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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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Li ZP, Chen J, Xin Q, Pei XY, Wu HL, Tan ZX. Triglyceride glucose-body mass index as a novel predictor of slow coronary flow phenomenon in patients with ischemia and nonobstructive coronary arteries (INOCA). BMC Cardiovasc Disord 2024; 24:60. [PMID: 38243161 PMCID: PMC10797862 DOI: 10.1186/s12872-024-03722-4] [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: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The triglyceride glucose-body mass index (TyG-BMI index) has been suggested as a novel predictor of insulin resistance. However, its predictive value for slow coronary flow phenomenon (SCFP) in patients with ischemia and nonobstructive coronary arteries (INOCA) remains unclear. METHODS We consecutively recruited 1625 patients with INOCA from February 2019 to February 2023 and divided them into two groups based on thrombolysis in myocardial infarction (TIMI) frame counts (TFCs): the SCFP group (n = 79) and the control group. A 1:2 age-matched case-control study was then performed. The TyG-BMI index was calculated as ln [plasma triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. RESULTS TyG-BMI index in the SCFP group (218.3 ± 25.2 vs 201.0 ± 26.5, P < .001) was significantly higher than in the normal controls. TyG-BMI index also increased with the number of coronary arteries involved in the SCFP. Multivariate logistic regression analysis showed that TyG-BMI, BMI, and TG were independent predictors for SCFP. Receiver operating characteristic (ROC) curve analysis showed that when the TyG-BMI index was above 206.7, the sensitivity and specificity were 88.6% and 68.5%, respectively, with an AUC of 0.809 (95% CI: 0.756-0.863, P = .027). Combined BMI with TG, the TyG-BMI index had a better predictive value for SCFP than BMI and TG (P < .001). CONCLUSION The TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.
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Affiliation(s)
- Zhi-Peng Li
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Juan Chen
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Qi Xin
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Xiao-Yang Pei
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Hong-Li Wu
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Zhi-Xu Tan
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China.
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Faramarzzadeh R, Fekrat F, Haghtalab A. Evaluation of the relationship between clinical and laboratory risk factors in atherosclerosis patients with coronary slow flow: a case-control analysis. Egypt Heart J 2023; 75:61. [PMID: 37439955 DOI: 10.1186/s43044-023-00388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/09/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is an angiographic entity distinguished by the delayed filling of the epicardial coronary arteries in the lack of significant obstructive artery disease. The pathological causes are still unknown. This study aimed to elucidate the relationship between clinical and laboratory-related risk factors in atherosclerosis patients diagnosed with CSF. RESULTS The research encompassed a study group of 142 individuals, with a mean age of 52.47 ± 10.62, and a male representation of 47.7%. A thorough statistical analysis was conducted, indicating that there were no noteworthy variations in age, gender, smoking history, hematocrit, blood sugar, and HDL levels between the groups of cases and controls (P > 0.05). Subsequent analysis of the data indicated that there were significant differences in history of hypertension, LDL, and BMI measurements between the groups of subjects who were designated as cases and those who were designated as controls. Our study revealed that male gender, a history of hypertension, and BMI were identified as independent predictors of CSF (P < 0.05). CONCLUSIONS After modeling regression, we were able to conclude that male gender, BMI, and history of hypertension are reliable predictors of slow coronary flow. These findings add to our growing understanding of the complex interplay between clinical and laboratory risk factors in the development and progression of CSF.
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Affiliation(s)
- Reza Faramarzzadeh
- Department of Cardiology, Ayatollah Taleghani Hospital, Kashani St., Urmia, 5715974677, West Azerbaijan, Iran
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran
| | - Farin Fekrat
- Department of Cardiology, Ayatollah Taleghani Hospital, Kashani St., Urmia, 5715974677, West Azerbaijan, Iran
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran
| | - Arian Haghtalab
- Department of Cardiology, Ayatollah Taleghani Hospital, Kashani St., Urmia, 5715974677, West Azerbaijan, Iran.
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran.
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Liao LP, Wu L, Yang Y. The relationship between triglyceride/high-density lipoprotein cholesterol ratio and coronary microvascular disease. BMC Cardiovasc Disord 2023; 23:228. [PMID: 37131145 PMCID: PMC10155446 DOI: 10.1186/s12872-023-03229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND As a novel marker of insulin resistance, the ratio of triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) has been recently reported to be related to the occurrence of coronary artery diseases. However, no research has been conducted to probe whether the TG/HDL-C ratio is associated with the occurrence of coronary microvascular disease (CMVD). AIM This study investigates the association between the TG/HDL-C ratio and the occurrence of CMVD. METHODS This study included 175 patients diagnosed with CMVD in the Department of Cardiology of our hospital from October 2017 to October 2021 as the study group and 175 patients with no chest pain, no history of cardiovascular disease and drug use, and negative results of exercise treadmill testing as the non-CMVD group. The clinical data of the two groups were compared. In addition, the risk factors of CMVD were analyzed with logistic regression, and the efficacy of independent risk factors in predicting CMVD was analyzed with a receiver operating characteristic (ROC) curve. RESULTS Compared with those in the non-CMVD group, the proportion of females, the incidence of hypertension and type 2 diabetes, the level of platelet count, TG, and C-reactive protein, and the ratio of TG/HDL-C were increased in the CMVD group, accompanied by decreased levels of albumin and HDL-C (P < 0.05). Logistic regression results revealed C-reactive protein (the area under the ROC curve [AUC] value: 0.754; 95% confidence interval [CI]: 0.681-0.827), sex (the AUC value: 0.651; 95%CI: 0.571-0.730), albumin (the AUC value: 0.722; 95%CI: 0.649-0.794), and TG/HDL-C ratio (the AUC value: 0.789; 95%CI: 0.718-0.859) as the independent risk factors of CMVD. CONCLUSION The TG/HDL-C ratio is an independent risk factor for the occurrence of CMVD.
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Affiliation(s)
- Li Ping Liao
- Cardiology Department, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 800 Huangjiahuayuan Road, Shanghai, 201803, China.
| | - Lei Wu
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China
| | - Yang Yang
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China
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Mareai RM, Mohammed AQ, Zhang H, Liu L, Zhang W, Mohammed AA, Yin G, Lv X, Xu Y, Abdu FA, Che W. Prognostic implication of coronary slow flow assessed by cTFC in patients with myocardial infarction with Non-obstructive coronary arteries. Eur J Intern Med 2023; 108:74-80. [PMID: 36464551 DOI: 10.1016/j.ejim.2022.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Coronary slow flow (CSF) is common and linked to worse cardiovascular events and life-threatening arrhythmias. However, the clinical implication of CSF among myocardial infarction with the non-obstructive coronary artery (MINOCA) has never been studied. We aimed to evaluate the impact of CSF on the MINOCA population. METHODS Patients diagnosed with MINOCA were consecutively selected. The corrected TIMI frame count (cTFC) was used to evaluate the coronary flow. CSF was defined as cTFC greater than 27 frames per second (FPS) in any of the three coronary arteries. Major adverse cardiovascular events (MACE) are the primary endpoint. Cox regression analysis was used to evaluate the association between CSF and MACE. RESULTS A total of 158 patients with MINOCA were enrolled, of which 54 (34.2%) patients had CSF. Forty incidents of MACE occurred during the median 28 months of follow-up. The MACE incidence was higher among patients who presented with CSF than the normal coronary flow patients (35.2% vs. 20.2%, p = 0.040). In the Kaplan-Meier analysis, CSF patients had significantly higher rates of MACE (log-rank P = 0.034). Multivariate Cox regression analysis showed that CSF was an independent predictor linked to an increased hazard of MACE (adjusted HR, 2.76; 95% CI, 1.34-5.67; P = 0.006). CONCLUSION The presence of CSF is associated with a higher risk of adverse events and is an independent predictor of clinical outcomes among patients with MINOCA. This result suggests that CSF might serve as a robust tool to stratify MINOCA patients.
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Affiliation(s)
- Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hengbin Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
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Dutta U, Sinha A, Demir OM, Ellis H, Rahman H, Perera D. Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries. J Am Heart Assoc 2022; 12:e027664. [PMID: 36565193 PMCID: PMC9973578 DOI: 10.1161/jaha.122.027664] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, adenosine-mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty-six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5±$$ \pm $$6.9 versus 20.2±$$ \pm $$6.9 cm/s; P=0.001 and 6.26±$$ \pm $$1.83 versus 5.36±$$ \pm $$1.83 mm Hg/cm/s; P=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%-0.50%] and 0.36 [95% CI, 0.23%-0.49%], respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.
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Affiliation(s)
- Utkarsh Dutta
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Aish Sinha
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Ozan M. Demir
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Howard Ellis
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Haseeb Rahman
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Divaka Perera
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
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The Systemic Immune-Inflammation Index May Predict the Coronary Slow Flow Better Than High-Sensitivity C-Reactive Protein in Patients Undergoing Elective Coronary Angiography. Cardiol Res Pract 2022; 2022:7344639. [PMID: 36407283 PMCID: PMC9668456 DOI: 10.1155/2022/7344639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/28/2022] [Indexed: 11/10/2022] Open
Abstract
Methods A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records. Results Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (p=0.022, OR 1.151, 95% CI 1.121–1.299), low-density lipoprotein (p=0.018, OR 1.028, 95% CI 1.005–1.052), hsCRP (p=0.044, OR 1.161, 95% CI 1.004–1.343), and SII (p < 0.001, OR 1.015, 95% CI 1.003–1.026) were independent predictors of CSF in the multivariable analysis. The optimal cutoff value of SII in predicting CSF was >877 in ROC curve analysis (p < 0.001, AUC = 0.892, 95% CI 0.848–0.936). This cutoff value of SII predicted the CSF with a sensitivity of 71.5% and specificity of 92.4%. Spearman correlation analysis showed a positive correlation between the mean TFC value and PLR, NLR, hsCRP, and SII. Conclusions SII may be used as a better indicator for the prediction of CSF than hsCRP.
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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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Zayat AE, Abdelaziz M, Yousry A, Ibrahim I. Evolution of Diastolic Dysfunction in Patients with Coronary Slow Flow Phenomenon and Acute Non-ST Segment Elevation Myocardial Infarction. J Cardiovasc Imaging 2021; 29:347-356. [PMID: 34080338 PMCID: PMC8592687 DOI: 10.4250/jcvi.2020.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diastolic function has been reported to be impaired in many patients with coronary slow flow phenomenon (CSFP). CSFP has broad spectrum of clinical presentations, including non-ST elevation myocardial infarction (NSTEMI). We sought to study the short-term evolution of diastolic function in CSFP patients presenting with NSTEMI. METHODS This study included 92 patients with CSFP and acute NSTEMI. Conventional echocardiography Doppler imaging and tissue Doppler echocardiography imaging were used to evaluate diastolic function during index NSTEMI and after 3 months. RESULTS Mean age of study patients was 45.7 ± 6.8 years. The prevalence of diastolic dysfunction (DD) at baseline was 69 patients (75%) and 28 patients (30.4%) at 3 months, p < 0.001. Various diastolic function indices showed significant improvement from baseline to 3 months follow-up. E/Em was 17.32 ± 3.41 at baseline compared to 12.41 ± 5.58 at 3 months, p = 0.039. Septal e' velocity was 5.67 ± 4.56 cm/s at baseline compared to 7.78 ± 3.22 cm/s at 3 months, p = 0.023. Medications used were not significantly different between those with improved versus unimproved DD. CONCLUSIONS Diastolic function seems to improve over short-term follow-up in patients with CSFP presenting with NSTEMI. This could reflect a transient worsening during acute NSTEMI.
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Affiliation(s)
- Ahmed El Zayat
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mahmoud Abdelaziz
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Yousry
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Ibrahim
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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10
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Erdal E, Ustaoğlu G, Karaş Z, Bilgin S. Investigation of patients with coronary slow flow in terms of periodontal health status. Rev Assoc Med Bras (1992) 2021; 67:561-565. [PMID: 34495061 DOI: 10.1590/1806-9282.20201043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the relationship between periodontal health status and coronary slow flow phenomenon. METHODS One hundred and two patients who underwent coronary angiography with the diagnosis of stable angina pectoris were included in the study. Patients were divided into two groups: patients with coronary slow flow (Test group) (n=51), and patients with normal coronary angiography (Control group) (n=51). Diagnosis of slow coronary flow was made according to Beltrame criteria by coronary angiography. Demographic characteristics of the participants were recorded. The periodontal health was assessed by clinical periodontal parameters such as probing depth, clinical attachment level, gingival index, plaque index, and bleeding on probing. RESULTS There were no significant differences between groups as regards the frequencies of hypertension, smoking (p>0.05). As for the periodontal parameters of the study groups, probing depth, gingival index, plaque index, bleeding on probing, and clinical attachment level values were statistically higher in the test group compared to the control group (p<0.05). CONCLUSIONS Periodontitis might be accepted as one of the underlying causes of coronary slow flow. Patients with coronary slow flow should be evaluated for an underlying periodontal disease, and treatment of periodontal disease can protect against future cardiovascular events.
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Affiliation(s)
- Emrah Erdal
- Bolu Abant Izzet Baysal University, Medical Faculty, Department of Cardiology - Bolu, Turkey
| | - Gülbahar Ustaoğlu
- Bolu Abant Izzet Baysal University, Dentistry Faculty, Department of Periodontology - Bolu, Turkey
| | - Zeynep Karaş
- Bolu Abant Izzet Baysal University, Dentistry Faculty, Department of Periodontology - Bolu, Turkey
| | - Satılmış Bilgin
- Bolu Abant Izzet Baysal University, Medical Faculty, Department of Internal Medicine - Bolu, Turkey
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Incremental Value of Three-dimensional Speckle-tracking Echocardiography for Evaluating Left Ventricular Systolic Function in Patients with Coronary Slow Flow. Curr Probl Cardiol 2021; 47:100928. [PMID: 34353632 DOI: 10.1016/j.cpcardiol.2021.100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
The purpose was to evaluate left ventricular (LV) systolic function in patients with coronary slow flow (CSF), and compared the incremental values of 3-dimensional (3D) speckle-tracking echocardiography (STE). Seventy-three patients with CSF and 60 control subjects were enrolled. CSF was diagnosed during coronary angiography. Two-dimensional (2D) and 3D global strain were measured using STE. Sex, mitral E, 2D GLS, and all 3D strain parameters were independent predictors of CSF. Combination of sex, mitral E, and 3D GTS had the highest area under the curve (AUC) for identifying CSF (AUC, 0.81; P < 0.001). Integrated discrimination index (IDI) improved adding 3D GTS to the combined sex and mitral E model (IDI = 0.12, P = 0.01) or 2D GLS model (IDI = 0.14, P < 0.001). LV systolic function was impaired in CSF patients. 3D GTS had an independent and incremental value for predicting CSF compared with 2D echocardiography.
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12
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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: 33] [Impact Index Per Article: 11.0] [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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Relationship between frontal QRS-T angle and coronary slow flow phenomenon. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.754698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rouzbahani M, Farajolahi S, Montazeri N, Janjani P, Salehi N, Rai A, Heidari Moghadam R, Naderipour A, Kanjorpor A, Javadirad E, Azimivghar J. Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province. J Cardiovasc Thorac Res 2021; 13:37-42. [PMID: 33815700 PMCID: PMC8007890 DOI: 10.34172/jcvtr.2021.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction: This study was conducted to investigate prevalence and predictors of slow coronary flow phenomenon (SCF) phenomenon. Methods: This cross-sectional study was performed at Imam Ali Cardiovascular Hospital affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah province, Iran. From March 2017 to March 2019, all the patients who underwent coronary angiography were enrolled in this study. Data were obtained using a checklist developed based on the study's aims. Independent samples t tests and chi- square test (or Fisher exact test) were used to assess the differences between subgroups. Multiple logistic regression model was applied to evaluate independent predictors of SCF phenomenon. Results: In this study, 172 (1.43%) patients with SCF phenomenon were identified. Patients with SCF were more likely to be obese (27.58±3.28 vs. 24.12±3.26, P <0.001), hyperlipidemic (44.2 vs. 31.7, P <0.001), hypertensive (53.5 vs. 39.1, P <0.001), and smoker (37.2 vs. 27.2, P =0.006). Mean ejection fraction (EF) (51.91±6.33 vs. 55.15±9.64, P <0.001) was significantly lower in the patients with SCF compared to the healthy controls with normal epicardial coronary arteries. Mean level of serum triglycerides (162.26±45.94 vs. 145.29±35.62, P <0.001) was significantly higher in the patients with SCF. Left anterior descending artery was the most common involved coronary artery (n = 159, 92.4%), followed by left circumflex artery (n = 50, 29.1%) and right coronary artery (n = 47, 27.4%). Body mass index (BMI) (OR 1.78, 95% CI 1.04-2.15, P <0.001) and hypertension (OR 1.59, CI 1.30-5.67, P =0.003) were independent predictors of SCF phenomenon. Conclusion: The prevalence of SCF in our study was not different from the most other previous reports. BMI and hypertension independently predicted the presence of SCF phenomenon.
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Affiliation(s)
- Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Farajolahi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nafiseh Montazeri
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Rai
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Heidari Moghadam
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arsalan Naderipour
- Department of Emergency Medicine, School of Paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asal Kanjorpor
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Etrat Javadirad
- Clinical Research Development Center of Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Azimivghar
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Prognosis of patients with previous myocardial infarction, coronary slow flow, and normal coronary angiogram. Herz 2020; 45:88-94. [DOI: 10.1007/s00059-019-4817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/03/2019] [Accepted: 05/02/2019] [Indexed: 11/27/2022]
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Akkaya H, Güntürk EE. The relationship between coronary slow flow phenomenon and carotid femoral pulse wave velocity and aortic elastic properties. JRSM Cardiovasc Dis 2020; 9:2048004020973094. [PMID: 33240493 PMCID: PMC7672767 DOI: 10.1177/2048004020973094] [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] [Received: 09/22/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction In this study, we aimed to investigate the relationship between coronary slow flow (CSF) and carotid-femoral pulse wave velocity (CFPWV). Methods 78 (27 women, mean age 43.95 ± 7.28) patients with CSF, and 70 (22 women, mean age 44.34 ± 7.08) healthy individuals were included in the study. Arterial stiffness measurement was performed to both groups via CFPWV, which is considered the gold standard. Aortic elastic properties (ASI-β and aortic distensibility) were evaluated in both groups. Results The CSF group had significantly higher CFPWV and aortic distensibility values and significantly lower ASI-β values compared to the control group. There was a positive correlation between TIMI frame count (TFC) obtained in all coronary arteries and CFPWV and aortic distensibility, and a negative correlation between TFC and ASI-β. It was determined that CFPWV predicted CSF with 97% specificity and 98% sensitivity at a 7.68 cut-off value (ROC area = 994, p < 0.001). ASI-β was determined to predict CSF with 64% specificity and 47% sensitivity at a 2.98 cut-off value (ROC area = 047, p < 0.001). Aortic distensibility was determined to predict CSF with 76% specificity and 79% sensitivity at a 3.94 cut-off value (ROC area = 706, p < 0.001). Conclusion Arterial stiffness increases in CSF patients, suggesting that CSF is a systemic pathology rather than a local disease and that a systemic cause such as atherosclerosis plays a role in etiology.
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Affiliation(s)
- Hasan Akkaya
- Cardiology Department, Niğde Ömer Halisdemir University Medicine Faculty Education and Research Hospital, Niğde, Turkey
| | - Ertuğrul Emre Güntürk
- Cardiology Department, Niğde Ömer Halisdemir University Medicine Faculty Education and Research Hospital, Niğde, Turkey
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Genc Tapar G, Elcik D, Dogan A, Altunel E, Inanc MT, Alcali B, Boylug S, Oguzhan A, Topsakal R, Ergin A, Kalay N. An investigation of the relationship between arterial aortic stiffness and coronary slow flow that was detected during coronary angiography. Echocardiography 2020; 37:528-535. [DOI: 10.1111/echo.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Deniz Elcik
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | - Ali Dogan
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | - Ebru Altunel
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | | | - Bilal Alcali
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | - Sibel Boylug
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | | | - Ramazan Topsakal
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | - Ali Ergin
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
| | - Nihat Kalay
- Department of Cardiology Erciyes University Medicine Faculty Kayseri Turkey
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Zhao J, Zhang Y, Huang Z, Wu F, Li N, Liang C. Association between impaired cutaneous microvascular endothelial function and lectin-like oxidized low-density lipoprotein receptor-1 in patients with coronary slow flow. Microvasc Res 2020; 129:103984. [PMID: 31954703 DOI: 10.1016/j.mvr.2020.103984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although increasing studies indicate coronary slow flow (CSF) is a systemic microvascular disorder, whether there is impaired cutaneous microvascular endothelial function in CSF patients remains unclear. This study was designed to test the hypothesis that the cutaneous microvascular endothelial function of CSF patients is impaired and correlates with lectin-like oxidized low-density lipoprotein receptor-1(LOX-1). METHODS 39 patients with CSF and 45 controls with normal coronary flow were enrolled. Velocity of coronary flow was quantitatively identified by thrombolysis in myocardial infarction frame count (TFC) method. LSCI system was used to assess subjects' cutaneous blood flow at rest and during PORH. Serum soluble LOX-1(sLOX-1) level was measured in all study subjects. RESULTS PORH-induced vasodilation was significantly reduced in CSF group in comparison with control group (0.26 ± 0.10 vs 0.35 ± 0.07 APU/mmHg, P < 0.001) and negatively correlated with the mean TFC for three coronary arteries (r = -0.385, P = 0.016). Serum sLOX-1 level in CSF group was significantly increased (582.93 ± 74.89 vs 483.64 ± 51.38 pg/ml, P < 0.001) and positively correlated with mean TFC(r = 0.467, P = 0.003).PORH response amplitudes had a significantly negative relationship with serum sLOX-1 level in CSF patients (r = -0.588, P < 0.001). CONCLUSION These data suggest that cutaneous microvascular endothelial function is impaired in patients with CSF, which is closely associated with increased LOX-1 expression.
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Affiliation(s)
- Jian Zhao
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanda Zhang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhigang Huang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Wu
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Na Li
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Chun Liang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Suspected Brugada Phenocopy Secondary to Coronary Slow Flow. Case Rep Cardiol 2019; 2019:9027029. [PMID: 31885934 PMCID: PMC6925924 DOI: 10.1155/2019/9027029] [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: 10/29/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
Abstract
Brugada syndrome (BrS) is a genetic condition that accentuates the risk of potentially lethal ventricular arrhythmias and sudden cardiac death (SCD) in a structurally normal heart. The Brugada electrocardiographic pattern may manifest separately from the syndrome—this clinical scenario has been described as Brugada phenocopy (BrP). Many etiologies of BrP have been reported, but it has not yet been reported as a result of coronary slow flow (CSF) phenomenon. This case report highlights a suspected coronary slow flow-associated Brugada type 1 electrocardiographic pattern, which subsequently normalized following the institution of guideline-directed medical therapy for acute coronary syndrome.
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Dong R, Lv Q, Gao Y, He C, Tan S, Zhang M, Zhou T. Carotid artery blood velocity decreases in patients with coronary slow flow: A manifestation of systemic arteriosclerosis. Echocardiography 2019; 36:2234-2240. [PMID: 31755583 DOI: 10.1111/echo.14540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Coronary slow flow phenomenon (CSFP) could be a manifestation of systemic arteriosclerosis, as coronary and carotid arteries have similar intimal thickening. However, as an initial cause of arteriosclerosis, hemodynamic changes in carotid arteries have rarely been studied. METHODS Twenty patients with angiography-proven CSFP and 39 patients with normal coronary flow (NCF) were enrolled. TIMI frame counts (CTFC) were investigated. Carotid intima-media thickness (CIMT), peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured by ultrasonography, and shear rate (SR) and resistance index (RI) were calculated. RESULTS The results showed that PSV, EDV, SR, and RI were significantly lower in patients with CSFP (p<0.01), but CIMT was significantly increased (P < 0.01). PSV, EDV, SR, and RI were negatively correlated with CTFC, while CIMT was positively correlated with CTFC. Logistic regression analysis revealed that PSV (OR = 0.95, P < 0.01) could be an independent protective factor against CSFP, but CIMT (OR = 1.10, P < 0.05) and male gender (OR = 9.89, P < 0.01) could be risk factors for CSFP. CONCLUSIONS The slow flow phenomenon was observed in both coronary and carotid arteries, which could be a characteristic manifestation of systemic arteriosclerosis in CSFP; the lower wall shear stress may be the underlying mechanism. Carotid ultrasound could be applied in the noninvasive diagnosis of CSFP in the future.
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Affiliation(s)
- Rui Dong
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qian Lv
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yannan Gao
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Caiyun He
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Siyuan Tan
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Mingyu Zhang
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Tao Zhou
- Department of Cardiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Li N, Tian L, Ren J, Li Y, Liu Y. Evaluation of homocysteine in the diagnosis and prognosis of coronary slow flow syndrome. Biomark Med 2019; 13:1439-1446. [PMID: 31617742 DOI: 10.2217/bmm-2018-0446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To identify the exact molecular markers related to coronary slow flow syndrome (CSFS) and its prognosis. Patients & methods: Data from 54 patients with CSFS diagnosed by coronary angiography and 101 normal control patients were collected and analyzed. Results: Logistic regression analysis confirmed that homocysteine (Hcy; odds ratio: 1.107; 95% CI: 1.018-1.205; p = 0.018) was associated with CSFS. Receiver-operating characteristic curve analysis identified an Hcy value of 17.1 μmol/l as an effective cut-off point for predicting CSFS. Cox survival analysis showed a relationship between high admission Hcy level (odds ratio: 1.19; 95% CI = 1.05-1.34; p = 0.005) and recurrent angina. Conclusion: Our results showed positive correlations of Hcy with CSFS and cardiac events.
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Affiliation(s)
- Nan Li
- Cardiac Department, PLA General Hospital, Beijing 100853, PR China.,Cardiac Department, Teda International Cardiovascular Hospital, Tianjin 300457, PR China
| | - Liuyang Tian
- Cardiac Department, PLA General Hospital, Beijing 100853, PR China.,Cardiac Department, Tianjin People's Hospital, Tianjin 300121, PR China
| | - Jiefeng Ren
- Cardiac Department, PLA General Hospital, Beijing 100853, PR China
| | - Yang Li
- Cardiac Department, PLA General Hospital, Beijing 100853, PR China
| | - Yuqi Liu
- Cardiac Department, PLA General Hospital, Beijing 100853, PR China.,Department of Cardiology & National Clinical Research Center of Geriatrics Disease, Chinese PLA General Hospital, Beijing 100853, PR China.,Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Cardiac department, Chinese PLA General Hospital, Beijing 100853, PR China.,National Key Laboratory of Kidney Diseases, Cardiac department, Chinese PLA General Hospital, Beijing 100853, PR China
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Abstract
OBJECTIVE The pathophysiology of coronary slow flow (CSF) has not been clarified. Salusin-β is released predominantly from the atheroma plaques and influences the pathophysiologic processes of atherosclerosis. Therefore, this study aimed to determine serum salusin-β levels in CSF and its correlation with CSF. METHODS The study included 39 patients with CSF, and the control group (n=42) consisted of consecutive subjects with normal coronary arteriogram. We measured salusin-β and thrombolysis in myocardial infarction frame count (TFC). RESULTS Age, body mass index (BMI), systolic blood pressure, diabetes, hyperlipidemia, and smoking rates were similar (p values>0.05) in both groups. High sensitive C-reactive protein (2.80±1.2 vs. 2.21±1.2 mg/dL, p=0.011), salusin-β [1205 (330-2092) vs. 162 (29-676), pg/ml, p<0.001], corrected TFC of left anterior descending coronary artery (29±9 vs. 19.7±3.7, p<0.001), circumflex artery TFC (25±10 vs. 15±3.2, p<0.001), right coronary artery TFC (28±7.1 vs. 13±3.3, p<0.001), and mean TFC (28±4.4 vs. 16±3.7, p<0.001) were significantly higher in the CSF group. In univariate and multivariate regression analysis, only BMI (unstandardized β±SE=0.178±0.08, p=0.036) and salusin-β levels (unstandardized β±SE=0.006±0.01, p<0.001) were determined as predictors of CSF. There was a good correlation between serum salusin-β and mean TFC values (r=0.564; p<0.001). CONCLUSION There is an association between serum salusin-β levels and CSF.
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Assessment of the relationship between coronary flow rates and myocardial perfusion abnormality in patients with nonobstructive coronary artery disease: an observational study in cardiac syndrome X and coronary slow flow. Nucl Med Commun 2019; 40:1122-1129. [PMID: 31568270 DOI: 10.1097/mnm.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study, we evaluated and compared the level of myocardial ischaemia caused by cardiac syndrome X (CSX) and coronary slow flow (CSF) with single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), and determined if changes in the level of myocardial ischaemia exist in CSF and CSX cases according to thrombolysis in myocardial infarction frame count (TFC). MATERIALS AND METHODS The study population consisted of 66 patients with CSF and 78 angiographically normal patients (36 of them with CSX and 42 of them healthy controls). The coronary flow rates of all patients were documented using TFC. Subsequently, all patients were evaluated with SPECT-MPI and categorized into the following groups according to their results: patients with CSF, patients with CSX, and patients with normal coronary arteries. Finally, we investigated whether a relationship existed between the SPECT-MPI and TFC results from these three groups. RESULTS All ischaemia scores for MPI were significantly higher in the CSF group than in the CSX and control groups (P < 0.05). TFC was significantly associated with the severity of ischaemia in the CSF patients. There was a significant positive correlation between the summon difference score (SDS) and mean TFC value (P < 0.05) as well as between the SDS and each individual coronary TFC value in the CSF patients (P < 0.05). The number of vessels involved in CSF was positively correlated with the SDS. CONCLUSION CSF is associated with more severe myocardial ischaemia than CSX. The level of myocardial ischaemia on SPECT-MPI was correlated with the TFC and the number of affected coronary vessels in patients with CSF. These results suggest that CSF is a more serious clinical entity than CSX, and that the clinical severity of CSF appears to increase as the coronary flow rate decreases.
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Demirci E, Çelik O, Kalçık M, Bekar L, Yetim M, Doğan T. Evaluation of homocystein and asymmetric dimethyl arginine levels in patients with coronary slow flow phenomenon. Interv Med Appl Sci 2019; 11:89-94. [PMID: 32148911 PMCID: PMC7044542 DOI: 10.1556/1646.11.2019.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have demonstrated that homocysteine and asymmetric dimethyl arginine (ADMA) levels were strongly associated with cardiovascular diseases including coronary artery disease. The aim of this study was to investigate the role of plasma homocysteine and ADMA levels in the pathogenesis of coronary slow flow (CSF) phenomenon. Methods Twenty-three patients with CSF and 25 controls with normal coronary flow were included in this study. The quantitative measurement of coronary blood flow was performed using the thrombolysis in myocardial infarction frame count method. Plasma homocysteine and ADMA levels were determined using enzymatic assays from venous blood samples. Results The patients with CSF had significantly higher plasma homocysteine levels than controls (16.2 ± 7.6 vs. 12.2 ± 2.2 μM/L; p = 0.023). The uric acid levels were significantly higher in CSF group than controls (5.4 ± 1.1 vs. 4.6 ± 0.9 mg/dl; p = 0.011). Plasma ADMA levels were also higher in the CSF group; however, this was not statistically significant (0.6 ± 0.1 vs. 0.5 ± 0.2 μM/L; p = 0.475). Conclusions Increased homocysteine and uric acid levels may play an important role in the pathogenesis of CSF. Further large scale studies are required to determine the relationship between ADMA levels and CSF.
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Affiliation(s)
- Erkan Demirci
- Department of Cardiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Kurtul A, Ornek E. Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review. Angiology 2019; 70:802-818. [PMID: 31030530 DOI: 10.1177/0003319719845186] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The platelet to lymphocyte ratio (PLR) is an integrated reflection of 2 opposite thrombotic/inflammatory pathways that are easily calculated from a complete blood count. The PLR initially served as a systemic inflammatory biomarker to predict the prognosis of neoplastic diseases. In recent years, the PLR has been used as a prognostic marker in cardiovascular (CV) conditions. In this review, we consider the evidence regarding the association of the PLR with CV disease (CVD) and its possible use as a prognostic marker of CVD. The role of PLR has been investigated in CV conditions in several studies. We assessed clinical trials using PubMed, EMBASE, and Web of Science (up to April 18, 2018) to evaluate the association between PLR and mortality/major adverse cardiac events in these conditions. Most of these studies reported significant relationships between a high PLR and diverse outcomes. In conclusion, we suggest that PLR is a cheap and easily available systemic inflammatory marker that can predict distinct outcomes in different types of CVD.
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Affiliation(s)
- Alparslan Kurtul
- 1 Cardiology Department, Tayfur Ata Sokmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Antakya, Turkey
| | - Ender Ornek
- 2 Cardiology Department, Ankara Numune Education and Research Hospital, Health Sciences University, Ankara, Turkey
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Circulating miRNA-155 as a Potential Biomarker for Coronary Slow Flow. DISEASE MARKERS 2018; 2018:6345284. [PMID: 30046360 PMCID: PMC6036848 DOI: 10.1155/2018/6345284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023]
Abstract
Objective Recent studies have demonstrated that miRNA-155 is involved in the occurrence and development of atherosclerosis. Furthermore, miRNA-155 has emerged as a new indirect marker for inflammation associated with adverse outcomes in oncology and cardiovascular diseases. This study investigated the correlation between the levels of miRNA-155 and coronary slow flow (CSF). Methods A total of 66 patients with CSF and 66 patients with normal coronary flow were enrolled in this study. Coronary flow velocity was determined using the thrombolysis in myocardial infarction frame count (TFC) method. The plasma levels of miRNA-155 were quantified using real-time quantitative polymerase chain reaction. Results The plasma levels of miRNA-155 were significantly higher in the CSF group compared to the control group (P < 0.05). In addition, miRNA-155 levels were positively correlated with TFC and high-sensitivity C-reactive protein (hs-CRP) levels (P < 0.05 for both parameters). Multivariate linear regression analysis demonstrated that plasma miRNA-155 (OR = 2.384, 95% confidence interval 1.847–3.273, P = 0.032) and hs-CRP (OR = 1.273, 95% confidence interval 1.036–2.253, P = 0.013) were independent predictors for CSF. Using plasma miRNA-155 levels as the test variable, ROC curve analysis indicated that the area under the curve was 0.782 (P < 0.05). Conclusion Patients with CSF have higher plasma levels of miRNA-155, and this may play an important role in the pathogenesis of CSF, and an elevated plasma miRNA-155 level may be a predictor for CSF. A large-scale and multicenter study is required to elucidate the role of miRNA-155 as a potential biomarker for patients with CSF.
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Sanghvi S, Mathur R, Baroopal A, Kumar A. Clinical, demographic, risk factor and angiographic profile of coronary slow flow phenomenon: A single centre experience. Indian Heart J 2018; 70 Suppl 3:S290-S294. [PMID: 30595277 PMCID: PMC6310702 DOI: 10.1016/j.ihj.2018.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 11/27/2022] Open
Abstract
Background The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary stenosis. Although it is well-known to interventional cardiologists for approximately four decades, the etiopathogenesis still remains unclear. Aims and objectives In this study, we aimed to determine the clinical, demographic, risk factor and angiographic profile of patients with CSFP. Methods Clinical, demographic, risk factor and angiographic profile were recorded in all consecutive patients who had undergone coronary angiography between September 2016 and March 2017 and showed features of CSFP and a control group who showed normal coronary flow (NCF). The CSFP was diagnosed on the basis of the corrected thrombolysis in myocardial infarction frame count. Results CSFP was significantly more prevalent in male patients. Among the traditional risk factors, there was significantly more prevalence of hypertension (31.25% versus 6.67%, p < 0.001), dyslipidemia (40% versus 7.5%, p < 0.001) and history of tobacco use (47.5% versus 10.0%, p < 0.001) in CSFP patients as compared to NCF patients. On multivariable regression analysis hypertension, dyslipidemia, history of smoking and tobacco chewing were found to have independent association with CSFP. Acute coronary syndrome (ACS) was the most common mode of presentation in CSFP patients. Conclusion CSFP was relatively common among patients who presented with ACS. Hypertension, dyslipidemia, smoking and tobacco chewing can be considered independent risk factors for this phenomenon. Therefore, CSFP should be considered as a pathological entity and not an entirely benign condition.
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Affiliation(s)
- Sanjeev Sanghvi
- Department of Cardiology, DR. S.N. Medical College, Jodhpur, India
| | - Rohit Mathur
- Department of Cardiology, DR. S.N. Medical College, Jodhpur, India
| | - Anil Baroopal
- Department of Cardiology, DR. S.N. Medical College, Jodhpur, India.
| | - Aditya Kumar
- Department of Cardiology, DR. S.N. Medical College, Jodhpur, India
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Jin Z, Tan Q, Sun B. Telmisartan ameliorates vascular endothelial dysfunction in coronary slow flow phenomenon (CSFP). Cell Biochem Funct 2018; 36:18-26. [PMID: 29314204 DOI: 10.1002/cbf.3313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Zhe Jin
- State Key Laboratory of Biomembrane and Membrane Biotechnology, School of Medicine, Tsinghua University, Beijing, China
| | - Qindong Tan
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bei Sun
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Şatıroğlu Ö, Durakoğlugil ME, Çetin M, Çiçek Y, Erdoğan T, Duman H. The role of urotensin II and atherosclerotic risk factors in patients with slow coronary flow. Interv Med Appl Sci 2016; 8:158-163. [PMID: 28180005 PMCID: PMC5283774 DOI: 10.1556/1646.8.2016.4.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/07/2016] [Accepted: 09/20/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Slow coronary flow (SCF) is an angiographic finding characterized with delayed opacification of epicardial coronary arteries without obstructive coronary disease. Urotensin II (UII) is an important vascular peptide, which has an important role in hypertension, coronary artery disease, and vascular remodeling in addition to potent vasoconstrictor effect. OBJECTIVES We investigated UII levels, hypertension, and other atherosclerotic risk factors in patients with SCF, a variety of coronary artery disease. METHODS We enrolled 14 patients with SCF and 29 subjects with normal coronary arteries without SCF. We compared the UII levels and the atherosclerotic risk factors between patients with SCF and control subjects with normal coronary flow. RESULTS UII concentrations were significantly higher in patients with SCF compared to controls (711.0 ± 19.4 vs. 701.5 ± 27.2 ng/mL, p = 0.006). We detected a positive correlation between SCF and age (r = 0.476, p = 0.001), BMI (r = 0.404, p = .002), UII concentrations (r = 0.422, p = 0.006), and hypertension (r = 0.594, p = 0.001). CONCLUSION We identified increased UII levels in patients with SCF. We think that UII concentrations may be informative on SCF pathogenesis due to relationship with inflammation, atherosclerosis, and vascular remodeling.
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Affiliation(s)
- Ömer Şatıroğlu
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Yüksel Çiçek
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Turan Erdoğan
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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Turkmen M, Barutcu I, Esen AM, Karakaya O, Esen O, Basaran Y. Effect of Slow Coronary Flow on P-Wave Duration and Dispersion. Angiology 2016; 58:408-12. [PMID: 17652223 DOI: 10.1177/0003319707304944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The slow coronary flow (SCF) phenomenon is often considered to be an incidental angiographic finding; however, several reports have shown it to be associated with cardiac events. In this study we aimed to assess P-wave duration and dispersion (PWD) in patients with SCF and to compare it with that of healthy subjects. Thus, 40 patients with angiographically proven SCF and otherwise normal coronary arteries (group 1) and 36 sex-age-matched healthy subjects (group 2) were included in this study. A 12-lead surface ECG, recorded at a paper speed of 50-mm/s and 2 mV/cm standardization, was obtained from each subject. P-wave duration was measured manually by use of a caliper. The difference between the maximum (Pmax) and minimum P (Pmin)-wave duration was calculated and defined as PWD. All subjects had undergone echocardiographic examination to exclude valvular disorders and wall motion abnormalities. There was no significant difference between the 2 groups in demographies of age, sex, heart rate, or blood pressure. Maximum P-wave duration and PWD were significantly higher in group 1 than in group 2 (120 ±7 vs 115 ±5, p = 0.003; 44 ±12 vs 38 ±9, p = 0.01, respectively). However, there was no significant difference in Pmin duration (75 ±9 vs 78 ±7, p = 0.4). In conclusion; SCF and otherwise normal epicardial coronary artery was found to be associated with prolonged P-wave duration and increased PWD. This may result from microvascular ischemia and/or altered autonomic control of cardiovascular system observed in this group of patients.
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Affiliation(s)
- Muhsin Turkmen
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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31
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Yazici M, Demircan S, Durna K, Sahin M. The Role of Adrenergic Activity in Slow Coronary Flow and Its Relationship to TIMI Frame Count. Angiology 2016; 58:393-400. [PMID: 17652227 DOI: 10.1177/0003319707305118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to investigate the role of adrenergic activity in patients with slow coronary flow (SCF) and its relationship to TIMI frame count on the pathogenesis of SCF. Plasma noradrenalin and adrenalin concentrations at rest were compared in 51 patients diagnosed with SCF through coronary angiography and TIMI frame count; and 44 healthy controls with normal coronary flow (NCF). Furthermore, the relationship between TIMI frame count and noradrenalin and adrenalin levels was investigated. Plasma noradrenalin (127.9 ±9.2 and 79.3 ± 7.3 ng/mL, p < 0.0001) and adrenalin levels (63.9 ± 2.6 and 44.7 ± 2.8 ng/mL, p < 0.0001) were higher in patients with SCF when compared to patients with NCF. Noradrenalin and adrenalin levels were effected with SCF-dominant vessels with respect to TIMI frame count (p = 0.012 and p < 0.0001). Patients with SCF in 1, 2, or 3 vessels had different noradrenalin and adrenalin levels (p <0.003 and p < 0.0001). Patients with TIMI frame count above the 75th percentile had significantly higher noradrenalin and adrenalin levels when compared with those between the 25th—50th percentiles and below (p < 0.001 and p = 0.011, respectively). Correlation analysis established that both adrenalin and noradrenalin levels were correlated with TIMI frame counts of left anterior descending (LAD) and circumflex (Cx) arteries. Exercise testing revealed ischemia in 6 patients. Their TIMI frame counts were above the 75th percentile, and they had higher noradrenalin and adrenalin levels when compared with those without ischemia (p = 0.029, p = 0.045). Higher noradrenalin and adrenalin levels and correlation between TIMI frame count and ischemia in patients with SCF suggest that increased adrenergic activity may be the manifestation of slow coronary flow.
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Affiliation(s)
- Mustafa Yazici
- Ondokuz Mayis University, Medical School, Department of Cardiology, Samsun, Turkey.
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Caliskan Z, Keles N, Gokturk HS, Ozdil K, Aksu F, Ozturk O, Kahraman R, Kostek O, Tekin AS, Ozgur GT, Caliskan M. Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation? Int J Cardiol 2016; 223:176-181. [PMID: 27541650 DOI: 10.1016/j.ijcard.2016.08.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. METHODS 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. RESULTS CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p<0.001]. CFR is negatively correlated with disease activity scores of IBD. CONCLUSION This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.
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Affiliation(s)
- Zuhal Caliskan
- Baskent University Department of Gastroenterology, Konya, Turkey
| | - Nursen Keles
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | | | - Kamil Ozdil
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Feyza Aksu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Oguzhan Ozturk
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Resul Kahraman
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Osman Kostek
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Ahmet S Tekin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Mustafa Caliskan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Sarapultsev PA, Sarapultsev AP. Stress cardiomyopathy: Is it limited to Takotsubo syndrome? Problems of definition. Int J Cardiol 2016; 221:698-718. [PMID: 27424315 DOI: 10.1016/j.ijcard.2016.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/04/2016] [Indexed: 02/09/2023]
Abstract
In 2006, Takotsubo syndrome (TTC) was described as a distinct type of stress-induced cardiomyopathy (stress cardiomyopathy). However, when thinking about Takotsubo cardiomyopathy from the viewpoints of the AHA and ESC classifications, 2 possible problems may arise. The first potential problem is that a forecast of disease outcome is lacking in the ESC classification, whereas the AHA only states that 'outcome is favorable with appropriate medical therapy'. However, based on the literature data, one can make a general conclusion that occurrence of myocardial lesions in TTC (i.e., myocardial fibrosis and contraction-band necrosis) causes the same effects as in other diseases with similar levels of myocardial damage and should not be considered to have a lesser impact on mortality. To summarise, TTC can cause not only severe complications such as pulmonary oedema, cardiogenic shock, and dangerous ventricular arrhythmias, but also damage to the myocardium, which can result in the development of potentially fatal conditions even after the disappearance of LV apical ballooning. The second potential problem arises from the definition of TTC as a stress cardiomyopathy in the AHA classification. In fact, the main factors leading to TTC are stress and microvascular anginas, since, as has been already discussed, coronary spasm can cause myocardium stunning, resulting in persistent apical ballooning. Thus, based on this review, 3 distinct types of stress cardiomyopathies exist (variant angina, microvascular angina, and TTC), with poor prognosis. Adding these diseases to the classification of cardiomyopathies will facilitate diagnosis and preventive prolonged treatment, which should include intensive anti-stress therapy.
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Affiliation(s)
- Petr A Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia
| | - Alexey P Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia.
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Wang T, Dong AH, Cao HY. Serum Salusin-β Levels Are Correlated with Slow Coronary Flow. Genet Test Mol Biomarkers 2016; 20:393-7. [PMID: 27227272 DOI: 10.1089/gtmb.2015.0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT Slow coronary flow (SCF) is a special coronary microvascular disorder associated with recurrent chest pain. The pathogenesis of SCF remain unclear. OBJECTIVES We sought to assess whether serum salusin-β levels are correlated with SCF. METHODS We enrolled 76 patients with angiographically confirmed SCF and 108 age- and gender-matched controls. We measured serum salusin-β levels by enzyme-linked immunosorbent assay and coronary flow rate was assessed using thrombolysis in myocardial infarction frame count (TFC). RESULTS Serum salusin-β levels were elevated in SCF patients compared with controls (4.33 [range 3.52-5.87] nmol/L vs. 3.76 [range 2.98-4.67] nmol/L). Multivariate logistic regression analysis revealed that salusin-β in serum was the independent predictor of SCF (odds ratio = 1.814). Serum salusin-β levels were independently correlated with mean-TFC (r = 0.355, p = 0.002). CONCLUSIONS Serum salusin-β levels were independently associated with SCF. Therefore, our findings implicate a potential role of salusin-β in the pathophysiology of SCF and provide insights on both risk stratification and modification in this patient population.
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Affiliation(s)
- Tao Wang
- 1 Department of Cardiology, Shandong Jiaotong Hospital , Jinan, China
| | - Ai-Hua Dong
- 2 Department of Cardiology, People's Hospital of Linzi District , Zibo, China
| | - Hong-Yun Cao
- 3 Department of Clinical Microbiology, People's Hospital of Linzi District , Zibo, China
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Yayla Ç, Akboğa MK, Gayretli Yayla K, Ertem AG, Efe TH, Şen F, Ünal S, Açar B, Özcan F, Turak O, Özeke Ö. A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio. Biomark Med 2016; 10:485-93. [PMID: 27089433 DOI: 10.2217/bmm-2016-0022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Recently, lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation which is associated with adverse outcomes in oncology and cardiovascular diseases. The aim of the study was to evaluate the relationship between LMR and slow coronary flow (SCF). PATIENTS & METHODS A total of 100 consecutive patients with SCF and 100 consecutive patients with normal coronary flow were enrolled in this study. RESULTS LMR was significantly lower in patients with SCF than in patients with normal coronary flow (p < 0.001). Also, LMR was negatively correlated with neutrophil-to-lymphocyte ratio and CRP levels (p < 0.001 and p = 0.005). LMR was found to be significantly and independently associated with SCF (p = 0.033). CONCLUSION LMR was negatively correlated with serum C-reactive protein and neutrophil-to-lymphocyte ratio levels.
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Affiliation(s)
- Çağrı Yayla
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboğa
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Dışkapı Yıldırım Beyazıt Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Göktuğ Ertem
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Tolga Han Efe
- Dışkapı Yıldırım Beyazıt Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fatih Şen
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sefa Ünal
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Burak Açar
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fırat Özcan
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Osman Turak
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Özcan Özeke
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
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Narimani S, Hosseinsabet A, Pourhosseini H. Effect of Coronary Slow Flow on the Longitudinal Left Ventricular Function Assessed by 2-Dimensional Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:723-729. [PMID: 26939598 DOI: 10.7863/ultra.15.05075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The coronary slow flow phenomenon is defined as the slow progression of an angiographic contrast agent to the distal part of the coronary arteries on selective coronary angiography in the absence of stenosis. There are some studies with different results about the effect of this phenomenon on left ventricular (LV) function. The aim of our study was to evaluate the longitudinal LV function in the coronary slow flow phenomenon using 2-dimensional (2D) speckle-tracking echocardiography. METHODS In a study with a patient-to-patient matched design, 36 patients with the coronary slow flow phenomenon and 36 individuals with normal coronary flow matched for age (±5 years), sex, hypertension, and diabetes mellitus were compared in terms of the longitudinal LV systolic and diastolic functions by pulsed wave tissue Doppler echocardiography and 2D speckle-tracking echocardiography-derived indices. RESULTS Lateral s' and e' waves were lower in the patients with the coronary slow flow phenomenon, but there were no statistically significant differences between the groups regarding the other tissue Doppler echocardiographic indices and longitudinal systolic strain and systolic and diastolic strain rates derived by 2D speckle-tracking echocardiography. CONCLUSIONS Our results showed that the coronary slow flow phenomenon could not impair the longitudinal LV systolic and diastolic functions.
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Affiliation(s)
- Sima Narimani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Pourhosseini
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Sanati H, Kiani R, Shakerian F, Firouzi A, Zahedmehr A, Peighambari M, Shokrian L, Ashrafi P. Coronary Slow Flow Phenomenon Clinical Findings and Predictors. Res Cardiovasc Med 2016; 5:e30296. [PMID: 26889458 PMCID: PMC4752610 DOI: 10.5812/cardiovascmed.30296] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 11/29/2022] Open
Abstract
Background: In some patients with chest pain, selective coronary angiography reveals slow contrast agent passage through the epicardial coronary arteries in the absence of stenosis. This phenomenon has been designated the slow coronary flow (SCF) phenomenon. Objectives: In this study, we aimed to describe the demographic and clinical findings and presence of common atherosclerosis risk factors in patients with the SCF phenomenon. Patients and Methods: Between October 2014 and March 2015, demographic data, clinical histories, atherosclerosis risk factors, and laboratory and angiographic findings were recorded for all consecutive patients scheduled for coronary angiography and diagnosed with the SCF phenomenon, as well as a control group (patients with normal epicardial coronary arteries; NECA). SCF was diagnosed based on the thrombolysis in myocardial infarction frame count (TFC). A TFC > 27 indicated a diagnosis of SCF phenomenon. Results: Among the 3600 patients scheduled for selective coronary angiography, 75 (2%) met the SCF criteria. SCF and NECA patients did not exhibit statistically significant differences in traditional risk factors except for hypertension, which was more prevalent in SCF than NECA patients (52% versus 31%, P = 0.008). A multivariable analysis indicated a low body mass index, presence of hypertension, low high-density lipoprotein cholesterol (HDL-c) level, and high hemoglobin level as independent predictors of the SCF phenomenon; of these, hypertension was the strongest predictor (odds ratio = 6.3, 95% confidence interval: 2.2 - 17.9, P = 0.001). Conclusions: The SCF phenomenon is relatively frequent, particularly among patients with acute coronary syndrome who are scheduled for coronary angiography. Hypertension, a low HDL-c level, and high hemoglobin level can be considered independent predictors of this phenomenon.
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Affiliation(s)
- Hamidreza Sanati
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Reza Kiani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Farshad Shakerian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Ali Zahedmehr
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ali Zahedmehr, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr ST., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123922108, Fax: +98-2122042026, E-mail:
| | - Mohammadmehdi Peighambari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Leila Shokrian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Peiman Ashrafi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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Kundi H, Gok M, Kiziltunc E, Topcuoglu C, Cetin M, Cicekcioglu H, Ugurlu B, Ulusoy FV. The Relationship Between Serum Endocan Levels With the Presence of Slow Coronary Flow: A Cross-Sectional Study. Clin Appl Thromb Hemost 2015; 23:472-477. [PMID: 26607436 DOI: 10.1177/1076029615618024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between endocan levels with the presence of slow coronary flow (SCF). METHODS In this cross-sectional study, a total of 88 patients, who admitted to our hospital, were included in this study. Of these, 53 patients with SCF and 35 patients with normal coronary flow were included in the final analysis. Coronary flow rates of all patients were determined by the Timi Frame Count (TFC) method. RESULTS In correlation analysis, endocan levels revealed a significantly positive correlation with high sensitive C-reactive protein and corrected TFC. In multivariate logistic regression analysis, the endocan levels were found as independently associated with the presence of SCF. Finally, using a cutoff level of 2.3, endocan level predicted the presence of SCF with a sensitivity of 77.2% and specificity of 75.2%. CONCLUSION In conclusion, our study showed that higher endocan levels were significantly and independently related to the presence of SCF.
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Affiliation(s)
- Harun Kundi
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Murat Gok
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunc
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Canan Topcuoglu
- 2 Biochemistry Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Hulya Cicekcioglu
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Burcu Ugurlu
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Feridun Vasfi Ulusoy
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Evolution of Coronary Flow in an Experimental Slow Flow Model in Swines: Angiographic and Pathological Insights. BIOMED RESEARCH INTERNATIONAL 2015; 2015:623986. [PMID: 26539516 PMCID: PMC4619871 DOI: 10.1155/2015/623986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 12/22/2022]
Abstract
Objective. Pathomechanism of coronary slow flow phenomenon remains largely unclear now. Present study observed the pathological and angiographic evolution in a pig model of coronary slow flow. Methods. Coronary slow flow was induced by repeat coronary injection of small doses of 40 µm microspheres in 18 male domestic pigs and angiographic and pathological changes were determined at 3 hours, 7 days, and 28 days after microspheres injection. Results. Compared to control group treated with coronary saline injection (n = 6) and baseline level, coronary flow was significantly reduced at 3 hours and 7 days but completely recovered at 28 days after coronary microsphere injection in slow flow group. Despite normal coronary flow at 28 days after microsphere injection, enhanced myocardial cytokine expression, left ventricular dysfunction, adverse remodelling, and ischemia/microembolism related pathological changes still persisted or even progressed from 3 hours to 28 days after coronary microsphere injection. Conclusions. Our results show that this large animal slow flow model could partly reflect the chronic angiographic, hemodynamic, and pathological changes of coronary slow flow and could be used to test new therapy strategies against the slow flow phenomenon.
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Evaluation of serum prolidase activity in patients with slow coronary flow. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:206-11. [PMID: 26677361 PMCID: PMC4631735 DOI: 10.5114/pwki.2015.54015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/12/2014] [Accepted: 05/05/2014] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Slow coronary flow (SCF) is described as the slow passage of contrast to distal coronaries despite anatomically normal coronary arteries. It has been shown that increased serum prolidase activity (SPA) correlates with collagen turnover. Increased collagen turnover might be associated with the development of atherosclerotic plaques. AIM To investigate the relationship between serum prolidase activity and slow coronary flow. MATERIAL AND METHODS This cross-sectional study included 40 SCF patients (mean age: 55.0 ±9.5 years, 20 females) and 40 controls (mean age: 53.9 ±8.2 years, 21 females) with normal coronary anatomy and normal coronary flow. The Thrombolysis in Myocardial Infarction (TIMI) frame-count (TFC) method was used for SCF diagnosis. Serum prolidase activity was measured spectrophotometrically, and the relevant parameters were compared between the groups. RESULTS There were no statistically significant differences between the SCF and control groups in terms of basic demographic, clinical, and laboratory data. However, the SPA was significantly higher in the SCF group compared to the control (702.7 ±13.8 and 683.9 ±13.2 respectively, p<0.001). Serum prolidase activity was significantly correlated with the mean TFC (r=0.463, p<0.001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 681.3. CONCLUSIONS Our study showed that SPA was increased in SCF patients. The activity of this enzyme was significantly correlated with the mean TFC.
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Altas Y, Kurtoglu E, Yaylak B, Baysal E, Ucaman B, Ugurlu HM, Karahan MZ, Altintas B, Adiyaman MS, Kaya İ, Erdolu U, Ozen K, Cakir C, Sevuk U. The relationship between eosinophilia and slow coronary flow. Ther Clin Risk Manag 2015; 11:1187-91. [PMID: 26316763 PMCID: PMC4542408 DOI: 10.2147/tcrm.s87761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim The pathophysiology of slow coronary flow (SCF) involves atherosclerosis, small vessel dysfunction, platelet function disorders, and inflammation. It has been known that eosinophils also play a significant role in inflammation, vasoconstriction, thrombosis, and endothelial dysfunction. We propose to evaluate the relationship between eosinophilia and SCF. Methods All patients who underwent coronary angiography between January 2011 and December 2013 were screened retrospectively. Of 6,832 patients, 102 patients with SCF (66 males, mean age 52.2±11.7 years) and 77 control subjects with normal coronary angiography (50 males, mean age 50.7±8.1 years) were detected. Baseline characteristics, hematological test results, and biochemical test results were obtained from the hospital database. Results Baseline characteristics of the study groups were comparable between groups. There was no significant difference between groups regarding leukocyte count, paletelet count, and mean platelet volume. However, patients with SCF had a higher eosinophil count than the controls (0.24±0.17×103/μL vs 0.16±0.15×103/μL, P=0.002). In addition, eosinophil count was found to be correlated with thrombolysis in myocardial infarction (TIMI) frame count in the SCF group (r=0.3, P<0.01). There was no significant correlation between eosinophil count and the number of coronary arteries showing slow flow. Conclusion Patients with SCF have higher blood eosinophil count, and this may play an important role in the pathogenesis of SCF. Elevated baseline eosinophil count may indicate the presence of SCF.
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Affiliation(s)
- Yakup Altas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | | | - Baris Yaylak
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Berzal Ucaman
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Hasan Murat Ugurlu
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Mehmet Zülkif Karahan
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Bernas Altintas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Mehmet Sahin Adiyaman
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - İlyas Kaya
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Umut Erdolu
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Kaya Ozen
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Cayan Cakir
- Department of Cardiology, Memorial Diyarbakir Hospital, Diyarbakir, Turkey
| | - Utkan Sevuk
- Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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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: 123] [Impact Index Per Article: 13.7] [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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Affiliation(s)
- M Reza Movahed
- Arizona CareMore Regional Cardiology, Director and Profesor of Medicine University of Arizona College of Medicine, Tucson; AZ-USA.
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Titterington JS, Hung OY, Wenger NK. Microvascular angina: an update on diagnosis and treatment. Future Cardiol 2015; 11:229-42. [DOI: 10.2217/fca.14.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
ABSTRACT Many patients with chest pain who are relieved to learn that they have no obstructive stenoses at diagnostic angiography are misclassified as having noncardiac chest pain. Only recently have we developed the conceptual framework and diagnostic tools to understand that ischemic heart disease is not exclusively caused by obstructive coronary artery disease, but often has its origin in the microcirculation. This article will focus on the diagnosis and treatment of microvascular angina as a cause of myocardial ischemia in patients with abnormal but ‘normal appearing’ coronary arteries.
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Affiliation(s)
- Jane S Titterington
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, USA
| | - Olivia Y Hung
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, USA
| | - Nanette K Wenger
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, USA
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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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Assessment of risk factors and left ventricular function in patients with slow coronary flow. Heart Vessels 2014; 31:288-97. [DOI: 10.1007/s00380-014-0606-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
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Seyyed-Mohammadzad MH, Khademvatani K, Kerachian A, Eskandari R, Rezaei Y. Slow coronary flow phenomenon and increased platelet volume indices. Korean Circ J 2014; 44:400-5. [PMID: 25469142 PMCID: PMC4248612 DOI: 10.4070/kcj.2014.44.6.400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/11/2014] [Accepted: 08/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives We sought to determine the relationship between mean platelet volume (MPV), platelet distribution width (PDW), and platelet larger cell ratio (P-LCR) with slow coronary flow (SCF). Subjects and Methods Eighty participants who underwent coronary angiography were divided into two groups, 50 participants with SCF as case group, and 30 with normal coronary flow (NCF) as control group. Baseline characteristics and laboratory data were collected before angiography. Results Platelet volume indices MPV (10.8±1.2 fL), PDW (14.5±2.2 fL), and P-LCR (30.5±8.1%) in the SCF group were significantly (p<0.05) higher than those (10.1±0.9 fL, 13.2±1.8 fL, and 26.8±6.8%, respectively) in the NCF group. The patients with three SCF arteries had significantly higher platelet volume indices compared to those with NCF arteries; however, the patients with one SCF artery did not. Based on linear regression model, MPV, PDW, and P-LCR were independent predictors of mean infarction frame counting (TFC). In multivariate analysis, MPV {odds ratio (OR)=32.393, 95% confidence interval (CI)=1.189-882.606, p=0.039} and P-LCR (OR=0.566, 95% CI=0.330-0.937, p=0.028) were independent predictors of SCF. Conclusion Platelet volume indices MPV, PDW, and P-LCR were associated with both the presence and extent of SCF.
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Affiliation(s)
| | - Kamal Khademvatani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Abdollah Kerachian
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ramin Eskandari
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
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Karaman K, Altunkaş F, Çetin M, Karayakali M, Arısoy A, Akar I, Zencir C, Aygüç B, Çelik A. New markers for ventricular repolarization in coronary slow flow: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Ann Noninvasive Electrocardiol 2014; 20:338-44. [PMID: 25267306 DOI: 10.1111/anec.12203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is characterized by normal or near-normal coronary arteries with delayed opacification of the distal vasculature that it may cause angina pectoris, acute myocardial infarction, life-threatening arrhythmias, and sudden cardiac death. The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with CSF by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. METHODS This study included 50 patients with CSF and 51 control subjects. Coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC). Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. RESULTS In electrocardiographic parameters analysis, QT, QTc, QTd, and QTcd were significantly increased in CSF patients compared with the control subjects (P < 0.001, P = 0.019, P < 0.001, P < 0.001, respectively). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in the CSF patients were significantly higher than those in the control subjects (Tp-e: 117 ± 21 milliseconds [ms] vs 96 ± 16 ms, P < 0.001; Tp-e/QT: 0.30 ± 0.06 vs 0.27 ± 0.06, P = 0.005; Tp-e/QTc: 0.27 ± 0.06 vs 0.24 ± 0.05, P < 0.001). In the multivariate analysis, increased Tp-e and Tp-e/QT ratio were associated with CSF. CONCLUSIONS Our study revealed that when compared to the control subjects, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc were significantly increased in the CSF patients.
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Affiliation(s)
- Kayihan Karaman
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Altunkaş
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Metin Karayakali
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Arif Arısoy
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ilker Akar
- Department of Cardiovascular Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Cemil Zencir
- Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Barış Aygüç
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ataç Çelik
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Impaired coronary microvascular and left ventricular diastolic function in patients with inflammatory bowel disease. Microvasc Res 2014; 97:25-30. [PMID: 25128749 DOI: 10.1016/j.mvr.2014.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. METHODS Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. RESULTS Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, p<0.05), and hyperemic DPFV (56.1±12.5 vs. 70.6±15.3, p<0.05) and CFR (2.34±0.44 vs. 3.14±0.54, p<0.05) were significantly lower in the IBD group than in the control group. In stepwise linear regression analysis, hs-CRP and lateral Em/Am ratio were independently correlated with CFR. CONCLUSION CFR, reflecting coronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP.
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