, an important primary pro-inflammatory cytokine, has a crucial role in the pathogenesis of atherosclerosis. Since the pathophysiological mechanism of coronary slow flow (CSF) is not fully understood, we investigated the level of TNF-α in coronary artery disease (CAD), CSF and healthy subjects.METHODS: This study was conducted in cross-sectional design involving 16 CAD, 18 CSF and 18 healthy subjects. Coronary angiography was recorded at the left anterior oblique, cranial, right anterior oblique, caudal, and horizontal positions. The flow in coronary arteries of the subjects were assessed using Thrombolysis in the Myocardial Infarction (TIMI) frame count method. Peripheral blood-derived serum was collected and level of TNF-α was determined by using highly sensitive enzymelinked immunosorbent assay (ELISA).RESULTS: No significant difference in level of TNF-α in CAD, CSF and healthy subjects (2.72±2.64 pg/mL, 1.88±0.8 pg/mL, 1.64±0.35 pg/mL, respectively) (p=0.087). In addition, there was no correlation between the concentration of TNF-α and TIMI frame count (r<0.2, p>0.05).CONCLUSION: There was no significant difference of TNF-α level in CAD, CSF and healthy subjects. In addition, there was no correlation between the TNF-α level with TIMI frame count as well. Nevertheless, further clinical studies with more subjects are needed.KEYWORDS: TNF-alpha, coronary artery disease, coronary slow flow

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CRT-200.00 Predictors Of Coronary Slow Flow In Stable Coronary Artery Disease

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2016.12.121 ◽

2017 ◽

Vol 10 (3) ◽

pp. S31-S32

Author(s):

Hanan I. Radwan ◽

Marwa M. Gad ◽

AbdelAziz I. Gomaa

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Slow Flow ◽

Coronary Slow Flow ◽

Artery Disease

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Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow?

Journal of International Medical Research ◽

10.1177/0300060516664637 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1443-1453 ◽

Cited By ~ 6

Author(s):

Mücahid Yılmaz ◽

Hasan Korkmaz ◽

Mehmet Nail Bilen ◽

Ökkeş Uku ◽

Ertuğrul Kurtoğlu

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Slow Flow ◽

Coronary Artery Ectasia ◽

Operating Characteristics ◽

Coronary Anatomy ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Coronary Slow Flow ◽

Artery Disease

Objective To determine whether neutrophil/lymphocyte ratio (NLR) differed between patients with isolated coronary artery disease (CAD), isolated coronary artery ectasia (CAE), coronary slow flow and normal coronary anatomy. Methods Patients who underwent coronary angiography were consecutively enrolled into one of four groups: CAD, coronary slow flow, CAE and normal coronary anatomy. Results The CAD ( n = 40), coronary slow flow ( n = 40), and CAE ( n = 40) groups had similar NLRs (2.51 ± 0.7, 2.40 ± 0.8, 2.6 ± 0.6, respectively) that were significantly higher than patients with normal coronary anatomy ( n = 40; NLR, 1.73 ± 0.7). Receiver operating characteristics demonstrated that with NLR > 2.12, specificity in predicting isolated CAD was 85% and sensitivity was 75%, with NLR > 2.22 specificity in predicting isolated CAE was 86% and sensitivity was 75%. With NLR > 1.92, specificity in predicting coronary slow flow was 89% and sensitivity was 75%. Multivariate logistic regression analyses identified NLR as an independent predictor of isolated CAE (β = −0.499, 95% CI −0.502, −0.178; P < 0.001), CAD (β = −0.426, 95% CI −1.321, −0.408; P < 0.001), and coronary slow flow (β = −0.430, 95% CI −0.811, −0.240; P = 0.001 Table 2 ). Conclusions NLR was higher in patients with CAD, coronary slow flow and CAE versus normal coronary anatomy. NLR may be an indicator of CAD, CAE and coronary slow flow.

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CXCL9: a biomarker for the coronary slow flow phenomenon in patients with coronary artery disease

10.21203/rs.2.13298/v1 ◽

2019 ◽

Author(s):

youfeng Liang ◽

xianhe Lin ◽

yuanyuan Xu ◽

chunmiao Wang ◽

Qi Zhou

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Multivariate Logistic Regression Analysis ◽

Serum Levels ◽

Slow Flow ◽

Flow Phenomenon ◽

Coronary Slow Flow ◽

Ifn Γ ◽

Artery Disease ◽

Coronary Slow Flow Phenomenon

Abstract Background: Atherosclerosis is a chronic inflammatory disease. The pathology underlying the disease consists of accumulation of the extracellular matrix, lipid and inflammatory cells. Coronary Slow Flow Phenomenon (CSFP) is closely related to inflammatory responses, while chemokines play an important role in the progression of atherosclerosis. However, the relationship between chemokines and CSFP is unclear. In this study, our aims were to evaluate the association between CXC Chemokines 9 (CXCL9) levels and CSFP in patients with coronary artery disease. Methods: We studied 46 patients diagnosed with CSFP and classed them as the CSFP group. 50 patients with normal coronary angiography (CAG) were randomly selected as the no-CSFP group in our study. The mean TIMI frame count was used to measure coronary blood flow velocity. The clinical and biochemical index, including serum levels of IL1, IL-6, IL-10, CXCL9, CD40L and interferon-γ (IFN-γ), were analyzed in all subjects. Results: The serum levels of IL-1, IL-6, IL-10, CXCL9, CD40L, IFN-γ and CXCL9 in the CSFP group were significantly higher than those in the no-CSFP group, with the differences being statistically significant (p<0.001). Furthermore, Pearson's correlation analysis reflected a significant positive correlation (r=0.171, p=0.01) in CXCL9 levels. Multivariate logistic regression analysis showed that CXCL9 are important risk factors for CSFP (β=1.795, P=0.000). Subsequent ROC curve analyses indicated that the serum CXCL9 levels demonstrated a high diagnostic value in differentiating patients with CSFP from that of normal controls (Area Under the Curve = 0.758) and the serum CXCL9 level of 131.915 mg/L was a predictor of CSFP, with a sensitivity of 54.3% and a specificity of 96.0%. Conclusions: Our findings are indicative of the potential clinical implications of CXCL9 in the occurrence and development of CSFP.

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Prevalence and Clinical Characteristics of Patients with Coronary Slow Flow Phenomenon (CSFP) and No Significant Coronary Artery Disease

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.124 ◽

2012 ◽

Vol 21 ◽

pp. S48

Author(s):

N. Rudd ◽

N. Nadarajah ◽

A. Jackson ◽

J. Mekel ◽

V. Mutha ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Clinical Characteristics ◽

Significant Coronary Artery Disease ◽

Slow Flow ◽

Flow Phenomenon ◽

Coronary Slow Flow ◽

Artery Disease ◽

Coronary Slow Flow Phenomenon

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P3596The role of MSCT and SPECT in patients with acute coronary syndromes and non-obstructive coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz745.0456 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Vorobyeva ◽

A V Mochula ◽

K V Zavadovsky ◽

V V Ryabov

Keyword(s):

Coronary Artery ◽

High Risk ◽

Soft Tissue ◽

Coronary Arteries ◽

Atherosclerotic Plaques ◽

Slow Flow ◽

Frequency Of Occurrence ◽

Risk Of Rupture ◽

Coronary Slow Flow

Abstract Background Approximately 1–14% of patients with ACS not have obstructive changes in the coronary arteries according to the data of invasive coronary angiography (ICA) is myocardial infarction (AMI) with non-obstructive coronary artery- MINOCA. MSCT has the ability to assess the lumen of the vessel, visualize the artery wall, the structure of the atherosclerotic plaque. SPECT is used to detect myocardial ischemia, determine the functional significance of atherosclerotic plaques, and evaluate regional tissue perfusion. There are no data on a research of a structurally functional condition of a coronary blood-groove by means of MSCT, SPECT.Aim. To study the role of MSCT and SPECT in patients with MINOCA, to compare MSCT with invasive coronarography. Material and methods The study is registered on ClinicalTrials.gov. Inclusion criteria are listed on the site. All patients underwent CT, SPECT, on the 6th day from the beginning of the index event. All MSCT and SPECT studies were performed on a 64-section combined single-photon-emission and X-ray computer tomograph GE Discovery NM/CT 570C. Endpoint: Frequency of occurrence of atherosclerosis, frequency of occurrence of unstable plaques according to MSCT, the magnitude of a transient defect in myocardial perfusion according to SPECT. Results The study included 14 patients with MINOCA, women predominate – 11 (78.6%), the average age was 61.1±14 years. The risk of GRACE was moderate in 8 (57%) pts. 12 (85.7%) pts were hospitalized within the first 6 hours of the onset of the disease.Thrombolytic therapy was performed in 3 (21.4%) pts, 2 of them were effective (14%). 57% of patients at admission were troponin-positive.According to the results of ICA, intact coronary arteries were detected in 9 (64.3%) pts, 5 (35%) had stenosis up to 50%. Coronary slow flow (TIMI 2) was determined in 11 (78.6%) pts, of which 8 (57%) pts have coronary slow flow and intact coronary arteries. Coronary spasm was in 1 (7.1%) patient. According to MSCT, the proportion of pts with intact coronary arteries decreased (9 (64.3%) → 5 (35.7%)) and the proportion with non-obstructive atherosclerosis increased (5 (35%) → 9 (64.3%)). All pts had a positive remodeling index, soft-tissue, predominantly calcified stenoses and eccentric plaques. The average Segment Involvement Score was 2.1 (0; 5), the Segment Stenosis Score was −2.4 (1; 3). 12 pts (85%) had transitory perfusion defects. The median SSS values were 7.5 (4; 13), SRS 4.7 (1.0; 9.0), SDS 4.7 (3.0; 8.0). Conclusion In 78% of pts had a slowing of the coronary blood flow and intact coronary arteries according to ICAG. However, according to MSCT, only 36% of the patients did not have plaques. MSCT allows to identify eccentric soft tissue atherosclerotic plaques that have a high risk of rupture/erosion, and, accordingly, the high risk of the development of AMI in this group. Using SPECT revealed a statistically significant transient perfusion defect.

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