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Pasupathy S, Tavella R, Zeitz C, Edwards S, Worthley M, Arstall M, Beltrame JF. Anti-Anginal Efficacy of Zibotentan in the Coronary Slow-Flow Phenomenon. J Clin Med 2024; 13:1337. [PMID: 38592159 PMCID: PMC10931575 DOI: 10.3390/jcm13051337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Patients with coronary microvascular disorders often experience recurrent angina for which there are limited evidence-based therapies. These patients have been found to exhibit increased plasma levels of endothelin; thus, selective endothelin-A (Et-A) receptor blockers such as zibotentan may be an effective anti-anginal therapy in these patients. The study evaluated the impact of a 10 mg daily dose of zibotentan on spontaneous angina episodes in patients with the coronary slow-flow phenomenon who had refractory angina (i.e., experiencing angina at least three times/week despite current anti-anginal therapy). METHODS Using a randomized, double-blind, placebo-controlled, crossover trial design with 4-week treatment periods, 18 patients (63.2 ± 9.9 years, 33% females) were recruited. The primary endpoint was angina frequency as measured by an angina diary, with secondary endpoints including nitrate consumption, angina duration/severity and the Seattle Angina Questionnaire (SAQ) domains. RESULTS During the 4 weeks of therapy, angina frequency significantly improved with zibotentan therapy (placebo 41.4 (58.5) vs. zibotentan 29.2 (31.6), p < 0.05), and sublingual nitrate consumption significantly reduced (placebo 11.8 (15.2) vs. zibotentan 8.8 (12.9), p < 0.05. CONCLUSIONS Zibotentan improved the frequency of spontaneous angina episodes and reduced sublingual nitrate consumption in patients unresponsive to standard anti-anginal therapy.
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Affiliation(s)
- Sivabaskari Pasupathy
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Rosanna Tavella
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Christopher Zeitz
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| | - Suzanne Edwards
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Matthew Worthley
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| | - Margaret Arstall
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Northern Adelaide Local Health Network, Adelaide, SA 5112, Australia
| | - John F. Beltrame
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (S.P.); (R.T.); (C.Z.); (S.E.); (M.W.); (M.A.)
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
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Du Z, Jiang W, Yu C, Lu X, Xia W. Asymmetric Dimethylarginine Is Associated with the Phenomenon of Coronary Slow Flow in Patients with Nonvalvular Atrial Fibrillation. Cardiology 2024; 149:208-216. [PMID: 38246155 DOI: 10.1159/000536024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Coronary slow flow phenomena (CSFP) are associated with endothelial and blood component abnormalities in coronary arteries. Asymmetric dimethylarginine (ADMA) can damage the endothelium of the heart or blood vessels in patients with non-valvular atrial fibrillation (NVAF), causing changes in levels of biological indicators. Our aim was to analyze the relationship between ADMA and CSFP in NVAF patients. METHODS We consecutively enrolled 134 patients diagnosed with NVAF and underwent coronary angiography, 50 control patients without a history of atrial fibrillation and with normal coronary angiographic flow were included at the same time. Based on the corrected TIMI frame count (CTFC), the NVAF patients were categorized into two groups, CTFC ≤27 frames and CTFC >27 frames. Plasma ADMA, P-selectin (p-sel), von Willebrand factor (vWF), D-dimer (D-Di), plasminogen activator inhibitor 1 (PAI-1), and nitric oxide (NO) were detected by ELISA in the different groups. RESULTS We found that plasma ADMA levels were significantly higher among NVAF patients in the CTFC >27 grade group compared with the control or CTFC ≤27 group. In addition, the levels of blood cells and endothelium-related biomarkers (NO, P-selectin, vWF, D-Di, and PAI-1) were significantly altered and correlated with ADMA levels. Multifactorial analysis showed that plasma ADMA (odd ratio [OR; 95% CI]: 1.65 [1.21-2.43], p < 0.001) and left atrial internal diameter (OR [95% CI]: 1.04 [1.02, 1.1], p < 0.001) could be used as independent risk factors for the development of CSFP in patients with NVAF. The ROC curves of ADMA can predict the development of CSFP in NVAF patients. The minimum diagnostic concentration for the development of CSFP in patients was 2.31 µmol/L. CONCLUSION Our study demonstrated that CSFP in NVAF patients was associated with high levels of ADMA and left atrial internal diameter. Therefore, aggressive preoperative detection and evaluation of ADMA and left atrial internal diameter can help deal with the intraoperative presence of CSFP.
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Affiliation(s)
- Zhaona Du
- School of Clinical Medicine, Weifang Medical University, Weifang, China,
| | - Wenbo Jiang
- Department of Neurosurgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Chengyun Yu
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xiuyan Lu
- First Department of Cardiology, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Wei Xia
- First Department of Cardiology, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
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Yu J, Yi D, Yang C, Zhou X, Wang S, Zhang Z, Sun Z, Yan M. Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow. Curr Probl Cardiol 2024; 49:102074. [PMID: 37689375 DOI: 10.1016/j.cpcardiol.2023.102074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.
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Affiliation(s)
- Jiang Yu
- Department of Hyperbaric Oxygen, the First Medical Centre of Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China
| | - Dan Yi
- Chinese PLA Medical School, Beijing, China
| | - Chengyu Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiang Zhou
- Department of Hyperbaric Oxygen, the First Medical Centre of Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China
| | - Sibin Wang
- Department of Hyperbaric Oxygen, the First Medical Centre of Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China
| | - Zhengbo Zhang
- Center for Artificial Intelligence, Medical Innovation and Research Department, Chinese PLA General Hospital, Beijing, China
| | - Zhijun Sun
- Department of Cardiology, the First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Oxygen, the First Medical Centre of Chinese PLA General Hospital, Beijing, China.
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Shamsara J, Elyasi S, Dastani M, Behzadian N, Hosseinjani H, Ataei M, Jafari F, Akbarzadeh M, Naserifar M, Sahebkar A, Mohammadpour AH. Evaluation of serum nitric oxide synthase levels in patients with coronary slow flow based on corrected TIMI frame count. Arch Med Sci Atheroscler Dis 2023; 8:e140-e145. [PMID: 38283932 PMCID: PMC10811541 DOI: 10.5114/amsad/176659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The coronary slow flow phenomenon (CSFP) finding in angiography is characterized by the delayed filling of the terminal vessels without significant epicardial coronary disease. The endothelium performs a vital role in cardiovascular homeostasis by releasing vasoactive substances. Endothelial cells produce nitric oxide (NO) as one of these essential compounds. Three isoforms of nitric oxide synthase (NOS) are endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and induced nitric oxide synthase (iNOS). We aimed to determine the role of NOS in the development of CSFP as the first human study. Material and methods A total of 129 patients who met the inclusion criteria were enrolled in the study. The patients were classified into five groups based on the results of coronary angiography: Group 1 without coronary artery disease (CAD) and without CSF, group 2 without CAD and with CSF, group 3 with CAD (< 50%) and without CSF, group 4 with CAD (50-90%) and without CSF, and group 5 with CAD and CSF. The serum level of NOS was determined in the participants. Coronary flow was quantified in patients with CSFP using the corrected TIMI frame count (CTFC) method, and the correlation between the levels of this biomarker and CTFC was investigated. Results In this study, the NOS serum levels were not significantly correlated with the mean CTFC. Since the total amount of NOS was measured as a result of 3 isoforms of this enzyme, the lack of correlation could be related to increased iNOS level and decreased eNOS concentration. Conclusions These results should be confirmed by more human studies.
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Affiliation(s)
- Jamal Shamsara
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Dastani
- Department of Cardiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nadia Behzadian
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hesamoddin Hosseinjani
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahshid Ataei
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Jafari
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Akbarzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahshid Naserifar
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Aparicio A, Cuevas J, Morís C, Martín M. Slow Coronary Blood Flow: Pathogenesis and Clinical Implications. Eur Cardiol 2022; 17:e08. [PMID: 35356630 PMCID: PMC8941644 DOI: 10.15420/ecr.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
Coronary slow flow (CSF) phenomenon, also known as cardiac syndrome Y, is defined as the delayed opacification of the coronary vasculature at the distal level. Different hypotheses and theories have been postulated about its substrate and mechanism, such as microvascular and endothelial dysfunction. Several studies have confirmed that CSF is a cause of ischaemia detected by non-invasive testing. Clinically, it can present as angina pectoris, acute coronary syndrome and sudden cardiac death. It has an incidence of 1–5% in patients undergoing coronary angiography and has been most frequently found in young men who are smokers with metabolic syndrome. There are no established treatments for CSF and further studies are still necessary.
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Affiliation(s)
- Andrea Aparicio
- Area de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Cuevas
- Area de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís
- Area de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Martín
- Area de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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The effect of coronary slow flow on left atrial structure and function. Sci Rep 2021; 11:7511. [PMID: 33820937 PMCID: PMC8021584 DOI: 10.1038/s41598-021-87193-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/24/2021] [Indexed: 12/01/2022] Open
Abstract
The coronary slow flow phenomenon (CSFP) is common in coronary angiography, however its impact on left atrial (LA) function is still controversial. This study aims to evaluate the LA structure and function of patients with CSFP using two-dimensional speckle tracking echocardiography (2D-STE). Consecutive patients scheduled for coronary angiography from January 2016 to September 2017 were enrolled in this study. Patients’ demographic data, clinical histories, laboratory and angiographic findings were collected and recorded. Diagnostic criteria for CSFP is based on Beltrame et al. proposed in 2012. Meanwhile 139 patients who have no significant stenosis (≤ 40%) and normal blood flow were selected as control. All patients received an echocardiographic examination 24 h before coronary angiography. LA structure and function were measured with echocardiography and 2D-STE. Our results showed that among the 1,954 patients who had received coronary angiography, 512 patients were included in the analysis after the exclusion criteria was implemented. Of those, 101 patients met the CSFP criteria (5.5%). CSFP is mainly seen in LAD (~ 70%). There was no statistical difference in baseline characteristics between the CSFP group and control group, except for a higher proportion of smokers in the CSFP group (P = 0.001). The percentage of monocytes is an independent risk factor for the occurrence of CSFP (P = 0.036) after binary logistic regression analysis. The LA global longitudinal strain (LA-GLS, represents reservoir functions) decreased and LA strain rate at late diastole (LA-SRa, represents booster function) increased in patients with CSFP compared to the control group (P < 0.05). Correlation test of continuous variables by Pearson test suggested that LA-GLS was negatively correlated with TIMI frame count (TFC). We concluded that the percentage of monocytes is an independent risk factor for the CSFP; the LA reservoir and booster functions were impaired in patients with CSFP; LA-GLS is negatively correlated with TFC.
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Chalikias G, Tziakas D. Slow Coronary Flow: Pathophysiology, Clinical Implications, and Therapeutic Management. Angiology 2021; 72:808-818. [PMID: 33779300 DOI: 10.1177/00033197211004390] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronary slow flow (CSF) is an angiographic phenomenon with specific epidemiologic characteristics, associated clinical presentation, and prognosis. Although patients with CSF are diagnosed as having "normal coronary arteries," it seems appropriate to consider CSF as a distinct disease entity requiring specific treatment. The patient with CSF is usually male, smoker, obese, with a constellation of risk factors suggestive of metabolic syndrome. Unstable angina is the most common clinical presentation, with recurrent episodes of chest pain at rest associated with electrocardiographic changes often requiring readmission and reevaluation. Regarding definition and diagnosis, interventionists should first exclude possible "secondary" causes of CSF, use objective means for definition and then differentiate from other similar conditions such as microvascular angina. Although the phenomenon is generally benign, patients with CSF are severely symptomatic with recurrent episodes of chest pain and poor quality of life. Furthermore, acute presentation of the phenomenon is commonly life-threatening with ventricular tachyarrhythmias, conduction abnormalities, or cardiogenic shock. Acute treatment of CSF includes, but is not restricted to, intracoronary infusion of dipyridamole, adenosine, or atropine. Chronic management of patients with CSF encompasses dipyridamole, diltiazem, nebivolol, telmisartan, and/or atorvastatin associated with amelioration of angina symptoms, improved quality of life, and good prognosis.
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Affiliation(s)
- George Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Kanar HS, Arsan A, Kup A, Kanar BG, Tanyıldız B, Akaslan D, Uslu A, Sadıç BÖ. Comparison of subfoveal choroidal thickness and retinal nerve fiber layer thickness in patients with coronary slow flow phenomenon and microvascular angina: Optical coherence tomography based study. Photodiagnosis Photodyn Ther 2021; 33:102189. [PMID: 33497818 DOI: 10.1016/j.pdpdt.2021.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate and compare the subfoveal choroidal thickness (SFCT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in patients with microvascular angina (MA), coronary slow flow phenomenon (CSFP) and healthy controls. METHODS Thirty-two consecutive patients with MA, 35 consecutive patients with CSFP and 40 age and sex-matched controls were enrolled. SFCT, average pRNFLT and four quadrants of pRNFLT were measured by spectral domain- optical coherence tomography (SD-OCT). RESULTS The mean SCFT in patients with CSFP (267.57 ± 30.61 μm) was significantly thinner than those of patients with MA (288.84 ± 28.25 μm) and control (291.21 ± 31.75 μm) (p = 0.002) while SFCT of patients with MA were similar with those of controls. Patients with CSFP had thinner superior and inferior pRNFLT compared to patients with MA and controls (p < 0.001 and p = 0.005, respectively) while there were no significant differences in average pRNFLT, nasal and temporal quadrant of pRNFLTs among three groups. In the multivariate linear regression analyses, the presence of CSFP was found negatively correlated with SFCT and superior pRNFLT. CONCLUSION Patients with CSFP had thinner SFCT, superior and inferior quadrants of pRNFLT proposing the presence of a generalized endothelial dysfunction and increased microvascular resistance in these patients.
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Affiliation(s)
- Hatice Selen Kanar
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Aysu Arsan
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Ayhan Kup
- Health Science University, Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Batur Gönenç Kanar
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Burak Tanyıldız
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Dursun Akaslan
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Abdulkadir Uslu
- Health Science University, Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Beste Özben Sadıç
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
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Evaluation of the Correlation between Serum Concentrations of Asymmetric Dimethylarginine and Corrected TIMI Frame Count in Patients with Slow Coronary Flow. Int J Vasc Med 2020; 2020:4592190. [PMID: 33014469 PMCID: PMC7520690 DOI: 10.1155/2020/4592190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
Coronary slow flow (CSF) is an important angiographic entity that is characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. Elevated levels of ADMA cause the induction of endothelial dysfunction and thus promote atherosclerosis. This study was aimed at determining the role of ADMA in the development of CSF. One hundred twenty-nine subjects who fulfilled the inclusion criteria were enrolled in this study. According to coronary angiography results, these subjects were divided into five groups. The serum concentration of ADMA was measured in these subjects. In this study, there was no significant correlation between serum concentrations of ADMA and mean corrected TIMI frame count (CTFC) (P > 0.05). However, the ADMA level was significantly correlated with CTFC in the left anterior descending (LAD) coronary artery in patients with CSF (r = −0.381, P = 0.045). Also, plasma ADMA levels were significantly higher in patients with CSF and without CAD compared to patients without CSF and with CAD (50-90%) (P = 0.034). Besides, serum concentrations of ADMA were significantly higher in subjects with BMI < 25 kg/m2 compared with those having BMI > 30 kg/m2 (P = 0.003). It was also shown that the levels of ADMA were significantly higher in subjects with age as a cardiovascular risk factor compared with those without this risk factor (P = 0.024). Further studies with larger population sizes are needed to confirm the present findings on the association between the serum concentrations of ADMA and CSF.
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Elamragy AA, Abdelhalim AA, Arafa ME, Baghdady YM. Anxiety and depression relationship with coronary slow flow. PLoS One 2019; 14:e0221918. [PMID: 31487310 PMCID: PMC6728014 DOI: 10.1371/journal.pone.0221918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Psychiatric disorders (depression / anxiety) are linked to coronary artery disease (CAD). Coronary slow flow (CSF) is a relatively common form of CAD with the same underlying mechanisms that are attributed to many anatomic and pathophysiologic factors. However, the relationship between psychiatric disorders and CSF is less well-established; and this is the aim of this study. Methods This cross-sectional observational study was conducted on the first 50 consecutive patients diagnosed with CSF by elective coronary angiography (CAG). They were compared with another 50 consecutive patients showing normal coronaries by CAG. Beck Anxiety Inventory and Beck Depression Inventory were used for assessment. CSF was diagnosed by coronary angiography “Thrombolysis In Myocardial Infarction” frame count. Lipid profile was obtained for all patients. Results Traditional risk factors (male gender, smoking, total cholesterol, low-density lipoproteins and triglycerides) were higher in the CSF group. Depression and anxiety scores were also higher in the CSF group. On multivariate analysis, male gender, depression and high triglycerides were the only significant independent predictors of CSF. A significant correlation existed between CSF and both anxiety and depression scores. Both scores were also significantly higher in multivessel vs single vessel affection. Conclusion Psychiatric depression, male gender and high triglycerides are highly associated with CSF in patients undergoing elective CAG. There is a significant correlation between CSF severity and the severity of both anxiety and depression. Further studies are warranted to explore the impact of psychological intervention on CSF and its long-term outcome.
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Kayapinar O, Ozde C, Kaya A. Relationship Between the Reciprocal Change in Inflammation-Related Biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin Ratios) and the Presence and Severity of Coronary Slow Flow. Clin Appl Thromb Hemost 2019; 25:1076029619835383. [PMID: 30857397 PMCID: PMC6714912 DOI: 10.1177/1076029619835383] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammation has been implicated in the pathogenesis of endothelial dysfunction, atherosclerosis, and microvascular coronary dysfunction. In this context, it is thought that fibrinogen, high-sensitive C-reactive protein (hsCRP), and albumin may be associated with the pathogenesis of coronary slow flow (CSF). We aimed to evaluate the ratios of fibrinogen-to-albumin and hsCRP-to-albumin in patients with CSF compared to patients with angiographically normal coronary arteries and stable coronary artery disease (CAD). In all, 65 patients with CSF, 65 patients with newly diagnosed stable CAD, and 65 control participants with angiographically normal coronary arteries were included. The coronary flow rates of all patients were determined by the Thrombolysis in Myocardial Infarction frame count method. Fibrinogen, hsCRP, and albumin levels were analyzed in all patients, and the fibrinogen-to-albumin and hsCRP-to-albumin ratios were calculated. The baseline characteristics of the 3 groups were similar. The plasma albumin level was significantly lower, whereas the fibrinogen and the hsCRP levels were significantly higher, in the CSF and CAD groups compared to the controls. The fibrinogen-to-albumin and hsCRP-to-albumin ratios were significantly higher in both the CSF and the CAD groups compared to the control group. The hsCRP-to-albumin ratio was positively correlated with the mean Thrombolysis in Myocardial Infarction frame count in the whole study population. According to the receiver–operating characteristic analysis, the efficacies of the fibrinogen-to-albumin and hsCRP-to-albumin ratios in predicting CSF were significant. The fibrinogen-to-albumin and hsCRP-to-albumin ratios, which were increased by a reciprocal change, suggest that inflammation may play a role in the pathogenesis of CSF.
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Affiliation(s)
- Osman Kayapinar
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Cem Ozde
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Adnan Kaya
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
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Baysal SS, Koc S. Oxidant-Antioxidant balance in patients with coronary slow flow. Pak J Med Sci 2019; 35:786-792. [PMID: 31258595 PMCID: PMC6572956 DOI: 10.12669/pjms.35.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Recent studies have focused on the probable role of oxidative stress in cardiovascular diseases. We aimed to assess the oxidant/antioxidant biomarkers in coronary slow flow (CSF). Methods The study included 51 subjects with CSF and age and sex matched 32 controls. Detailed anamnesis of the patients in the study was taken and routine physical examinations were performed. Routine biochemical blood tests were analyzed. Total oxidative status (TOS), oxidative stress index (OSI) and lipid hydroxyperoxide (LOOH) levels as oxidant biomarkers; paraoxonase (PON1), ceruloplasmin (CP), free sulphydryl (SH) groups, and total antioxidant capacity (TAS) levels as antioxidant biomarkers were studied. Results Baseline demographic characteristics of the study population did not differ significantly between groups.TOS, OSI and LOOH concentrations were higher in study group than in control group. However, there was no significant difference detected in levels of TAS, PON1, SH and CP. Multivariate logistic regression analysis revealed that TOS, hsCRP and smoking were indepedent risk factors of CSF. Conclusions Although there was not any significant difference in antioxidant biomarkers (TAS, PON1, SH and CP) in CSF patients, we detected increased TOS, OSI and LOOH levels which have oxidant properties. These data supported the possible involvement of oxidative stress in pathogenesis of CSF as previous studies reported.
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Affiliation(s)
- Sadettin Selcuk Baysal
- Sadettin Selcuk Baysal, Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, 63300, Sanliurfa, Turkey
| | - Sahbender Koc
- Sahbender Koc, Cardiology Department, Kecioren Training and Research Hospital, 06300, Ankara, Turkey
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Xing Y, Shi J, Yan Y, Liu Y, Chen Y, Kong D, Shu X, Pan C. Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography. Microcirculation 2018; 26:e12509. [PMID: 30365186 DOI: 10.1111/micc.12509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. METHODS Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. RESULTS Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL-C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (-19.03% vs -21.42%, P < 0.001 and -19.72% vs -22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo- and mid-myocardial layers were affected. LV-GLS and RV-GLS were found to be well correlated with mTFC and HDL-C in CSFP groups (r = 0.463 vs r = 0.439; r = -0.569 vs r = -0.552, all P < 0.05). ROC curve analysis demonstrated that LV-GLS-endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. CONCLUSIONS Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early-stage myocardial impairment in patients with CSFP.
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Affiliation(s)
- Yumeng Xing
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Jing Shi
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yan Yan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yongle Chen
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
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Sanchez-Garcia ME, Ramirez-Lara I, Gomez-Delgado F, Yubero-Serrano EM, Leon-Acuña A, Marin C, Alcala-Diaz JF, Camargo A, Lopez-Moreno J, Perez-Martinez P, Tinahones FJ, Ordovas JM, Caballero J, Blanco-Molina A, Lopez-Miranda J, Delgado-Lista J. Evaluación cuantitativa de los cambios microvasculares capilaroscópicos en pacientes con cardiopatía isquémica establecida. Med Clin (Barc) 2018; 150:131-137. [DOI: 10.1016/j.medcli.2017.06.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 11/28/2022]
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15
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Li Y, Fang F, Ma N, Li R, Sun Q, Yang J, Nie S, Yu CM, Yang Y. Feasibility Study of Transthoracic Echocardiography for Coronary Slow Flow Phenomenon Evaluation: Validation by Coronary Angiography. Microcirculation 2016; 23:277-82. [PMID: 26991324 DOI: 10.1111/micc.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to assess echocardiography parameters in CSFP evaluation. METHODS This study enrolled 79 consecutive patients with CSFP validated by coronary angiography and control individuals with normal coronary flow. Coronary flow rates were determined by corrected CTFC. Clinical and coronary angiography data and coronary parameters assessed by echocardiography using the CFI were recorded. RESULTS Baseline characteristics were similar between the two groups. Patients with CSFP were predominantly males, with higher BMI values, weights and triglyceride levels (p < 0.05), but lower platelet counts (p < 0.05). Conventional echocardiography parameters were similar in the two groups. However, echocardiographic measurements of the LAD, including PDV, MDV, PDP, MDP and VTI, in the CSFP group were lower compared with control values (p < 0.05). BMI was positively correlated with CSFP. LAD's CTFC showed strong inverse correlations with PDV, MDV, PDP, and MDP in CSFP groups. ROC curve analysis revealed that coronary artery flow-related parameters occupied more than half of the AUC. CONCLUSIONS CSFP could be identified with the help of echocardiography.
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Affiliation(s)
- Yijia Li
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Fang Fang
- Department of Echocardiography, The Chinese University of Hong Kong, HongKong, China
| | - Ning Ma
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Rongjuan Li
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Qiwei Sun
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Jiao Yang
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Shaoping Nie
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Cheuk-Man Yu
- Department of Echocardiography, The Chinese University of Hong Kong, HongKong, China
| | - Ya Yang
- Department of Echocardiography, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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Kundi H, Gok M, Cetin M, Kiziltunç E, Topcuoglu C, Neşelioğlu S, Erel O, Ulusoy FV. Association of thiol disulfide homeostasis with slow coronary flow. SCAND CARDIOVASC J 2016; 50:213-7. [PMID: 26891417 DOI: 10.3109/14017431.2016.1156736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Harun Kundi
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Murat Gok
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunç
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Canan Topcuoglu
- Department of Biochemistry, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Biochemistry, Yildirim Beyazit University Medical Faculty, Ankara, Turkey
| | - Ozcan Erel
- Department of Biochemistry, Yildirim Beyazit University Medical Faculty, Ankara, Turkey
| | - Feridun Vasfi Ulusoy
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Caglar IM, Ozde C, Biyik I, Caglar FNT, Akturk IF, Ugurlucan M, Karakaya O. Association between soluble lectin-like oxidized low-density lipoprotein receptor 1 levels and coronary slow flow phenomenon. Arch Med Sci 2016; 12:31-7. [PMID: 26925116 PMCID: PMC4754361 DOI: 10.5114/aoms.2015.51412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The coronary slow flow phenomenon (CSFP) has been associated with myocardial ischemia, myocardial infarction, life-threatening arrhythmias, sudden cardiac death and increased cardiovascular mortality similar to coronary artery disease (CAD). Possible underlying mechanisms of CSFP are endothelial dysfunction, chronic inflammation, microvascular dysfunction and diffuse atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) seems to play an important role in the pathogenesis of atherosclerosis. We hypothesized that sLOX-1 might be associated with CSFP, and aimed to research the relationship between sLOX-1 and CSFP. MATERIAL AND METHODS Forty patients with angiographically proven CSFP and 43 patients with a normal coronary flow pattern (NCFP) were included in this study. Coronary blood flow was measured according to the Thrombolysis In Myocardial Infarction (TIMI) frame count method. sLOX-1 levels were measured in all study subjects. RESULTS Serum levels of sLOX-1 were significantly higher in the CSFP group than the NCFP group (1061.80 ±422.20 ng/ml vs. 500.043 ±282.97 ng/ml, p < 0.001, respectively). Multivariate logistic regression analysis including sLOX-1, MPV, GGT and uric acid levels revealed a significant association between sLOX-1 levels and CSFP (Exp (B)/OR: 1.006, 95% CI: 1.002-1.010, p = 0.001). CONCLUSIONS The present study demonstrated that serum sLOX-1 levels were significantly higher in patients with CSFP and there was a strong association between high sLOX-1 levels and CSFP. High serum sLOX-1 levels may have an important role in the pathogenesis of CSFP. Future studies are needed to confirm these results.
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Affiliation(s)
- Ilker Murat Caglar
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Cem Ozde
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ismail Biyik
- Department of Cardiology, Usak State Hospital, Usak, Turkey
| | | | - Ibrahim Faruk Akturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Karakaya
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Gulel O, Akcay M, Soylu K, Aksan G, Yuksel S, Zengin H, Meric M, Sahin M. Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography. Echocardiography 2015; 33:714-23. [DOI: 10.1111/echo.13146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Okan Gulel
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Murat Akcay
- Cardiology Clinic; Terme State Hospital; Samsun Turkey
| | - Korhan Soylu
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Gokhan Aksan
- Cardiology Clinic; Sisli Hamidiye Etfal Education and Research Hospital; Istanbul Turkey
| | - Serkan Yuksel
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Halit Zengin
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Murat Meric
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Mahmut Sahin
- Department of Cardiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
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19
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Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C, Turak O, Aras D, Aydogdu S. Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb Hemost 2015; 22:476-82. [PMID: 26139836 DOI: 10.1177/1076029615594002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease. HYPOTHESIS We aimed to assess the relationship between MHR and SCF. METHODS Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF. RESULTS The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels (P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001). CONCLUSION Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation.
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Affiliation(s)
- Ugur Canpolat
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Elif Hande Çetin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Serkan Cetin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Selahattin Aydin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboga
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Cagri Yayla
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Osman Turak
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Dursun Aras
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sinan Aydogdu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
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Cakmak HA, Aslan S, Yalcin AA, Akturk IF, Yalcin B, Uzun F, Ozturk D, Erturk M, Gul M. Relationship between serum visfatin levels and coronary slow-flow phenomenon. Herz 2015; 40:921-8. [DOI: 10.1007/s00059-015-4313-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/20/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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21
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Akboga MK, Canpolat U, Balci KG, Akyel A, Sen F, Yayla C, Cay S, Aras D, Aydogdu S. Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow. Angiology 2015; 67:21-6. [PMID: 25725035 DOI: 10.1177/0003319715574625] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies showed that both inflammation and platelets have a role in development of slow coronary flow (SCF). Platelet to lymphocyte ratio (PLR) as an emerging inflammatory indicator was significantly associated with adverse cardiovascular events. Therefore, we aimed to assess the relationship between PLR and SCF. Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 221 as SCF group and n = 293 as control group). Patients who had thrombolysis in myocardial infarction frame counts (TFC) above the normal cutoffs were considered to have SCF. Both PLR and C-reactive protein (CRP) were significantly higher in the SCF group. In correlation analysis, PLR has a significantly positive correlation with the left anterior descending artery TFC (P = .001), circumflex artery TFC (P < .001), right coronary artery TFC (P < .001), and serum CRP level (P < .001). In multiple logistic regression analysis, PLR was independently associated with presence of SCF (odds ratio: 1.014, P < .001). In conclusion, higher PLR levels were significantly and independently related to the presence of SCF. Besides, PLR was positively correlated with serum CRP level as a conventional marker for systemic inflammation.
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Affiliation(s)
- Mehmet Kadri Akboga
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kevser Gulcihan Balci
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ahmet Akyel
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Fatih Sen
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Sadr-Ameli MA, Saedi S, Saedi T, Madani M, Esmaeili M, Ghardoost B. Coronary slow flow: Benign or ominous? Anatol J Cardiol 2014; 15:531-5. [PMID: 25537993 PMCID: PMC5337030 DOI: 10.5152/akd.2014.5578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: Coronary slow flow phenomenon has been arbitrarily defined as delayed coronary blood flow in the absence of obstructive coronary artery disease. The present study sought to investigate the clinical features, natural history, and outcomes of affected patients. Methods: In this prospective cross-sectional study, 217 consecutive patients who had undergone coronary angiography and showed features of coronary slow flow phenomenon were evaluated for demographic and coronary risk factor profile, as well as clinical outcomes, at baseline and following treatment. Results: The study population consisted of 165 (76%) males and 52 (24%) females. The mean age of patients was 52.6±10 years. Mean ejection fraction was 48.2±5.4, 39.3% had diabetes, 43.3% had hypertension, 49.8% was a cigarette smoker, 41.9% had dyslipidemia, and 15% had a familial history of cardiac disease. Forty-nine percent was detected to have abnormal hsCRP levels. The most prevalent presenting complaint was atypical chest pain. Fifty-four percent of patients had slow blood flow in all three vessels. Thirty-six people had undergone repeat coronary angiography in a follow-up period of 5-7 years due to persisting or worsening clinical symptoms, of whom 6 (16.6%) showed significant coronary artery stenosis. Eight (22.2%) had mild CAD, and the rest still showed coronary slow flow without significant stenosis. The most common complaint during follow-up and after initiation of medical therapy was nonanginal chest pain. Conclusion: Patients with coronary slow flow phenomenon are predisposed to atherosclerosis and obstructive coronary artery disease. Therefore, this pathology should not be considered as a totally benign condition. Primary and secondary cardiovasculature preventive measures should be constituted and seem worthwhile in this patient population.
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Affiliation(s)
- Mohammad Ali Sadr-Ameli
- Department of Cardiology, Shahid Rajaie Cardiovascular, Medical, Research Center, Iran University of Medical Sciences; Tehran-Iran.
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Wang X, Nie SP. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther 2013; 1:37-43. [PMID: 24282683 DOI: 10.3978/j.issn.2223-3652.2011.10.01] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/10/2011] [Indexed: 11/14/2022]
Abstract
The coronary slow flow phenomenon (CSFP) is an important, angiographic entity characterized by delayed progression of the injected contrast medium through the coronary tree. It is a frequent finding, typically observed in patients presenting with acute coronary syndromes. Although it is well known to interventional cardiologists for approximately four decades, the pathogenic mechanisms remain unclear. The clinical implications are significant, with over 80% of patients experiencing recurrent chest pain, resulting in considerable impairment in quality of life. This article will address in detail the characteristics, possible mechanisms, and clinical implications of this entity to provide further insight into its clinical significance and management strategies.
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Affiliation(s)
- Xiao Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Li L, Gu Y, Liu T, Bai Y, Hou L, Cheng Z, Hu L, Gao B. A randomized, single-center double-blinded trial on the effects of diltiazem sustained-release capsules in patients with coronary slow flow phenomenon at 6-month follow-up. PLoS One 2012; 7:e38851. [PMID: 22761709 PMCID: PMC3384631 DOI: 10.1371/journal.pone.0038851] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/10/2012] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study is to observe the chronic effects of diltiazem release capsules on patients with coronary slow flow (CSF) phenomenon. Methods From 2004 to 2009, 80 consecutive patients with chest pain and normal coronary arteries evidenced by coronary angiography and CSF were included in this randomized, double-blind, placebo-controlled trial. CSF patterns were evaluated by the corrected TIMI frame count. Patients were randomly assigned at 1∶1 ratio to diltiazem sustained-release capsules treatment group (Dil, 90 mg twice daily) or placebo control group. Holter, liver and kidney function, treadmill exercise test, coronary angiography and left ventricular angiography were measured at baseline and after 6 months. The incidence of cardiovascular events (re-admission or progress in coronary heart disease, myocardial infarction, malignant arrhythmia or cardiac death) was evaluated during the 6 months follow up. Results Thirty-nine patients in control and 40 patients in Dil group completed the 6 months follow-up. There was no medication induced drug withdraw during follow up. Left ventricular ejection fraction was similar between the 2 groups at baseline and during follow up. Heart rate was significantly lower in Dil group than in control group and there was no symptomatic bradycardia and II and III degree atrioventricular conduction block in both groups. Significant improvement was observed in the onset of chest pain, treadmill exercise test and coronary blood flow in Dil group while these parameters remained unchanged in control group at the end of 6 months follow up. The incidence of cardiovascular events was similar between the two groups. Conclusion Diltiazem slow-release capsules improved coronary blood flow and alleviated angina in patients with CSF. Trial Registration Chinese Clinical Trial Registry ChiCTR-TCC-11001864
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Affiliation(s)
- Lun Li
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Ye Gu
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
- * E-mail:
| | - Tao Liu
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Yupeng Bai
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Lingbo Hou
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Zhong Cheng
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Liqun Hu
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
| | - Bo Gao
- Department of Cardiology, Wuhan Puai Hospital, Huazhong University Of Science and Technology, Wuhan, China
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Ozeke O, Gungor M, Ertan C, Celik A, Aydin D, Erturk O, Hizel SB, Ozgen F, Demir AD, Ozer C. Association of sleep apnea with coronary slow-flow phenomenon. J Cardiovasc Med (Hagerstown) 2012; 13:376-80. [DOI: 10.2459/jcm.0b013e3283528f14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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26
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Finley JJ, Savage MP. Coronary slow flow phenomenon: more than just an angiographic curiosity. Interv Cardiol 2012. [DOI: 10.2217/ica.12.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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