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Dhungana R, Pokharel P, Poudel CM, Khanal RR, Shakya S, Gajurel RM. Myocardial infarction with nonobstructive coronaries (MINOCA) following rabies postexposure prophylaxis: A case report. Clin Case Rep 2024; 12:e8532. [PMID: 38385055 PMCID: PMC10879642 DOI: 10.1002/ccr3.8532] [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: 11/13/2023] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Key Clinical Message This case underscores the importance of considering myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients experiencing acute chest pain following rabies vaccination, emphasizing the need for heightened awareness and further research into the association between MINOCA and Rabies vaccination. Abstract Rabies is a vaccine-preventable deadly viral disease prevalent in Asia and Africa that causes thousands of deaths annually. Rabies pre (PrEP) and postexposure prophylaxis (PEP) is highly effective in annulling rabies-associated deaths. The adverse reactions following rabies vaccination are typically mild. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare condition, and its association with rabies vaccination is unprecedented. We present a case of a 43-year-old male with MINOCA following Rabies PEP. A 43-year-old male, nonsmoker and nonalcoholic, presented to the ER with complaints of acute onset left sided chest pain following the completion of the third dose of intradermal rabies vaccine, whose clinical features, ECG changes and lab reports were suggestive of acute presentation of inferior wall MI. Coronary angiography was performed, which however revealed normal coronaries with only slow flow being noted in the left anterior descending (LAD) artery. Echocardiography later showed a normal study with no other relevant diagnosis unveiled on further investigations. Hence a diagnosis of vaccine-induced MINOCA was made. Treatment included antiplatelet therapy, statins, and beta-blockers. MINOCA following rabies vaccination is an unprecedented finding. The clear etiology behind this couldn't be ascertained. The patient's treatment was conventional, emphasizing the need for further research and clinical trials in MINOCA diagnosis and management. This case highlights the need for clinicians to consider MINOCA in patients with acute chest pain post-rabies vaccination. Further research is essential to unravel the association between MINOCA and rabies vaccination, paving the way for optimal management strategies.
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Affiliation(s)
- Reechashree Dhungana
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterInstitute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Prajjwal Pokharel
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterKathmanduNepal
| | - Chandra Mani Poudel
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterKathmanduNepal
| | - Raja Ram Khanal
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterKathmanduNepal
| | - Smriti Shakya
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterKathmanduNepal
| | - Ratna Mani Gajurel
- Department of CardiologyManmohan Cardiothoracic Vascular and Transplant CenterKathmanduNepal
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Karasu M, Bolayır HA. Cut-off value for interleukin-34 as an additional potential inflammatory biomarker for estimation of slow coronary flow risk. BMC Cardiovasc Disord 2024; 24:2. [PMID: 38166811 PMCID: PMC10762812 DOI: 10.1186/s12872-023-03677-y] [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: 08/24/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Inflammatory markers may provide insights into the underlying mechanisms of slow coronary flow (SCF), including subclinical atherosclerosis and endothelial dysfunction. Interleukin-34 (IL-34), known for its role in immuno-inflammatory diseases, might hold significance in SCF. We aimed to explore the potential association between IL-34 and SCF in patients undergoing diagnostic elective coronary angiography. METHODS This observational, cross-sectional study enrolled 256 participants: 124 with SCF and 132 with normal coronary flow (NCF). All participants had undergone outpatient coronary angiography for suspected coronary artery disease. SCF assessment employed the TIMI frame count (TFC) for quantifying coronary flow rate. RESULTS SCF patients exhibited significantly elevated TFC in all three major coronary arteries compared to controls (p < 0.05). IL-34 displayed a noteworthy positive correlation with average TFC [for all participants: r = 0.514, p < 0.001; for SCF patients: r = 0.526, p < 0.001; for normal controls: r = -0.288, p > 0.05]. Similarly, high-sensitivity C-reactive protein (hsCRP) showed a significant and positive relationship with average TFC [for all participants: r = 0.504, p < 0.001; for SCF patients: r = 0.558, p < 0.001; for normal controls: r = -0.148, p > 0.05]. SCF patients presented coronary arteries of larger size compared to controls. CONCLUSION Mean coronary diameter and IL-34 emerged as independent predictors of SCF. Additionally, hsCRP, mean coronary diameter, and IL-34 exhibited a positive correlation with mean TFC values. IL-34 appears to be a more effective indicator than hsCRP in SCF patients.
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Affiliation(s)
- Mehdi Karasu
- Department of Cardiology, Fethi Sekin Sehir Hastanesi, Elazıg, Turkey.
| | - Hasan Ata Bolayır
- Department of Cardiology, Malatya Turgut Özal Üniversitesi Kardiyoloji ABD, Malatya, Turkey
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Ghodrat M, Separham A, Banisefid E, Alamdari NM, Akbarzadeh M, Alipour S, Yahyapoor T, Roshanravan N, Ghaffari S. The expression levels of PPAR-α/γ and UCP1/2 on the slow coronary flow phenomenon; results from a case-control study. Mol Biol Rep 2023; 50:7527-7533. [PMID: 37501045 DOI: 10.1007/s11033-023-08668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE The slow coronary flow (SCF) phenomenon is considered a coronary artery disorder. Because of the critical function of peroxisome proliferator-activated receptors (PPARs) in regulating the oxidative stress and inflammatory reactions in cardiovascular disease, The aim of the current study was to investigate the expression of the genes for uncoupling proteins 1 and 2 (UCP1 and UCP2), peroxisome proliferator-activated receptors and (PPAR- PPAR-), and PPAR- in SCF patients. METHODS In this case-control study, coronary angiography examination was used to analyze 35 individuals with SCF and 35 subjects with normal coronary flow (NCF). SCF was diagnosed using the TIMI (thrombolysis in myocardial infarction frame count) method. The SCF phenomenon is thought to be the TIMI > 27. In the peripheral blood mononuclear cells (PBMCs), the messenger ribonucleic acid (mRNA) expression levels of the PPAR-, PPAR-, UCP1, and UCP2 genes were evaluated. RESULTS UCP1 and UCP2 expression levels were significantly higher in the SCF group compared to the NCF group (P = 0.034 and P0.001, respectively). The PPAR- and PPAR- levels were found to be significantly lower in the SCF group compared to the NCF group (P = 0.015, P0.001, respectively). According to the results of the logistic regression analysis, high UCP1 and UCP2 levels and low PPAR- and PPAR- levels are each independent predictors of the SCF phenomenon. CONCLUSION This research provided evidence about the potential role of PPAR-α, PPAR-γ, UCP1, and UCP2 as biomarkers in SCF. More investigations are suggested to assess the functions of these factors in SCF patients mechanistically.
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Affiliation(s)
- Mahshid Ghodrat
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 5166615573, Iran
| | - Ahmad Separham
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 5166615573, Iran
| | - Erfan Banisefid
- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Moloud Akbarzadeh
- Centre de Recherche de L'Institut Universitaire de Cardiologie Et de Pneumologie de Québec (CRIUCPQ), Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Shahriar Alipour
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
- Department of Clinical Biochemistry and Applied Cell Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Tohid Yahyapoor
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 5166615573, Iran
| | - Neda Roshanravan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 5166615573, Iran.
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 5166615573, Iran.
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Dogan Z, Ileri C, Ozben B, Sunbul M, Tigen MK, Sahin O, Yesildag O. Evaluation of Arterial Stiffness and Subfoveal Choroidal Thickness in Patients with Coronary Slow Flow. ACTA CARDIOLOGICA SINICA 2023; 39:733-741. [PMID: 37720409 PMCID: PMC10499956 DOI: 10.6515/acs.202309_39(5).20230209a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/09/2023] [Indexed: 09/19/2023]
Abstract
Background Coronary slow flow may not only affect the coronary arteries, but it may also be a vascular problem affecting the rest of the arterial system. Objective The aim of this study was to determine peripheral arterial stiffness and the thickness of the choroid layer in patients with slow coronary flow. Methods Fifty consecutive patients (age, 54.3 ± 11.4 years, 38 male) with coronary slow flow and 25 consecutive patients (age, 50.5 ± 9.9 years, 16 male) with normal coronary arteries both documented by coronary angiography were included. Arterial stiffness parameters were measured noninvasively using a Mobil-O-Graph arteriography system. The choroidal thickness was assessed using the enhanced depth imaging optical coherence tomography method. Results The patients with coronary slow flow had significantly higher peripheral systolic blood pressure, peripheral pulse pressure, central pulse pressure, and pulse wave velocity (PWV) and significantly thinner choroidal thickness compared to the controls. Thrombolysis in myocardial infarction frame count was positively correlated with PWV (r: 0.237, p = 0.041) and negatively correlated with choroidal thickness (r: -0.249, p = 0.031). There was also a negative correlation between PWV and mean choroidal thickness (r: -0.565, p < 0.001). Linear regression analysis showed that coronary slow flow was an independent predictor of both PWV and choroidal thickness when adjusted by age and sex. Conclusions The acceleration of average peripheral arterial PWV with a thinning of choroidal thickness in patients with coronary slow flow may support the idea that this phenomenon may be a coronary presentation of a systemic microvascular disorder.
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Affiliation(s)
- Zekeriya Dogan
- Department of Cardiology, Marmara University School of Medicine
| | - Cigdem Ileri
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital
| | - Beste Ozben
- Department of Cardiology, Marmara University School of Medicine
| | - Murat Sunbul
- Department of Cardiology, Marmara University School of Medicine
| | - M Kursat Tigen
- Department of Cardiology, Marmara University School of Medicine
| | - Ozlem Sahin
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Osman Yesildag
- Department of Cardiology, Marmara University School of Medicine
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Ipek G, Kamber T, Yilmaz H, Bolca O. Long-Term Change in Flow Rates in Patients with Coronary Slow Flow. Cardiology 2023; 148:500-505. [PMID: 37634497 DOI: 10.1159/000533802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Coronary slow flow (CSF) is a condition characterized by impaired blood flow rates in the coronary arteries. It can result in severe cardiovascular outcomes. There is no sufficient evidence regarding the certain etiology and reversibility of slow flow patterns and changes in frame counts with long-term management. METHODS We retrospectively enrolled 48 patients with chronic coronary syndrome and CSF who underwent a second angiography. A corrected coronary frame rate (CFR) >27 was defined as CSF. We created 3 groups according to the change in CSF status as the improved, not changed, and worsened groups. We compared the CFR and CSF status of the patients between the first and second angiographies within a median of 2.6 years. RESULTS We determined a nonsignificant change in cCFR in left anterior descending (LAD) artery (34.4 [18.9] vs. 31.59 [10.3], p = 0.35), circumflex (Cx) artery (42.84 [12.56] vs. 40.66 [13.2], p = 0.35), and right coronary artery (RCA) (57.80 [30.13] vs. 50.32 [19.5], p = 0.11). In the comparison of CSF status of LAD (75% vs. 63%, p = 0.27), Cx (96% vs. 83%, p = 0.09), RCA (94% vs. 94%, p = 1.0) between first and second angiographies, there was no significant change. In the comparison of the 3 groups according to the improvement of CSF status, there was no significant difference in demographic features, change in laboratory parameters, and time between the groups. CONCLUSION There was no significant change in the median CFR and CSF status in the overall group between the two angiographies after 3 years.
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Affiliation(s)
- Gokturk Ipek
- Cardiology Department, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
| | - Tugay Kamber
- Cardiology Department, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
| | - Hale Yilmaz
- Cardiology Department, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
| | - Osman Bolca
- Cardiology Department, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
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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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Elsanan MAHA, Tahoon IHHH, Mohamed GI, ZeinElabdeen SG, Shehata IE. Relationship between inflammatory markers and coronary slow flow in type 2 diabetic patients. BMC Cardiovasc Disord 2023; 23:244. [PMID: 37161453 PMCID: PMC10169369 DOI: 10.1186/s12872-023-03275-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Diabetes is a serious and quickly expanding global health problem. Cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. Coronary slow flow (CSF) is characterised by delayed distal perfusion during coronary angiography with normal coronary arteries. This study aimed to investigate the correlation between CSF and inflammatory markers regarding glycemic status in T2DM. METHODS This cross-sectional study included 120 patients who were divided equally into 4 groups according to their glycemic control and presence or absence of coronary slow flow: Group I included patients with T2DM with good glycemic control without CSF; Group II included patients with T2DM with good glycemic control and CSF; Group III included patients with T2DM with poor glycemic control without CSF; and Group IV included patients with T2DM with poor glycemic control and CSF. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), platelets, hematocrit, and haemoglobin were also evaluated as risk factors for coronary slow flow. RESULTS This study showed that body mass index (BMI), hematocrit level, NLR, and CRP demonstrated a moderate but significant correlation (r = 0.53) with CSF in poorly controlled T2DM. NLR cutoff > 2.1 could predict CSF in poorly controlled T2DM with a modest sensitivity and specificity. A 1.9 increase in HbA1c increases the likelihood of coronary slow flow. Dylipidemia increases the likelihood of coronary slow flow by 0.18 times. Other predictors for coronary slow flow include NLR, PLR, CRP, platelets, hematocrit, and hemoglobin. The effect of the predictors is still statistically significant after being adjusted for glycemic status, age, and sex (p < 0.001). CONCLUSIONS Poor glycemic control increases the incidence of CSF. This supports the hypothesis that CSF is related to endothelial dysfunction as poor glycemic control causes endothelial dysfunction due to inflammation. TRIAL REGISTRATION ZU-IRB#9419-3-4-2022 Registered 3 April 2022, email. IRB_123@medicine.zu.edu.eg .
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Affiliation(s)
| | | | - Ghada Ibrahim Mohamed
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Sharkia Governorate, Egypt
| | - Shimaa Gamal ZeinElabdeen
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Sharkia Governorate, Egypt
| | - Islam Elsayed Shehata
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Sharkia Governorate, Egypt.
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Muacevic A, Adler JR. Non-Dipper Blood Pressure Impact on Coronary Slow Flow in Hypertensive Patients With Normal Coronary Arteries. Cureus 2023; 15:e33356. [PMID: 36751148 PMCID: PMC9897294 DOI: 10.7759/cureus.33356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Coronary slow flow (CSF) is linked to myocardial ischemia, malignant arrhythmias, and cardiovascular mortality. On the other hand, hypertension (HTN) is an important risk factor for vascular disorders. There is limited research on the relationship between CSF and HTN. This study aimed to investigate TIMI frame count (TFC), which is an indicator of CSF, in dipper and non-dipper hypertensive individuals with normal coronary arteries. METHODS The study was conducted as a retrospective observational study. Patients diagnosed with CSF and dipper or non-dipper hypertension were included in this study. Blood tests were routinely conducted for all patients. ECG was conducted for each patient, and echocardiography was performed. Coronary artery images were obtained in the CAG laboratory. Blood pressure (BP) measurements were obtained from the ambulatory Holter records. The patients were separated into two groups based on ambulatory Holter monitoring. The relationship between CSF and HTN was also examined. RESULTS A total of 71 patients, comprising 25 women (37.2%) and 46 men (62.8%) with an average age of 52.75±9.42 years, were enrolled in the research. Based on ambulatory BP, the individuals were separated into two groups: non-dipper (n=36) and dipper (n=35). The pulse rate was significantly higher in the non-dipper group (p<0.001). In terms of mean systolic and diastolic blood pressure, there were no substantial differences across the groups (p = 0.326 and p = 0.654, respectively). The daytime mean systolic and diastolic BP did not significantly differ across the groups (p = 0.842 and p = 0.421). The dipper group had substantially lower nighttime systolic and diastolic BP values (p <0.001). The LAD, Cx, and RCA TIMI frame scores were significantly lower in the dipper group (p<0.001). CONCLUSION In this study, non-dipper patients had a greater CSF rate than dipper.
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Wang Y, Liu J, Liu H, Sun X, Chen R, Liao B, Zeng X, Zhang X, Dong S, Xia Z, Yuan J. Slow flow induces endothelial dysfunction by regulating thioredoxin-interacting protein-mediated oxidative metabolism and vascular inflammation. Front Cardiovasc Med 2022; 9:1064375. [PMID: 36465470 PMCID: PMC9708747 DOI: 10.3389/fcvm.2022.1064375] [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: 10/08/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
Endothelial cells are highly sensitive to hemodynamic shear stresses, which act in the blood flow's direction on the blood vessel's luminal surface. Thus, endothelial cells on that surface are exposed to various physiological and pathological stimuli, such as disturbed flow-induced shear stress, which may exert effects on adaptive vascular diameter or structural wall remodeling. Here we showed that plasma thioredoxin-interactive protein (TXNIP) and malondialdehyde levels were significantly increased in patients with slow coronary flow. In addition, human endothelial cells exposed to disturbed flow exhibited increased levels of TXNIP in vitro. On the other hand, deletion of human endothelial TXNIP increased capillary formation, nitric oxide production and mitochondrial function, as well as lessened oxidative stress response and endothelial cell inflammation. Additional beneficial impacts from TXNIP deletion were also seen in a glucose utilization study, as reflected by augmented glucose uptake, lactate secretion and extracellular acidification rate. Taken together, our results suggested that TXNIP is a key component involved in mediating shear stress-induced inflammation, energy homeostasis, and glucose utilization, and that TXNIP may serve as a potentially novel endothelial dysfunction regulator.
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Affiliation(s)
- Yongshun Wang
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Jingjin Liu
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Huadong Liu
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Xin Sun
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Ruimian Chen
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Bihong Liao
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Xiaoyi Zeng
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Xiaoxin Zhang
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Shaohong Dong
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Zhengyuan Xia
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jie Yuan
- Department of Cardiology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College, Jinan University, Shenzhen, China
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Caiati C, Iacovelli F, Mancini G, Lepera ME. Hidden Coronary Atherosclerosis Assessment but Not Coronary Flow Reserve Helps to Explain the Slow Coronary Flow Phenomenon in Patients with Angiographically Normal Coronary Arteries. Diagnostics (Basel) 2022; 12:diagnostics12092173. [PMID: 36140575 PMCID: PMC9497914 DOI: 10.3390/diagnostics12092173] [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: 07/19/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
The significance of the slow coronary flow phenomenon (SCFph), as visualized in patients (pts) with angiographically normal coronary arteries, is controversial. Absolute coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD), non-invasively assessed by a transthoracic color-guided pulsed-wave Doppler (E-Doppler TTE), is a reliable parameter to assess coronary microcirculatory dysfunction (CMD). Mild and angiographically hidden epicardial atherosclerosis (Hath), as visualized by intracoronary ultrasound (IVUS), which could be the clue to atherosclerotic coronary microvascular involvement, has never been investigated together with CFR in patients. This study was aimed at assessing the value of CFR and HA in explaining the SCFph. Methods. Both non-invasive assessment of CFR in the LAD and corrected TIMI frame count assessment of the coronary contrast runoff were performed in 124 pts with angiographically normal coronary arteries. Among the whole group, 32 patients also underwent intracoronary ultrasounds in the LMCA and LAD, and the maximal plaque burden was assessed (Lesion external elastic (EEM) cross sectional area (CSA)—Lesion Lumen CSA/Lesion EEM CSA * 100). We found that 24 of the 124 pts (group 1) had the SCFph and the remaining 100 had a normal runoff (group 2). CFR, evaluated in both groups, was not significantly different, being 2.79 ± 0.79 (Mean ± SD) in group 1 and 2.90 ± 0.8 in group 2 (p = ns); in the pts also examined by IVUS (32 pts), the SCFph was always associated with hidden atherosclerosis, and a plaque burden of ≥33%. On the contrary, in the normal runoff group, any grade of PB was observed (from no athero to a PB > 70%) and remarkably, 10 pts had no signs of athero or just a minimal plaque burden. This resulted in a ROC curve analysis in which PB < 33% had a high negative predictive value (100%) in ruling out the SCFph. In addition, considering a CFR value < 2.21 as an index of coronary microcirculatory dysfunction, we found CMD in 15 pts (15%) in group 1 and in 7 pts (29%) in group 2 (p = ns). In conclusion, the SCFph is strongly connected to epicardial athero to the extent that the absence of hidden coronary athero has a very high negative predictive power in ruling out SCFph. CFR that is based on an endothelium-independent mechanism remains fairly normal in this condition. An endothelium-dependent microcirculatory constriction at rest due to atherosclerotic involvement of the coronary microvascular network is a possible explanation of the SCFph.
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Affiliation(s)
- Carlo Caiati
- Correspondence: ; Tel.: +39-080-5592117; Fax: +39-080-5478796
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Guo H, Li X, Zhu M. Meta-analysis and trial sequential analysis of shexiang baoxin pill for coronary slow flow. Front Pharmacol 2022; 13:955146. [PMID: 36071856 PMCID: PMC9441803 DOI: 10.3389/fphar.2022.955146] [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: 05/28/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Coronary slow flow (CSF) is a common cardiovascular phenomenon with no effective treatment in conventional Western medicine (CWM). Shexiang Baoxin Pill (SXBXP) is a widely used Chinese medicine for cardiovascular disease in China, and clinical studies have shown that it has good efficacy for CSF. Objective: To systematically evaluate the efficacy and safety of SXBXP for CSF. Methods: Seven databases were searched to identify related randomized controlled trials (RCTs). The Meta-analysis, trial sequential analysis (TSA), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were performed using Stata 14.1, TSA 0.9.5.10 Beta and GRADE profiler 3.2.2 software respectively. Results: A total of 10 RCTs were included. Meta-analysis showed that compared with CWM treatment alone, SXBXP combined with CWM further improved the angina pectoris efficacy [RR = 1.37, 95% CI (1.23, 1.52), p < 0.000 01] and nitric oxide (NO) level [WMD = 11.32, 95% CI (0.04, 22.59), p = 0.049], decreased the mean corrected TIMI frame count (CTFC) [WMD = −4.23, 95% CI (−5.51, −2.95), p < 0.000 01], CTFC of the left anterior descending artery (LAD) [WMD = −6.36, 95% CI (−12.07, −0.65), p = 0.029], left circumflex artery (LCX) [WMD = -5.73, 95% CI (−8.79, −2.67), p < 0.000 01], and right coronary artery (RCA) [WMD = −6.72, 95% CI (−10.60, −2.84), p = 0.001], decreased the positive rate of treadmill exercise test [RR = 0.45, 95% CI (0.25, 0.83), p = 0.010], endothelin-1 (ET-1) level [WMD = -11.03, 95% CI (−13.92, −8.14), p < 0.000 01], high-sensitivity C-reactive protein (hs-CRP) [WMD = −1.95, 95% CI (−2.57, −1.34), p < 0.000 01], and adverse reactions [RR = 0.20, 95% CI (0.05, 0.85), p = 0.030]. The GRADE evidence quality rating presented with moderate, low or very low quality of evidence. TSA further affirmed the clinical efficacy. Conclusion: Although some results suggest that there may be a positive effect of SXBXP for CSF, the quality of the primary study including the reporting is too poor and therefore, no benefits could be demonstrated. More high-quality studies are still needed to further confirm the efficacy and safety. Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022329469).
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Affiliation(s)
- Hongxin Guo
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xingyuan Li
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Mingjun Zhu
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Mingjun Zhu,
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12
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Javadi HR, Mirakbari SM, Allami A, Salavati E. Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran. ADDICTION & HEALTH 2022; 14:224-228. [PMID: 36544982 PMCID: PMC9743821 DOI: 10.34172/ahj.2022.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
Background Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. Methods This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. Findings This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107). Conclusion This study indicated that opium use is not associated with primary CSFP.
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Affiliation(s)
- Hamid Reza Javadi
- Department of Cardiology, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyed Mostafa Mirakbari
- Department of Clinical Toxicology, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran,Corresponding Author: Seyed Mostafa Mirakbari, MD,
| | - Abbas Allami
- Department of Infectious Diseases, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ebrahim Salavati
- Department of Cardiology, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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13
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Karimi Y, Sehati F, Sarreshtedari A, Mirzad M, Khalili Y, Kiani R, Taheri Bajgan E, Hosseini Moghadam M, Mehrvarz F, Bakhshandeh H, Parham M, Malakootian M, Sadeghipour P. Endothelial nitric oxide synthase Asp298Glu (894G/T) gene polymorphism as a possible risk factor for the coronary slow flow phenomenon among Iranians. BMC Cardiovasc Disord 2022; 22:300. [PMID: 35773625 PMCID: PMC9248196 DOI: 10.1186/s12872-022-02736-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mounting evidence indicates an association between endothelial dysfunction and the coronary slow flow phenomenon (CSFP). In the present study, we aimed to evaluate the possible role of endothelial nitric oxide synthase (eNOS) 894G/T and interleukin-1β (IL-1β) 315C/T polymorphisms as possible risk factors for CSFP. Methods This prospective study enrolled patients with CSFP and individuals with normal coronary arteries. Genotypes were assessed using regular polymerase chain reaction and direct Sanger-sequencing techniques. Results The study population consisted of 267 individuals: 180 patients with CSFP (49 women [27.2%]) at a median age of 55 (48–62) years and 87 controls with normal coronary arteries (56 women [64.4%]) at a median age of 47 (41–58) years. The allelic distribution of eNOS 894G/T was significantly associated with CSFP (odds ratio [OR], 1.58; 95% confidence interval (CI), 1.04–2.42; P = 0.03). This polymorphism increased the risk of CSFP under the dominant model (OR 1.73; 95% CI I.02–2.95; P = 0.04). However, the allelic frequencies (1.05; 95% CI 0.68–1.59; P = 0.83) and genotypic frequencies (0.88; 95% CI 0.52–1.49; P = 0.63) of the IL-1β 315C/T polymorphism were not associated with the incidence of CSFP in the Iranian population. Conclusions The CSFP and control groups were statistically different regarding the eNOS 894G/T polymorphism. Our findings also demonstrated that the IL-1β 315C/T polymorphism was not a risk factor for CSFP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02736-0.
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Affiliation(s)
- Yeganeh Karimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sehati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarreshtedari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Mirzad
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Reza Kiani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Elham Taheri Bajgan
- Molecular Genetics Department, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Hosseini Moghadam
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Farzaneh Mehrvarz
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Parham
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Mahshid Malakootian
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran.
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran. .,Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran.
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14
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Afsin A, Kaya H, Suner A, Uzel KE, Bursa N, Hosoglu Y, Yavuz F, Asoglu R. Plasma atherogenic indices are independent predictors of slow coronary flow. BMC Cardiovasc Disord 2021; 21:608. [PMID: 34930134 PMCID: PMC8686646 DOI: 10.1186/s12872-021-02432-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although the pathophysiology of coronary slow flow (CSF) has not been fully elucidated, emerging data increasingly support potential role for subclinical diffuse atherosclerosis in the etiology of CSF. We aimed to investigate relationship between atherogenic indices and CSF. Methods 130 patients with CSF diagnosed according to Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) method and 130 controls who had normal coronary flow (NCF) were included in this retrospective study. Atherogenic indices (atherogenic index of plasma [AIP], Castelli risk indices I and II [CRI-I and II]) were calculated using conventional lipid parameters. Results The logistic regression analyses demonstrated that AIP (OR, 5.463; 95% confidence interval [CI], 1.357–21.991; p = 0.017) and CRI-II (OR, 1.624; 95% CI, 1.138–2.319; p = 0.008) were independent predictors of CSF. Receiver operating characteristic analysis showed that the optimal cutoff value to predict the occurrence of CSF was 0.66 for AIP (sensitivity, 59%; specificity, 73%; area under curve [AUC], 0.695; p < 0.001) and 3.27 for CRI-II (sensitivity, 60%; specificity, 79%; AUC, 0.726; p < 0.001). Conclusions AIP and CRI-II levels were independent predictors of CSF. Prospective studies in larger cohorts of patients may elucidate the role of atherogenic dyslipidemia in the pathophysiology of CSF.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Arif Suner
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Kader Eliz Uzel
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Nurbanu Bursa
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Yusuf Hosoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Fethi Yavuz
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ramazan Asoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
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15
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Lal K, Singh N, Kumar A, Agarwal N, Datta R, Datta R, Bhardwaj P, Chadha DS, Ghosh AK, Kumar R. Association of ischemic electrocardiographic changes in high-altitude areas with coronary angiography. Med J Armed Forces India 2021; 77:403-407. [PMID: 34594067 DOI: 10.1016/j.mjafi.2020.11.001] [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: 08/09/2018] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG. Methods A prospective study was conducted on patient's from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/asymptomatic soldiers with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD. Results The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG. Conclusion Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.
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Affiliation(s)
- Krishan Lal
- SMO, HCMS, LNJP Civil Hospital, Kurukshetra, Haryana, India
| | - Navreet Singh
- Senior Adviser (Cardiology), AFCME Subroto Park, New Delhi, India
| | - Anil Kumar
- Senior Adviser (Medicine and Cardiologist), 7 Air Force Hospital, Kanpur, U.P., India
| | - Naveen Agarwal
- Dy Commandant & Chief Instructor, Army Medical Centre, Centre & College, Lucknow, India
| | | | | | | | - D S Chadha
- Professor and Senior Consultant (Cardiology), Manipal Hospitals, Kodihalli, Bangalore, India
| | - A K Ghosh
- Senior Adviser (Medicine and Cardiology), Army Institute of Cardio Thoracic Sciences, Pune, 40, India
| | - Ratheesh Kumar
- Senior Adviser (Medicine and Cardiology), Command Hospital (Eastern Command), Kolkata, India
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Dastani M, Mokhtari M, Khameneh Bagheri R, Hassanzadeh P, Jannati Yazdan Abad M, Mohammadpour AH, Elyasi S. A Pilot study on correlation between Zinc and Magnesium serum concentrations and coronary slow flow phenomenon. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021279. [PMID: 34487108 PMCID: PMC8477114 DOI: 10.23750/abm.v92i4.9471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The pathophysiology of slow flow includes microvascular disorders, endothelial dysfunction, subclinical atherosclerosis, inflammation and anatomical factors. The role of magnesium and zinc in the development of microvascular and endothelial dysfunctions as well as atherosclerosis has been proven in previous studies, and the mechanism of the development has been studied. The aim of current study was to evaluate the serum concentration of zinc and magnesium in patients with epicardial coronary artery slow flow. DESIGN 125 patients who referred to Ghaem Hospital in Mashhad were selected based on inclusion and exclusion criteria. Magnesium and Zinc levels were evaluated in patients. The plasma levels of studied elements were compared among the different groups and the rate of coronary artery slow flow was evaluated based on the TIMI score. RESULTS The results of present study indicated that the serum level of Magnesium in the studied groups did not show a significant correlation with rate of coronary artery slow flow (P> 0.05). Serum Zinc concentration was significantly different in the studied groups, which means serum Zinc level in patients without coronary artery occlusion and without epicardial slow flow were significantly higher than other groups (P> 0.01). CONCLUSION In the present study, no significant relationship was found between the serum level of zinc and magnesium with the intensity of coronary artery slow flow based on TIMI, and further studies seem to be needed to investigate this relationship.
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17
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Lee HJ. The Evolution of Diastolic Function may be a Marker of Myocardial Ischemia in Coronary Slow Flow Phenomenon. J Cardiovasc Imaging 2021; 29:357-360. [PMID: 34080346 PMCID: PMC8592678 DOI: 10.4250/jcvi.2021.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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18
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Atorvastatin improves the proliferation and migration of endothelial progenitor cells via the miR-221/VEGFA axis. Biosci Rep 2021; 40:226426. [PMID: 32936287 PMCID: PMC7689653 DOI: 10.1042/bsr20193053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
The present study was aimed at investigating the detailed functions of atorvastatin, a lipid-lowering agent, in the pathogenesis of coronary slow flow (CSF), a clinical disease characterized by delayed angiographic coronary opacity without obstructive coronary disease. In the present study, we successfully identified isolated endothelial progenitor cells (EPCs) from the peripheral blood of patients with CSF. Their vascular endothelial growth factor-A (VEGFA) protein levels were determined using immunoblotting analyses. We determined cell viability using MTT assays, cell migration capacity using Transwell assays, and the angiogenic capacity using a tube formation assay. The target association between miR-221 and VEGFA was validated with a luciferase reporter assay. Atorvastatin treatment increased EPC VEGFA protein levels, proliferation, migration, and angiogenesis. miR-221 expression was down-regulated after atorvastatin treatment; miR-221 overexpression exerted an opposing effect to atorvastatin treatment on VEGFA protein, EPC proliferation, migration, and angiogenesis. The protective effects of atorvastatin treatment on VEGFA protein and EPCs could be significantly suppressed by miR-221 overexpression. miR-221 directly bound the VEGFA 3'UTR to inhibit its expression. In conclusion, atorvastatin improves the cell proliferation, migration, and angiogenesis of EPCs via the miR-221/VEGFA axis. Thus, atorvastatin could be a potent agent against CSF, pending further in vivo and clinical investigations.
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19
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The effect of coronary slow flow on left atrial structure and function. Sci Rep 2021; 11:7511. [PMID: 33820937 PMCID: PMC8021584 DOI: 10.1038/s41598-021-87193-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/24/2021] [Indexed: 12/01/2022] Open
Abstract
The coronary slow flow phenomenon (CSFP) is common in coronary angiography, however its impact on left atrial (LA) function is still controversial. This study aims to evaluate the LA structure and function of patients with CSFP using two-dimensional speckle tracking echocardiography (2D-STE). Consecutive patients scheduled for coronary angiography from January 2016 to September 2017 were enrolled in this study. Patients’ demographic data, clinical histories, laboratory and angiographic findings were collected and recorded. Diagnostic criteria for CSFP is based on Beltrame et al. proposed in 2012. Meanwhile 139 patients who have no significant stenosis (≤ 40%) and normal blood flow were selected as control. All patients received an echocardiographic examination 24 h before coronary angiography. LA structure and function were measured with echocardiography and 2D-STE. Our results showed that among the 1,954 patients who had received coronary angiography, 512 patients were included in the analysis after the exclusion criteria was implemented. Of those, 101 patients met the CSFP criteria (5.5%). CSFP is mainly seen in LAD (~ 70%). There was no statistical difference in baseline characteristics between the CSFP group and control group, except for a higher proportion of smokers in the CSFP group (P = 0.001). The percentage of monocytes is an independent risk factor for the occurrence of CSFP (P = 0.036) after binary logistic regression analysis. The LA global longitudinal strain (LA-GLS, represents reservoir functions) decreased and LA strain rate at late diastole (LA-SRa, represents booster function) increased in patients with CSFP compared to the control group (P < 0.05). Correlation test of continuous variables by Pearson test suggested that LA-GLS was negatively correlated with TIMI frame count (TFC). We concluded that the percentage of monocytes is an independent risk factor for the CSFP; the LA reservoir and booster functions were impaired in patients with CSFP; LA-GLS is negatively correlated with TFC.
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20
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Zengin A, Karaca M, Aruğaslan E, Yıldırım E, Karataş MB, Çanga Y, Emre A, Tayyareci G. Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary syndrome. J Cardiovasc Thorac Res 2021; 13:125-130. [PMID: 34326966 PMCID: PMC8302892 DOI: 10.34172/jcvtr.2021.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/18/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction: In this study, we aimed to determine if neutrophil to lymphocyte ratio could predict long term morbidity and mortality in patients who hospitalized for non-ST segment elevation acute coronary syndrome (NSTE-ACS) and had coronary slow flow on coronary angiography. Methods: In this observational study, 111 patients who presented with NSTE-ACS and diagnosed with coronary slow flow phenomenon on angiographic examination were included. Neutrophil to lymphocyte ratio (NLR) calculated as the ratio of the number of neutrophils to the number of lymphocytes. Patients classified into three groups according to NLR values. The term coronary slow flow phenomenon was depicted by calculating Thrombolysis in Myocardial Infarction frame count.Patients were followed up and the occurrence of recurrent angina, recurrent myocardial infarction, and long-term mortality was determined using medical records, phone calls, or face-to-face interviews. P values <0.05 considered to indicate statistical significance. Results: Recurrent angina and myocardial infarction occurred more frequently in the highest NLR tertile compared with middle and lowest NLR tertiles. High NLR group (NLR≥ 3.88 n=38) was significantly associated with younger age and smoking status. WBC, troponin I and CRP levels increased as the NLR tertile increased. Recurrent myocardial infarction and angina showed strong relationship with increasing NLR values. In multivariate regression analyses smoking and high NLR levels were independent predictors of recurrent myocardial infarction (HR:4.64 95%CI 0.95-22.52 P=0.04, HR: 1.48 95%CI 1.16-1.90 P<0.01 respectively) in the long term follow up. Conclusion: Our study demonstrated that high NLR values can be a valuable prognostic tool in the long term follow up of patients who presented with NSTE-ACS and diagnosed with slow flow phenomenon on coronary angiography.
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Affiliation(s)
- Ahmet Zengin
- Department of Cardiology, University of Health Scienses, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Karaca
- Department of Cardiology, Private Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Emre Aruğaslan
- Department of Cardiology, University of Health Scienses, Bilkent City Hospital, Ankara, Turkey
| | - Ersin Yıldırım
- Department of Cardiology, University of Health Sciences Ümraniye Training and Research Hospital Istanbul, Turkey
| | - Mehmet Baran Karataş
- Department of Cardiology, University of Health Scienses, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Yiğit Çanga
- Department of Cardiology, University of Health Scienses, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Emre
- Department of Cardiology, University of Health Scienses, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Gülşah Tayyareci
- Department of Cardiology, University of Health Scienses, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
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21
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Carvalho FPD, Azevedo CFD. Coronary Slow Flow Phenomenon - Adding Myocardial Fibrosis to the Equation. Arq Bras Cardiol 2020; 114:552-553. [PMID: 32267329 PMCID: PMC7792736 DOI: 10.36660/abc.20200187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Filipe Penna de Carvalho
- Diagnósticos da América SA, Rio de Janeiro, RJ - Brasil
- Américas Serviços Médicos, Rio de Janeiro, RJ - Brasil
| | - Clério Francisco de Azevedo
- Diagnósticos da América SA, Rio de Janeiro, RJ - Brasil
- Duke University Hospital - Medicine/Cardiology, Durham, North Carolina - EUA
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22
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Seyyed-Mohammadzad MH, Rashtchizadeh S, Khademvatani K, Afsargharehbagh R, Nasiri A, Sepehrvand N. Ventricular Dysfunction in Patients with Coronary Slow-Flow Phenomenon: A Single-center Case-control Study. Heart Views 2020; 21:60-64. [PMID: 33014297 PMCID: PMC7507914 DOI: 10.4103/heartviews.heartviews_119_18] [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: 11/22/2018] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Coronary slow-flow phenomenon (CSFP), characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis, has effects on exercise capacity and clinical outcomes. The aim of this study was to explore the systolic and diastolic function of patients with CSFP and to compare it with a group of controls with normal coronary anatomy and flow. Materials and Methods: In this case–control study, 45 consecutive CSFP patients and 45 age-, body mass index-, and presentation season-matched controls with normal coronary arteries and normal coronary flows were enrolled from Seyyedoshohada Heart Center from March 2015 to March 2016. A transthoracic echocardiography was done by a blinded echocardiographer using both conventional and tissue Doppler imaging techniques. Results: Patients with CSFP were more likely to be male (P = 0.006) and smoker (P = 0.02) compared to controls. Other risk factors were not different between the two groups. There were no differences between groups in terms of the peak early (E) and late (A) diastolic velocities, deceleration time, early (E’) and late (A’) peak diastolic velocities at the mitral annulus, and the systolic mitral annular velocity (S’). Global longitudinal strain and peak systolic strain rates was lower in patients with CSFP compared to controls (−16.7% ±2.4% vs. −18.9% ±1.6%, P < 0.001 and 1.10 ± 0.1 vs. 1.24 ± 0.3, P = 0.008, respectively). Conclusion: Patients with CSFP showed signs of the left ventricular systolic dysfunction in tissue Doppler echocardiography, which underlines the importance of close follow-up in these patients. Patients with CSFP should be screened for ventricular function preferably by tissue Doppler echocardiography.
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Affiliation(s)
| | - Sanam Rashtchizadeh
- Department of Cardiology, Seyyedoshohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Kamal Khademvatani
- Department of Cardiology, Seyyedoshohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Roghaiyeh Afsargharehbagh
- Department of Cardiology, Seyyedoshohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Aliakbar Nasiri
- Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran
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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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Wang Y, Li J, Liu S, Mu L, Li G, Yu H, Yang J, Ma C. Value of exercise stress electrocardiography for stratification of exercise capacity and left ventricular systolic and diastolic function on coronary slow flow: case-control study. BMC Cardiovasc Disord 2019; 19:288. [PMID: 31830922 PMCID: PMC6909497 DOI: 10.1186/s12872-019-01291-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Coronary slow flow phenomenon (CSFP) is an angiographic entity characterized by delayed coronary opacification in absence of evident obstructive lesion in the epicardial coronary artery. However, whether patients with CSFP exhibit differing responses to exercise is still not known. This study aimed to evaluate results of exercise stress electrocardiography (ExECG) and left ventricular (LV) function during exercise, and study the value of ExECG for stratification of exercise capacity and LV function in patients with CSFP. Methods Thirty patients with CSFP and 24 controls were enrolled in the study. Diagnosis of CSFP was made by Thrombolysis in Myocardial Infarction frame count. ExECG and LV function measured by echocardiography at rest, during exercise and recovery phase were evaluated. Results Negative ExECG was found in 24 (80%) patients with CSFP. At rest, LV global longitudinal strain (GLS) decreased and mitral average E/e’ increased in patients with CSFP compared with controls; however, there were no differences in these parameters between CSFP patients with negative ExECG and patients with positive ExECG. During exercise, CSFP patients with negative ExECG and controls had significantly increased LV GLS and decreased mitral average E/e’, but CSFP patients with positive ExECG had significantly decreased LV GLS and increased mitral average E/e’. Conclusions About 80% patients with CSFP exhibited negative ExECG. CSFP patients with negative ExECG exhibited improved LV function but CSFP patients with positive ExECG exhibited impaired LV function during exercise. ExECG may aid in the stratification of exercise capacity and LV function in patients with CSFP.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Jinyang Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Lixin Mu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Hang Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China.
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25
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Elamragy AA, Abdelhalim AA, Arafa ME, Baghdady YM. Anxiety and depression relationship with coronary slow flow. PLoS One 2019; 14:e0221918. [PMID: 31487310 PMCID: PMC6728014 DOI: 10.1371/journal.pone.0221918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Psychiatric disorders (depression / anxiety) are linked to coronary artery disease (CAD). Coronary slow flow (CSF) is a relatively common form of CAD with the same underlying mechanisms that are attributed to many anatomic and pathophysiologic factors. However, the relationship between psychiatric disorders and CSF is less well-established; and this is the aim of this study. Methods This cross-sectional observational study was conducted on the first 50 consecutive patients diagnosed with CSF by elective coronary angiography (CAG). They were compared with another 50 consecutive patients showing normal coronaries by CAG. Beck Anxiety Inventory and Beck Depression Inventory were used for assessment. CSF was diagnosed by coronary angiography “Thrombolysis In Myocardial Infarction” frame count. Lipid profile was obtained for all patients. Results Traditional risk factors (male gender, smoking, total cholesterol, low-density lipoproteins and triglycerides) were higher in the CSF group. Depression and anxiety scores were also higher in the CSF group. On multivariate analysis, male gender, depression and high triglycerides were the only significant independent predictors of CSF. A significant correlation existed between CSF and both anxiety and depression scores. Both scores were also significantly higher in multivessel vs single vessel affection. Conclusion Psychiatric depression, male gender and high triglycerides are highly associated with CSF in patients undergoing elective CAG. There is a significant correlation between CSF severity and the severity of both anxiety and depression. Further studies are warranted to explore the impact of psychological intervention on CSF and its long-term outcome.
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26
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Xing Y, Chen Y, Liu Y, Kong D, Yan Y, Shu X, Pan C. Evaluation of left atrial volume and function in patients with coronary slow flow phenomenon using real-time three-dimensional echocardiography. Int J Cardiovasc Imaging 2019; 35:2197-2203. [PMID: 31346892 DOI: 10.1007/s10554-019-01676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate the left atrial (LA) volume and phasic functions using real-time three-dimensional echocardiography (RT3DE) in coronary slow flow phenomenon (CSFP) patients with preserved left ventricular ejection fraction (LVEF). 56 patients with CSFP (36 males, 20 females) and 48 controls with normal coronary flow (27 males, 21 females) were prospectively enrolled. Comprehensive transthoracic echocardiographic examination and RT3DE for the assessment of LA dynamics were performed in all participants. LA maximum, minimum, and pre-atrial contraction volumes (LAV-max, LAV-min, and LAV-preA) were obtained for every subject. Conventional echocardiographic parameters, except for isovolumetric relaxation time and transmitral deceleration time, did not differ in two groups. RT3DE demonstrated higher LAV-max, LAV-min, LAV-preA, indexed LAV-max (LAVi-max), LA total emptying volume, and LA active emptying volume and fraction for CSFP patients compared with controls (all P < 0.05). In addition, LA total emptying fraction and LA passive emptying fraction were found to be lower in CSFP patients than in controls (all P < 0.05). Moreover, there were positive correlations between mean thrombolysis in myocardial infarction frame count values and LAV-max, LAV-min, LAV-preA, LAVi-max, and LA total and active emptying volumes. CSFP was associated with enlarged LA volumes, impaired LA reservoir and conduit function and enhanced contractile function. Evaluation of LA dynamics using RT3DE could facilitate recognition of subtle myocardial alterations related with CSFP.
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Affiliation(s)
- Yumeng Xing
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yongle Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yan Yan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Tse G, Bazoukis G, Roever L, Liu T, Wu WKK, Wong MCS, Baranchuk A, Korantzopoulos P, Asvestas D, Letsas KP. T-Wave Indices and Atherosclerosis. Curr Atheroscler Rep 2018; 20:55. [PMID: 30225618 DOI: 10.1007/s11883-018-0756-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tpeak-Tend interval, the time difference between the peak and the end of the T-wave, reflects the degree of dispersion of repolarization. Its prolongation has been associated with higher risks of developing ventricular arrhythmias and sudden cardiac death in different pro-arrhythmic conditions such as Brugada and long QT syndromes. In this review, we will provide a comprehensive overview on how Tpeak-Tend is altered in different atherosclerotic conditions such as hypertension, stable coronary artery disease, acute coronary obstruction, and coronary slow flow as well as inflammatory diseases affecting the arterial tree. We will explore its relationship with arterial function and dysfunction, ventricular remodeling, and arrhythmic and mortality outcomes. The published literature shows that patients with coronary atherosclerosis, whether in the form of stable coronary artery disease, chronic total occlusion, slow flow, or acute coronary obstruction, have prolonged Tpeak-Tend intervals and Tpeak-Tend/QT ratios. These can be used to predict the occurrence of ventricular arrhythmias and sudden cardiac death. They also correlate with the extent and severity of arterial stenosis and structural remodeling of the ventricles as well as arterial function and dysfunction. Finally, they can be normalized following revascularization and may therefore be used as a surrogate measure of treatment success.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China. .,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
| | - George Bazoukis
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - Dimitrios Asvestas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece. .,Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece.
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Gong X, Liu M, Guo Y, Han W, Liao D, Cai H, Jiang P. Alleviating Effect of Antidepressant Treatment on Psychiatric Symptoms and Cardiac Conditions in a Patient with Coronary Slow Flow Comorbid with Depression and Anxiety. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1068-1070. [PMID: 30185769 PMCID: PMC6140453 DOI: 10.12659/ajcr.909643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Coronary slow flow Symptoms: Frequent chest pain • serious TIMI grade 2 flow without any coronary stenosis • comorbid with depression and anxiety Medication: — Clinical Procedure: — Specialty: Psychiatry
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Affiliation(s)
- Xiaoxue Gong
- Institute of Clinical Pharmacy, Jining First People's Hospital, Jining Medical University, Jining, Shandong, China (mainland)
| | - Min Liu
- Department of Cardiology, Jining First People's Hospital, Jining Medical University, Jining, Shandong, China (mainland)
| | - Yujin Guo
- Institute of Clinical Pharmacy, Jining First People's Hospital, Jining Medical University, Jining, Shandong, China (mainland)
| | - Wenxiu Han
- Institute of Clinical Pharmacy, Jining First People's Hospital, Jining Medical University, Jining, Shandong, China (mainland)
| | - Dehua Liao
- Department of Pharmacy, Hunan Cancer Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Hualin Cai
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Pei Jiang
- Institute of Clinical Pharmacy, Jining First People's Hospital, Jining Medical University, Jining, Shandong, China (mainland)
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29
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Alvarez C, Siu H. Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review. J Investig Med High Impact Case Rep 2018; 6:2324709618789194. [PMID: 30038914 PMCID: PMC6050810 DOI: 10.1177/2324709618789194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/10/2018] [Accepted: 06/23/2018] [Indexed: 01/08/2023] Open
Abstract
Background. Coronary slow-flow phenomenon (CSFP) is characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis. CSFP has been reported as a cause of chest pain and abnormal noninvasive ischemic tests and is often underrecognized. Material and Methods. Charts and angiographic records from our institution were reviewed to identify 15 consecutive patients who were diagnosed with CSFP from January 2016 to January 2017. Results. Of the 15 patients (4 females and 11 males) studied, the mean age was 59.1 years (range = 45-86 years); all had left ventricular ejection fraction >45% and without significant valvular stenosis/regurgitation. The indication for coronary angiography for all 15 patients was chest pain with abnormal noninvasive tests. Of the 11 patients who underwent previous coronary angiograms, all revealed prior evidence of CSFP. None of these patients were on calcium channel blockers (CCBs) or long-acting nitroglycerin agents before angiography. Intracoronary CCBs were effectively utilized to alleviate the angiographic finding (improvement in Thrombolysis in Myocardial Infarction frame count) in all 15 patients. Oral CCBs were started with subsequent improvement in all 15 patients (mean follow-up time = 13.6 months). Conclusion. Coronary slow-flow should be a diagnostic consideration in patients presenting with chest pain and abnormal noninvasive ischemic testing with nonobstructive epicardial vessels. CSFP remains underrecognized, and the specific standard of care for treatment has not been established. In each of the 15 cases, intracoronary nifedipine resolved the angiographic manifestation of coronary slow-flow. Furthermore, in follow-up, all patients improved symptomatically from their chest pain after oral CCBs were initiated.
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Affiliation(s)
| | - Henry Siu
- St. Francis Medical Center, Trenton, NJ, USA.,Thomas Jefferson University, Philadelphia, PA, USA
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30
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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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Chacko J, Brar G, Mundlapudi B, Kumar P. Papillary Muscle Dysfunction Due to Coronary Slow-Flow Phenomenon Presenting with Acute Mitral Regurgitation and Unilateral Pulmonary Edema. Indian J Crit Care Med 2018; 22:806-808. [PMID: 30598569 PMCID: PMC6259443 DOI: 10.4103/ijccm.ijccm_343_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cardiogenic pulmonary edema usually presents with characteristic clinical features and bilateral infiltrates on the chest radiograph. Rarely, pulmonary edema may manifest unilaterally, leading to a mistaken diagnosis of a primary lung pathology. We present a 30-year-old man who developed acute coronary syndrome following an overdose of alprazolam. He developed breathlessness with unilateral infiltrates on the chest radiograph. Echocardiography revealed regional wall motion abnormalities related to underlying ischemia and acute mitral regurgitation with an eccentric jet. Besides, he had significant impairment of left ventricular systolic function. His coronary angiogram revealed a slow-flow phenomenon in the right coronary and left anterior descending artery territories. Ischemia-related dysfunction of the posterolateral papillary muscle probably led to a floppy posterior mitral leaflet and an eccentrically directed regurgitant jet, leading to unilateral pulmonary edema. He was commenced on dual antiplatelet therapy, heparin infusion, atorvastatin, frusemide, and ramipril, following which he showed gradual clinical improvement along with resolution of the radiological infiltrates. His left ventricular function improved, and the mitral valve function normalized on echocardiography within a week.
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Affiliation(s)
- Jose Chacko
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Gagan Brar
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Bhargav Mundlapudi
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Pradeep Kumar
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
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Niu H, Wei Z, Zhang Y, He J, Jia D. Atorvastatin improves coronary flow and endothelial function in patients with coronary slow flow. Exp Ther Med 2017; 15:904-908. [PMID: 29399097 PMCID: PMC5772870 DOI: 10.3892/etm.2017.5484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/31/2017] [Indexed: 01/16/2023] Open
Abstract
The underlying mechanisms behind the effect of atorvastatin on patients with coronary slow flow (CSF) remain largely unknown. To investigate the possible underlying molecular mechanisms 108 patients were divided into atorvastatin group and control group. Coronary flow was quantified according to corrected TIMI frame count (CTFC). Serum high sensitivity C-reactive protein (hs-CRP), lipids, ET-1, interleukin (IL)-6, NO, circulating endothelial progenitor cell (cEPC) count, adhesion, migration and proliferation were measured in pretreatment and post-treatment. After respective treatment, the atorvastatin group had significantly decreased levels of TC, TG, LDL-C, hs-CRP, ET-1 and IL-6 and increased NO compared to the control group. The atorvastatin group had a more significant improvement of CTFC, effective rate, cEPC number, EPC adhesion, migration and proliferation compared to the control group. In conclusion, atorvastatin can be used in treatment of CSF by suppressing inflammation and improving endothelial function.
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Affiliation(s)
- Hongmei Niu
- Department of Cardiovascular Medicine, Shandong Provincial Third Hospital, Jinan, Shandong 250000, P.R. China
| | - Zhenzhen Wei
- Department of Cardiovascular Medicine, The First People's Hospital of Jinan, Jinan, Shandong 250000, P.R. China
| | - Yanling Zhang
- Department of Cardiovascular Medicine, The First People's Hospital of Jinan, Jinan, Shandong 250000, P.R. China
| | - Jian He
- Digestive Disease Department of Internal Medicine, The First People's Hospital of Jinan, Jinan, Shandong 250000, P.R. China
| | - Danyan Jia
- Jinan First Aid Center, Jinan, Shandong 250000, P.R. China
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Rasmi Y, Bagheri M, Faramarz-Gaznagh S, Nemati M, Khadem-Ansari MH, Saboory E, Seyed-Mohamadzad MH, Shirpoor A. Transcriptional activity of tumor necrosis factor-alpha gene in peripheral blood mononuclear cells in patients with coronary slow flow. ARYA ATHEROSCLEROSIS 2017; 13:196-201. [PMID: 29147131 PMCID: PMC5677324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary slow flow (CSF), an angiographic phenomenon that is characterized by a delayed coronary blood flow in the absence of obstructive coronary artery stenosis, is known as a disorder of the coronary microcirculation. Inflammation has an important role in the vascular hemostasis and endothelial dysfunction especially regarding monocyte adhesion and infiltration. Pro-inflammatory cytokines released by inflammatory cells result in endothelial cell dysfunction and cardiovascular diseases. It has been demonstrated that tumor necrosis factor-alpha (TNF-α) mainly influences the vascular homeostasis and endothelial dysfunction. In the present enquiry the transcriptional activity of TNF-α gene in peripheral blood mononuclear cells (PBMCs) of patients with CSF was compared with healthy controls in order to further survey the role of TNF-α in pathophysiology of CSF. METHODS The study was carried out on 30 patients with CSF and 30 matched healthy controls. To analysis gene expression of TNF-α, total mRNA was isolated from PBMCs. The quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was used to compare the transcriptional activity of TNF-α gene between patients with CSF and controls. RESULTS The mean ± standard error of mean of fold in CSF patients and controls were 0.20 ± 0.04 and 1.38 ± 0.27, respectively. The mRNA mean expressions of TNF-α (fold) were different in tested groups, which indicated a significant decrease in TNF-α in patients with CSF group (P = 0.0001). CONCLUSION Expression of TNF-α was decreased in patients with CSF. Changes in TNF-α expression suggest a potential role for altered immune function in the pathophysiology of CSF.
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Affiliation(s)
- Yousef Rasmi
- Professor, Cellular and Molecular Research Center AND Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Morteza Bagheri
- Assistant Professor, Cellular and Molecular Research Center AND Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran,Correspondence to: Morteza Bagheri,
| | - Sanaz Faramarz-Gaznagh
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohadeseh Nemati
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Ehsan Saboory
- Professor, Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mir Hossein Seyed-Mohamadzad
- Associate Professor, Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Alireza Shirpoor
- Associate Professor, Department of Physiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Fallah F, Narimani S, Yarmohammadi S, Hosseinsabet A, Jalali A. Is Left Atrial Function Affected by Coronary Slow Flow? A Two-dimensional Speckle-Tracking Echocardiographic Study. J Cardiovasc Echogr 2017; 27:121-125. [PMID: 29142809 PMCID: PMC5672683 DOI: 10.4103/jcecho.jcecho_9_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The coronary slow flow phenomenon (CSFP) is the slow passage of the angiographic contrast agent to the distal portion of the coronary artery in the absence of significant stenosis. We evaluated the left atrial (LA) function in patients with the CSFP using two-dimensional speckle-tracking echocardiography (2DSTE). Methods: The LA function was compared through 2DSTE between 36 patients with the CSFP and 36 participants with a normal coronary flow. The two groups were matched for age, sex, hypertension, diabetes mellitus, and the left ventricular function. Results: There were no statistically significant differences between the CSFP group and the control group regarding longitudinal systolic strain, early and late diastolic strains, and the strain rate of the LA myocardium. Conclusions: The LA function as evaluated with 2DSTE was not different between the CSFP group and the normal coronary flow group when they were matched for age, sex, hypertension, diabetes, and the left ventricular function.
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Affiliation(s)
- Flora Fallah
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Narimani
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Yarmohammadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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35
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Caglar IM, Ozde C, Biyik I, Caglar FNT, Akturk IF, Ugurlucan M, Karakaya O. Association between soluble lectin-like oxidized low-density lipoprotein receptor 1 levels and coronary slow flow phenomenon. Arch Med Sci 2016; 12:31-7. [PMID: 26925116 PMCID: PMC4754361 DOI: 10.5114/aoms.2015.51412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The coronary slow flow phenomenon (CSFP) has been associated with myocardial ischemia, myocardial infarction, life-threatening arrhythmias, sudden cardiac death and increased cardiovascular mortality similar to coronary artery disease (CAD). Possible underlying mechanisms of CSFP are endothelial dysfunction, chronic inflammation, microvascular dysfunction and diffuse atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) seems to play an important role in the pathogenesis of atherosclerosis. We hypothesized that sLOX-1 might be associated with CSFP, and aimed to research the relationship between sLOX-1 and CSFP. MATERIAL AND METHODS Forty patients with angiographically proven CSFP and 43 patients with a normal coronary flow pattern (NCFP) were included in this study. Coronary blood flow was measured according to the Thrombolysis In Myocardial Infarction (TIMI) frame count method. sLOX-1 levels were measured in all study subjects. RESULTS Serum levels of sLOX-1 were significantly higher in the CSFP group than the NCFP group (1061.80 ±422.20 ng/ml vs. 500.043 ±282.97 ng/ml, p < 0.001, respectively). Multivariate logistic regression analysis including sLOX-1, MPV, GGT and uric acid levels revealed a significant association between sLOX-1 levels and CSFP (Exp (B)/OR: 1.006, 95% CI: 1.002-1.010, p = 0.001). CONCLUSIONS The present study demonstrated that serum sLOX-1 levels were significantly higher in patients with CSFP and there was a strong association between high sLOX-1 levels and CSFP. High serum sLOX-1 levels may have an important role in the pathogenesis of CSFP. Future studies are needed to confirm these results.
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Affiliation(s)
- Ilker Murat Caglar
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Cem Ozde
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ismail Biyik
- Department of Cardiology, Usak State Hospital, Usak, Turkey
| | | | - Ibrahim Faruk Akturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Karakaya
- Department of Cardiology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Totsugawa T, Sakaguchi T, Hiraoka A, Irisawa Y, Maeda K, Yoshitaka H. Hypertrophic aortic branches can potentially cause critical problems during minimally invasive cardiac surgery. Gen Thorac Cardiovasc Surg 2015; 64:10-3. [PMID: 26499060 DOI: 10.1007/s11748-015-0597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/10/2015] [Indexed: 11/28/2022]
Abstract
Here we present two cases in which hypertrophic aortic branches caused trouble during minimally invasive cardiac surgery. We performed mitral valvuloplasty with the Maze procedure in Case 1 and mitral valvuloplasty with aortic valve replacement in Case 2 via mini-thoracotomy. In preoperative computed tomography scan, we did not note a hypertrophic bronchial artery in Case 1 or a dilated intercostal artery in Case 2. The right atrium was distended after aortic cross-clamping and perioperative myocardial infarction occurred in Case 1. Whereas, we could effectively deal with this situation in Case 2. The increased pulmonary blood flow can potentially cause critical problems during minimally invasive surgery. Sufficient venting of the right ventricle and secure myocardial protection is the key to perform safe surgery in the presence of dilated aortic branches. However, surgeons should not hesitate to convert to sternotomy under poor surgical exposure despite sufficient venting.
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Akboğa MK, Yayla Ç, Canpolat U, Aras D. Platelet to lymphocyte ratio: a novel and simple predictor of slow coronary flow. Anatol J Cardiol 2015; 15:679. [PMID: 26301354 PMCID: PMC5336877 DOI: 10.5152/anatoljcardiol.2015.6460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mehmet Kadri Akboğa
- Clinic of Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital; Ankara-Turkey.
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Ozyurtlu F, Yavuz V, Cetin N, Acet H, Ayhan E, Isik T. The association between coronary slow flow and platelet distribution width among patients with stable angina pectoris. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:161-5. [PMID: 25489301 PMCID: PMC4252306 DOI: 10.5114/pwki.2014.45142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/07/2014] [Accepted: 02/13/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Coronary slow flow (CSF) is an angiographic phenomenon characterised by the delay of distal vessel opacification in the absence of significant stenosis of the epicardial coronary arteries. Some of the factors playing a role in CSF pathophysiology are increased thrombogenic activity and inflammation. AIM To examine the relationship between platelet distribution width (PDW) and CSF. MATERIAL AND METHODS Taking into consideration the exclusion criteria, 136 patients with CSF and 152 patients with normal coronary angiographies (control group) were included in the study. The association between thrombolysis infarction frame count (TFC) in myocardial and laboratory and other clinical parameters were evaluated. RESULTS The stated parameters were significantly higher in the group with CSF than in the normal coronary angiography group (control group). The PDW (16.6 ±0.7 vs. 16.4 ±0.6, p = 0.002), neutrophil lymphocyte ratio (NLR) (3.1 ±3.4 vs. 2.4 ±1.1, p = 0.027), haemoglobin (Hb) (14.1 ±1.3 vs. 14.7 ±1.1, p < 0.001), and red cell distribution width (RDW) (13.6 ±0.7 vs. 14.1 ±2.8, p = 0.026) were significantly higher in the CSF group than in the control group. Moreover, our study showed that PDW > 16.15 and Hb > 1 3.75 were predictors of the presence of CSF with sensitivities of 83% and 73% and specificities of 40% and 42%, respectively. CONCLUSIONS This study has demonstrated that compared to normal coronary flow, PDW, Hb, NLR, and RDW are significantly higher in CSF patients. We believe that further studies are needed to clarify the role of PDW and Hb in patients with CSF.
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Affiliation(s)
| | | | | | - Halit Acet
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Erkan Ayhan
- Department of Cardiology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Turgay Isik
- Department of Cardiology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
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Yuksel S, Pancar Yuksel E, Yenercag M, Soylu K, Zengin H, Gulel O, Meriç M, Aydin F, Senturk N, Sahin M. Abnormal nail fold capillaroscopic findings in patients with coronary slow flow phenomenon. Int J Clin Exp Med 2014; 7:1052-1058. [PMID: 24955181 PMCID: PMC4057860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
The coronary slow flow phenomenon (CSFP) is the delayed opacification of coronary arteries in the absence of significant stenosis. The pathogenesis of CSFP has not been completely understood yet. There are several proposed mechanisms such as the structural and functional abnormalities in coronary microcirculation. Nail fold capillaroscopy is a simple, noninvasive examination of the microvasculature and suggested to be a useful technique for analysis in various inflammatory and autoimmune diseases. In this study; we hypothesized that; CSFP is a part of systemic vascular entity rather than a problem confined to coronary vasculature and our aim was to investigate the nail fold capillaries of the patients with CSFP and compare to those with normal coronary flow (NCF). The study was designed as a case-control study and total 25 patients (10 male, mean age 55 ± 9 years) with documented CSFP, and 24 patients (15 male, mean age 55 ± 11 years) with NCF were recruited. Nail fold capillaroscopy examinations were performed by video dermatoscopy in all patients and results were compared between two groups. The demographic and clinical characteristics were similar between patients of CSFP and NCF groups. Nail fold capillary abnormalities including dilatation, tortuosity and microhemorrhage were present in 15 (60%) patients in CSFP group and 5 (21%) patients in NCF group (p < 0.05 OR: 5.7 95% C.I 1.602-20.279). In this study, we found that the abnormalities in nail fold capillaries suggesting the presence of inflammation and anatomical changes were significantly higher in patients with CSFP.
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Affiliation(s)
- Serkan Yuksel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Esra Pancar Yuksel
- Department of Dermatology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Mustafa Yenercag
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Halit Zengin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Okan Gulel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Murat Meriç
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Fatma Aydin
- Department of Dermatology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Nilgun Senturk
- Department of Dermatology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
| | - Mahmut Sahin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis UniversitySamsun, Turkey
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Masci PG, Bogaert J. Post myocardial infarction of the left ventricle: the course ahead seen by cardiac MRI. Cardiovasc Diagn Ther 2013; 2:113-27. [PMID: 24282705 DOI: 10.3978/j.issn.2223-3652.2012.04.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/26/2012] [Indexed: 12/13/2022]
Abstract
In the last decades, cardiac magnetic resonance imaging (MRI) has gained acceptance in cardiology community as an accurate and reproducible diagnostic imaging modality in patients with ischemic heart disease (IHD). In particular, in patients with acute myocardial infarction (MI) cardiac MRI study allows a comprehensive assessment of the pattern of ischemic injury in term of reversible and irreversible damage, myocardial hemorrhage and microvascular obstruction (MVO). Myocardial salvage index, derived by quantification of myocardium (area) at risk and infarction, has become a promising surrogate end-point increasingly used in clinical trials testing novel or adjunctive reperfusion strategies. Early post-infarction, the accurate and reproducible quantification of myocardial necrosis, along with the characterization of ischemic myocardial damage in its diverse components, provides important information to predict post-infarction left ventricular (LV) remodeling, being useful for patients stratification and management. Considering its non-invasive nature, cardiac MRI suits well for investigating the time course of infarct healing and the changes occurring in peri-infarcted (adjacent) and remote myocardium, which ultimately promote the geometrical, morphological and functional abnormalities of the entire left ventricle (global LV remodeling). The current review will focus on the cardiac MRI utility for a comprehensive evaluation of patients with acute and chronic IHD with particular regard to post-infarction remodeling.
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Affiliation(s)
- Pier Giorgio Masci
- Magnetic Resonance Imaging and Cardiovascular Medicine Departments, Fondazione CNR/Regione Toscana 'G. Monasterio', Pisa, Italy
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Schoenhagen P, Isma’eel H, Mocumbi AO. 'Longitudinal' topics in Cardiovascular Diagnosis and Therapy (CDT). Cardiovasc Diagn Ther 2012; 2:83-4. [PMID: 24282701 PMCID: PMC3839149 DOI: 10.3978/j.issn.2223-3652.2012.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/08/2012] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Ana Olga Mocumbi
- National Health Institute & Eduardo Mondlane University-Mozambique
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