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Zhu Q, Wang S, Huang X, Zhao C, Wang Y, Li X, Jia D, Ma C. Understanding the pathogenesis of coronary slow flow: Recent advances. Trends Cardiovasc Med 2024; 34:137-144. [PMID: 36516963 DOI: 10.1016/j.tcm.2022.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/24/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Coronary slow flow is taken to be indicative of delayed filling of terminal vessels of the coronary arteries in the absence of coronary stenosis, as detected using coronary angiography. Patients suffering from coronary slow flow typically experience recurrent chest pain, thereby markedly affecting their quality of life. The etiology and pathogenesis of coronary slow flow, which is gradually attracting clinical attention, have yet to be sufficiently established, although it is currently believed that they may be associated with endothelial dysfunction in the coronary arteries, inflammatory response, abnormalities in microvascular reserve function, subclinical atherosclerosis, blood cell and platelet abnormalities, and genetic factors. In this review, we provide a brief overview of recent progress in research on the pathogenesis of coronary slow flow with a view toward elucidating the possible underlying pathogenesis and identify targets and directions for the treatment of this condition.
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Affiliation(s)
- Qing Zhu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China
| | - Shitong Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China
| | - Xin Huang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Cuiting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China
| | - Xinxin Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China
| | - Dalin Jia
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China; Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, China.
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Ono R, Iwahana T, Kato H, Okada S, Kobayashi Y. Literature reviews of stroke with hypereosinophilic syndrome. IJC HEART & VASCULATURE 2021; 37:100915. [PMID: 34888412 PMCID: PMC8636825 DOI: 10.1016/j.ijcha.2021.100915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
Hypereosinophilic syndrome (HES) is defined by persistently elevated blood eosinophil levels and is associated with evidence of organ damage. Cardiovascular involvement in HES is most commonly associated with Loffler endocarditis (cardiac HES). Cardiac HES is typically characterized by progressive subendocardial fibrosis with overlying mural thrombus formation, leading to restrictive dysfunction of the left ventricle. The thrombus from cardiac HES could result in cardiogenic stroke; however, most of the stroke cases with HES were not associated with huge thromboembolism rather multiple infarcts in the watershed area. The major clinical features of 97 previously reported cases of stroke with HES are as follows: the median age was 52 years, of which 61 (63%) were men; the initial presenting symptoms were neurological (73%), followed by headache (16%), respiratory symptoms (9%), and visual symptoms (9%). Almost half of the cases were diagnosed with cardiac HES. The characteristics of cardiac findings were mural thrombi, endomyocardial fibrosis, and a restrictive pattern of heart failure. Cerebral findings revealed 78 cases (80%) were described as multiple infarctions and 55 cases (57 %) were involved with watershed areas, whereas 11 cases (11%) were described as embolic stroke for one proximal large-vessel occlusion. Regarding treatment, 71 (73%), 28 (29%), and 16 (16%) patients were treated with steroids, anticoagulants, and antiplatelets, respectively. The overall mortality and recovery rates were 11% and 89%, respectively. Physicians should know most cases of stroke with HES are characterized by multiple infarctions in the watershed area, and cardiac HES is not always associated with stroke.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Güner A, Zehİr R, KalçIk M, Uslu A, Ösken A, Kalkan AK, Güner EG. Eosinophil percentage as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Interv Med Appl Sci 2020; 11:146-153. [PMCID: PMC9467337 DOI: 10.1556/1646.11.2019.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p < 0.01 and 32.8% vs. 11.3%, p < 0.01, respectively). On multivariate logistic regression analyses, EOS% (OR = 0.44, p < 0.01) was found to be one of the independent predictors of MACE. The EOS% lower than 0.60 on admission predicted inhospital MACE with a sensitivity of 68% and a specificity of 72% (AUC: 0.684, p < 0.01). Conclusions Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.
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Affiliation(s)
- Ahmet Güner
- 1 Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Regayİp Zehİr
- 2 Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Macİt KalçIk
- 3 Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Abdulkadİr Uslu
- 1 Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Altuğ Ösken
- 2 Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alİ Kemal Kalkan
- 4 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ezgİ Gültekİn Güner
- 4 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Çekici Y, Yılmaz M, Seçen Ö. New inflammatory indicators: association of high eosinophil-to-lymphocyte ratio and low lymphocyte-to-monocyte ratio with smoking. J Int Med Res 2019; 47:4292-4303. [PMID: 31319727 PMCID: PMC6753567 DOI: 10.1177/0300060519862077] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Smoking has been proven to increase systemic inflammation in previous studies
using different biomarkers. The eosinophil-to-lymphocyte ratio (ELR),
neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR)
are new indicators of systemic inflammation that are used as predictors of
systemic inflammation, morbidity, and mortality associated with many
diseases. We investigated the effects of smoking on these inflammatory
indicators. Methods In total, 616 consecutive smoking healthy subjects and 387 age-matched
nonsmoking healthy subjects were enrolled. White blood cell counts
(neutrophils, lymphocytes, basophils, eosinophils, and monocytes) were
determined by electrical impedance with an automatic blood cell counting
device. The ELR, LMR, and NLR were calculated based on these cell counts.
Smoking habits of participants were calculated as pack/year. Results The NLR and ELR were significantly higher and the LMR was significantly lower
in smokers than nonsmokers. The pack-years were positively correlated with
the NLR and ELR and negatively correlated with the LMR. Conclusion A high NLR and ELR and low LMR are associated with cigarette smoking and may
be useful indicators of systemic inflammation activity, even in healthy
smokers. Smokers with a high NLR and ELR and low LMR can easily be
identified during routine blood analysis and might benefit from preventive
treatment.
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Affiliation(s)
- Yusuf Çekici
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Mücahid Yılmaz
- Department of Cardiology, Elazığ Education and Research Hospital, Elazığ, Turkey
| | - Özlem Seçen
- Department of Cardiology, Elazığ Education and Research Hospital, Elazığ, Turkey
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Abstract
Objective: Coronary slow flow phenomenon (CSFP) is characterized by the decreased rate of contrast progression in epicardial coronary arte-ries in the absence of significant coronary stenosis. Mounting evidence has showed a significant association between inflammation and CSFP severity. This study aimed to evaluate possible associations between interleukin-1 receptor antagonist (IL-1ra) gene variable number tandem repeat (VNTR), IL-1β -511 single nucleotide (SNP), and IL-1β+3954 SNP mutations with CSFP. Methods: Forty-eight patients with CSFP and 62 controls with angiographically normal coronary arteries were prospectively enrolled in the study. Genotypes were assessed using the polymerase chain reaction (PCR)-based restriction fragment length polymorphism (PCR-RFLP) technique. Results: Homozygote genotype for allele 2 of+3954 C>T 2/2 genotype was significantly more frequent in patients with CSFP than in the control group, whereas 1/2 genotype was more frequent in the control group (35.4% versus 14.5% for 2/2 genotype and 25% versus 35.5% for 1/2 genotype in CSFP and control groups, respectively, X2=6.6; p=0.04). The allelic frequency of allele 2 of this polymorphism was significantly higher in the CSFP group than in the control group (47.9% versus 28.6% in the control group, X2=5.6; p=0.02). However, there was no significant difference with regard to genotype or allelic frequencies of IL-1ra VNTR or IL-1β -511 SNP polymorphisms between patients with CSFP and controls. Conclusion: IL-1β+3954 SNP mutations are significantly more common in patients with CSFP. It may suggest that the tendency for inflammation may contribute to the presence of this phenomenon.
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Mir Syed RR, Lopez MA, Thomas C, Clopton P, Smith DM, Jagasia P. Dependence of Elevated Eosinophil Levels on Geographic Location in the VA San Diego Healthcare System. Fed Pract 2017; 34:28-33. [PMID: 30766278 PMCID: PMC6370435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An investigation of patient records at multiple locations found high eosinophil levels, which may be related to dyslipidemia or Coccidioides immitis infection.
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Affiliation(s)
- Rehan R Mir Syed
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
| | - Michael A Lopez
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
| | - Colin Thomas
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
| | - Paul Clopton
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
| | - Davey M Smith
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
| | - Priya Jagasia
- and are medical students at the University of California, San Diego School of Medicine. , , and are physicians at the University of California, San Diego and the VA San Diego Healthcare System. is a statistician at the VA San Diego Healthcare System
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Arjmand N, Dehghani MR. Complete blood cell count components and coronary slow-flow phenomenon. Ther Clin Risk Manag 2016; 12:1827-1829. [PMID: 27980412 PMCID: PMC5144915 DOI: 10.2147/tcrm.s121433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Nasim Arjmand
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Reza Dehghani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
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Dogan A, Oylumlu M, Kilit C, Özgeyik M. ST elevation myocardial infarction caused by coronary slow flow: Case report and brief review of the literature. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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