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Yu J, Ran Y, Yi D, Yang C, Zhou X, Wang S, Li H, Yu W, Sun Z, Zhang Z, Yan M. Establishment and verification of a nomogram that predicts the risk for coronary slow flow. Front Endocrinol (Lausanne) 2024; 15:1337284. [PMID: 38501108 PMCID: PMC10944880 DOI: 10.3389/fendo.2024.1337284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024] Open
Abstract
Background Coronary slow flow (CSF) has gained significance as a chronic coronary artery disease, but few studies have integrated both biological and anatomical factors for CSF assessment. This study aimed to develop and validate a simple-to-use nomogram for predicting CSF risk by combining biological and anatomical factors. Methods In this retrospective case-control study, 1042 patients (614 CSF cases and 428 controls) were randomly assigned to the development and validation cohorts at a 7:3 ratio. Potential predictive factors were identified using least absolute shrinkage and selection operator regression and subsequently utilized in multivariate logistic regression to construct the nomogram. Validation of the nomogram was assessed by discrimination and calibration. Results N-terminal pro brain natriuretic peptide, high density lipoprotein cholesterol, hemoglobin, left anterior descending artery diameter, left circumflex artery diameter, and right coronary artery diameter were independent predictors of CSF. The model displayed high discrimination in the development and validation cohorts (C-index 0.771, 95% CI: 0.737-0.805 and 0.805, 95% CI: 0.757-0.853, respectively). The calibration curves for both cohorts showed close alignment between predicted and actual risk estimates, demonstrating improved model calibration. Decision curve analysis suggested high clinical utility for the predictive nomogram. Conclusion The constructed nomogram accurately and individually predicts the risk of CSF for patients with suspected CSF and may be considered for use in clinical care.
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Affiliation(s)
- Jiang Yu
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Yangshan Ran
- Department of Internal Medicine, Xuanhan Chinese Medicine Hospital, Dazhou, Sichuan, China
| | - Dan Yi
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Chengyu Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Zhou
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Sibin Wang
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Hao Li
- Department of General Medicine, Zhige Township Hospital, Meishan, Sichuan, China
| | - Wensi Yu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Zhijun Sun
- Department of Cardiology, The First Medical Centre of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhengbo Zhang
- Center for Artificial Intelligence, Medical Innovation and Research Department, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
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Stępień K, Nowak K, Karcińska A, Horosin G, del Carmen Yika A, Lenart J, Górowska A, Iwańczyk S, Podolec M, Siniarski A, Nessler J, Zalewski J. Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact. Int J Mol Sci 2024; 25:1297. [PMID: 38279297 PMCID: PMC10816693 DOI: 10.3390/ijms25021297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25-40) vs. 40 (35-45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12-48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.
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Affiliation(s)
- Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Aleksandra Karcińska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Grzegorz Horosin
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Alicia del Carmen Yika
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Julia Lenart
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Anna Górowska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
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Toprak K, Özen K, Memioğlu T, İnanır M, Kaplangöray M, Akyol S, Tascanov MB, Biçer A, Demirbağ R. Comparison of the effect of uric acid/albumin ratio on coronary slow flow with other inflammation-based markers. Biomark Med 2024; 18:25-37. [PMID: 38323551 DOI: 10.2217/bmm-2023-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Many inflammation-based markers (IBMs) have been shown to be closely related to coronary slow flow (CSF), but the effect of the uric acid/albumin ratio (UAR) on CSF and its relationship with other IBMs are not clearly known. In this study, we aimed to compare the effects of UAR and other IBMs on CSF. Methods: After the exclusion criteria, 126 patients with CSF detected on coronary angiography and 126 subjects with normal coronary flow as the control group were included in the study. Results: UAR was determined as an independent predictor for CSF. In addition, the UAR was superior to other IBMs in detecting CSF (p < 0.05 for all). Conclusion: This study is the first to investigate the effect of UAR on CSF in comparison with other IBMs.
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Affiliation(s)
- Kenan Toprak
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, 63050, Turkey
| | - Kaya Özen
- Gazi Yaşargil Training & Research Hospital, Department of Cardiology, Diyarbakır, 21010, Turkey
| | - Tolga Memioğlu
- Abant Izzet Baysal University, Medical Faculty, Department of Cardiology, Bolu, 14300, Turkey
| | - Mehmet İnanır
- Abant Izzet Baysal University, Medical Faculty, Department of Cardiology, Bolu, 14300, Turkey
| | - Mustafa Kaplangöray
- Şeyh Edebali University, Medical Faculty, Department of Cardiology, Bilecik, 11230, Turkey
| | - Selahattin Akyol
- Kartal Kosuyolu High Specialization Training & Research Hospital, Department of Cardiology, İstanbul, 34865, Turkey
| | - Mustafa B Tascanov
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, 63050, Turkey
| | - Asuman Biçer
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, 63050, Turkey
| | - Recep Demirbağ
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, 63050, Turkey
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Oksen D, Aslan M, Ozmen E, Yavuz YE. Ranolazine improved left ventricular diastolic functions and ventricular repolarization indexes in patients with coronary slow flow. Front Cardiovasc Med 2023; 10:1207580. [PMID: 37671136 PMCID: PMC10475721 DOI: 10.3389/fcvm.2023.1207580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Coronary slow flow (CSF) is a condition commonly encountered during angiography. Recent studies have shown the adverse effects of CSF on left ventricular diastolic functions. CSF reportedly increases the novel ventricular repolarization parameters. Ranolazine is a preparation with a prominent anti-anginal activity that has positive effects on anti-arrhythmic and diastolic parameters. In this context, this study was carried out to investigate the effects of ranolazine on left ventricular diastolic functions and repolarization in patients with CSF. Material and methods Forty-six patients with CSF and 29 control subjects were included in the patient and control groups, respectively. Both groups received ranolazine for one month and were evaluated using 12-lead electrocardiography, conventional echocardiography, and tissue Doppler imaging at the baseline and after one month of ranolazine treatment. Results Corrected P, QT dispersion, and Tp-e interval values were significantly higher in the patient group than in the control group. There was a significant decrease in isovolumic relaxation time (IVRT) and deceleration time (DT) values after the ranolazine treatment compared to the baseline values in the patient group but not the control group. A significant increase was observed in the mean E and A velocities and the mean E/A ratio after the ranolazine treatment compared to the baseline values in the patient group. Additionally, there was a significant difference between the Tp-e interval and corrected P dispersion values measured after the ranolazine treatment compared to the baseline values in the patient group but not in the control group. Conclusion This study's findings demonstrated that ranolazine positively affected impaired diastolic functions and repolarization parameters, particularly in patients with CSF.
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Affiliation(s)
- Dogac Oksen
- Department of Cardiology, Faculty of Medicine, Altınbaş University, Istanbul, Türkiye
| | - Muzaffer Aslan
- Department of Cardiology, Faculty of Medicine, Siirt University, Siirt, Türkiye
| | - Emre Ozmen
- Department of Cardiology, Faculty of Medicine, Siirt University, Siirt, Türkiye
| | - Yunus Emre Yavuz
- Department of Cardiology, Faculty of Medicine, Siirt University, Siirt, Türkiye
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Dong T, Zhu Q, Wang S, Liu S, Wang S, Wang Y, Li H, Li G, Ma C. Evaluation of left ventricular function in patients with coronary slow flow: A systematic review and meta-analysis. Cardiol J 2023:VM/OJS/J/91952. [PMID: 37519056 DOI: 10.5603/cj.a2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is an angiographic finding defined as delayed distal vessel perfusion without severe stenosis of the epicardial coronary arteries. However, definite alterations in left ventricular (LV) function in patients with CSF remains inconsistent. This study aimed to clarify the changes in LV function in patients with CSF and explore the factors that may influence LV function. METHODS PubMed, Embase, and Cochrane Library databases were systematically searched. Standardized mean differences and 95% confidence intervals (CI) for the LV function parameters were calculated. Subgroup analysis, meta-regression analysis, and correlation analysis were performed to explore the factors influencing LV function. RESULTS Twenty-two studies (1101 patients with CSF) were included after searching three databases. In patients with CSF, LV ejection function in patients with CSF was marginally lower (61.8%; 95% CI: 61.0%, 62.7%), global longitudinal strain was decreased (-18.2%; 95% CI: -16.7%, -19.7%). Furthermore, left atrial diameter, left atrial volume index, and E/e' were significantly increased, while E/A and e' were significantly decreased. The mean thrombolysis in myocardial infarction frame count (TFC) was linearly associated with LV function; the larger the mean TFC, the greater the impairment of LV function. CONCLUSIONS Left ventricular systolic and diastolic functions were impaired in patients with CSF, and this impairment was aggravated with increasing mean TFC.
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Affiliation(s)
- Tianxin Dong
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Qing Zhu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Shang Wang
- Dalian Medical University, Dalian, Liaoning, China
| | - Shuo Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Shitong Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Honghe Li
- School of Computer Science and Engineering, Northeastern University, Shenyang, Liaoning, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, Liaoning, China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China.
- Clinical Medical Research Center of Imaging in Liaoning Province, Shenyang, Liaoning, China.
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Belharty N, Fertat O, El Ghali T, Tabti F, Benmessaoud FA, Oukerraj L, Cherti M. Ectatic Coronary Arteries: Diversity at Its Finest. Cureus 2023; 15:e38381. [PMID: 37265918 PMCID: PMC10231275 DOI: 10.7759/cureus.38381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
Coronary artery ectasia (CAE) is an entity causing inappropriate dilatation of the coronary tree, that is angiographically defined, albeit arbitrarily, by the diameter of the ectatic segment being more than 1.5 times larger in comparison with an adjacent healthy reference segment. Although the causative mechanisms are poorly understood, atherosclerosis is greatly implicated in the causation of CAE. Clinical, angiographic, and therapeutic features have been puzzling clinicians. We illustrate three different angiographic subsets, co-existing with myocardial bridge/coronary slow flow and diversely presenting as asymptomatic, pauci, and frankly symptomatic with stable and acute coronary syndrome. These cases illuminate the diversity of CAE's clinical and angiographic presentations and pathologic progression, shedding light on this medical condition and its implications.
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Affiliation(s)
- Najlaa Belharty
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
| | - Oumaima Fertat
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
| | - Tanae El Ghali
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
| | - Fatine Tabti
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
| | | | - Latifa Oukerraj
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
| | - Mohamed Cherti
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, MAR
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Aksoy S, Öz D, Öz M, Agirbasli M. Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow. Medicina (Kaunas) 2023; 59:medicina59040763. [PMID: 37109721 PMCID: PMC10144203 DOI: 10.3390/medicina59040763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Coronary slow flow (CSF) is an angiographic phenomenon characterized by the slow progression of an injected contrast agent during diagnostic coronary angiography in the absence of significant stenosis. Although CSF is a common angiographic finding, the long-term outcomes and mortality rates are still unknown. This study aimed to investigate the underlying causes of mortality over a 10-year period in patients diagnosed with stable angina pectoris (SAP) and CSF. Materials and Methods: This study included patients with SAP who underwent coronary angiography from 1 January 2012 to 31 December 2012. All patients displayed CSF despite having angiographically normal coronary arteries. Hypertension (HT), diabetes mellitus (DM), hyperlipidaemia, medication compliance, comorbidities, and laboratory data were recorded at the time of angiography. Thrombolysis in myocardial infarction (TIMI) frame count (TFC) was calculated for each patient. The cardiovascular (CV) and non-CV causes of long-term mortality were assessed. Results: A total of 137 patients with CSF (93 males; mean age: 52.2 ± 9.36 years) were included in this study. Twenty-one patients (15.3%) died within 10 years of follow-up. Nine (7.2%) and 12 (9.4%) patients died of non-CV and CV causes, respectively. Total mortality in patients with CSF was associated with age, HT, discontinuation of medications, and high-density lipoprotein cholesterol (HDL-C) levels. The mean TFC was associated with CV mortality. Conclusion: Patients with CSF exhibited a notable increase in cardiovascular-related and overall mortality rates after 10 years of follow-up. HT, discontinuation of medications, HDL-C levels, and mean TFC were associated with mortality in patients with CSF.
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Affiliation(s)
- Sukru Aksoy
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul 34668, Turkey
| | - Dilaver Öz
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul 34668, Turkey
| | - Melih Öz
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul 34668, Turkey
| | - Mehmet Agirbasli
- Department of Cardiology, Faculty of Medicine, Medeniyet University, Istanbul 34722, Turkey
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Zhu Q, Zhao C, Wang Y, Mu L, Li X, Qi Y, Yang J, Ma C. Soluble Vascular Cell Adhesion Molecule-1 as an Inflammation-Related Biomarker of Coronary Slow Flow. J Clin Med 2023; 12. [PMID: 36675472 DOI: 10.3390/jcm12020543] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Coronary slow flow (CSF) is an angiographic entity characterized by delayed coronary opacification with no evident obstructive lesion in the epicardial coronary artery. Several studies have shown that the occurrence and development of CSF may be closely related to inflammation. Soluble vascular cell adhesion molecule-1 (sVCAM-1) is a biomarker related to inflammation. The aim of this study was to evaluate the correlation between plasma soluble VCAM-1 level and CSF occurrence and thus the predictive value of VCAM-1 for CSF. Methods: Forty-six CSF patients and thirty control subjects were enrolled. Corrected thrombolysis in myocardial infarction frame count (cTFC) was used to diagnose CSF. Functional status and quality of life were determined by the Seattle Angina Questionnaire (SAQ). Echocardiography was used to evaluate the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV). The plasma levels of sVCAM-1, IL-6, and TNF-α were quantified by enzyme-linked immunosorbent assay. Results: Compared with the control group, the physical limitation score by the SAQ, the LV global longitudinal strain (GLS), mitral E, and mitral E/A decreased in patients with CSF, while the plasma IL-6 and TNF-α levels increased. The plasma sVCAM-1 level in the CSF group was significantly higher than that in the control group (186.03 ± 83.21 vs. 82.43 ± 42.12 ng/mL, p < 0.001), positively correlated with mean cTFC (r = 0.57, p < 0.001), and negatively correlated with the physical limitation score (r = −0.32, p = 0.004). Logistic regression analyses confirmed that plasma sVCAM-1 level (OR = 1.07, 95%CI: 1.03−1.11) is an independent predictor of CSF, and the receiver operating characteristic curve analysis showed that plasma sVCAM-1 levels had statistical significance in predicting CSF (area under curve = 0.88, p < 0.001). When the sVCAM-1 level was higher than 111.57 ng/mL, the sensitivity for predicting CSF was 87% and the specificity was 73%. Conclusions: Plasma sVCAM-1 level can be used to predict CSF and was associated with the clinical symptoms of patients. It may serve as a potential biomarker for CSF in the future.
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Gao YF, Chen Y, Wang CJ, Du Y, Ding YH. Atrial fibrillation episode status and incidence of coronary slow flow: A propensity score-matched analysis. Front Cardiovasc Med 2023; 10:1047748. [PMID: 37020520 PMCID: PMC10067859 DOI: 10.3389/fcvm.2023.1047748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/27/2023] [Indexed: 04/07/2023] Open
Abstract
Background Previous studies have shown that patients with a history of atrial fibrillation (AF) have a higher risk of developing coronary slow flow (CSF). However, whether AF episode status affects the incidence of CSF has not been confirmed. This study investigated the correlation between AF episode status and the incidence of CSF. Methods We enrolled patients with AF who underwent coronary angiography for symptoms of myocardial ischemia between January 1, 2017, and April 30, 2022, at our institution and classified them according to whether they had an episode of AF in the perioperative period. The outcomes were defined the occurrence of CSF overall and in each of the three coronary arteries. The analysis was repeated after adjusting the baseline information by the propensity score matching method in a 1:1 ratio. Results 214 patients who met the inclusion and exclusion criteria were included in the study (AF episode group: 100 patients, AF non-episode group: 114 patients). Before matching, age, left atrial size, ejection fraction, heart rate, CSF incidence, and mean corrected thrombolysis in myocardial infarction frame counts were higher in patients with intraoperative AF episodes than in patients without episodes. To prevent the dependent variable (CSF incidence) from being confounded by confounding factors, we matched the two groups for age, left atrial size, and ejection fraction. In the logistic regression analysis, the incidence of CSF was significantly higher in the intraoperative AF episode group (P = 0.010, OR = 2.327, 95% CI: 1.226-4.416) than in the non-episode group. Conclusion In patients with AF, AF episode status is significantly correlated with an increased overall incidence of CSF.
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Affiliation(s)
- Ya-fang Gao
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Graduate Department, Bengbu Medical College, Bengbu, China
| | - Yan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cheng-jian Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ya-hui Ding
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Correspondence: Ya-hui Ding
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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] [What about the content of this article? (0)] [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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Gocer H, Gunday M, Abusharekh M, Unal M. To show the effect of intermittent fasting during ramadan on endothelial dysfunction via TIMI frame count. Niger J Clin Pract 2021; 24:943-947. [PMID: 34121745 DOI: 10.4103/njcp.njcp_626_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Fasting and coronary functions are prestige fields for the study. There are a limited number of studies on these topics. The effect of Ramadan fasting on endothelial dysfunction, which can be manifested by loss of nitric oxide bioavailability, has been demonstrated via flow-mediated vasomotion in patients with the slow coronary flow in a small number of studies. To our knowledge, there is no study showing the relationship between TIMI frame count and Ramadan fasting. Aims We aimed to prove that Ramadan fasting can improve endothelial dysfunction which can be documented via the TIMI frame count method in angiography. Method This retrospective study included 67 patients diagnosed with the coronary slow flow by coronary angiographic before Ramadan. All of them were evaluated again via TIMI frame count within a period of 1 to 3 months after Ramadan. We tested our hypothesis that fasting may improve endothelial dysfunction and it was proved by the TIMI frame count method in our study. Results TIMI frame counts measured angiographically from LAD, Cx, and RCA and they were significantly lower than the counts before fasting. All coronary frame count parameters showed significant improvement after Ramadan compared with the baseline values before the Ramadan fasting period (P < 0.001). Conclusion Our results revealed that fasting and lifestyle changes during Ramadan may be beneficial for the improvement of endothelial dysfunctions in patients with the slow coronary flow and this can be showed easily using TIMI frame count. This is a practical and easy method for showing coronary functions.
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Affiliation(s)
- H Gocer
- Department of Cardiology, Medical Park Usak Hospital, Afyon/, Turkey
| | - M Gunday
- Department of Cardiovascular surgery, Afyon Health Science University Medical Faculty, Afyon/, Turkey
| | - M Abusharekh
- Department of Cardiology, Medical Park Usak Hospital, Afyon/, Turkey
| | - M Unal
- Department of Cardiovascular Surgery, Bicard Clinic, Bishkek/, Kirghizstan
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Zhu Q, Zhao C, Wang Y, Li X, Xue Y, Ma C. LncRNA NEAT1 Promote Inflammatory Responses in Coronary Slow Flow Through Regulating miR-148b-3p/ICAM-1 Axis. J Inflamm Res 2021; 14:2445-2463. [PMID: 34135616 PMCID: PMC8200141 DOI: 10.2147/jir.s312583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Coronary slow flow (CSF) is an angiographic phenomenon characterized by delayed coronary opacification with normal or near-normal epicardial coronary arteries. The pathogenesis of CSF is closely related to inflammatory response. Accumulating evidence shows that long non-coding RNAs (lncRNAs) play an important role in cardiovascular disease. However, the mechanism underlying the influence of the lncRNA nuclear enriched abundant transcripts 1 (NEAT1) on CSF is still unknown. Patients and Methods Forty CSF patients and forty control subjects were included in the study and underwent coronary angiography, Seattle angina questionnaire (SAQ) and echocardiography. The plasma levels of the inflammatory factors soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were determined by ELISA. The expression levels of NEAT1, miR-148b-3p and ICAM-1 in cells were measured by qRT-PCR or Western blotting. Cell proliferation was measured by 5‐Ethynyl‐2ʹ‐deoxyuridine (EdU) and Cell Counting Kit-8 (CCK-8) assay. Cell apoptosis was detected by apoptosis assay. The relationship between NEAT1 and miR-148b-3p was verified by luciferase reporter gene assay, RNA immunoprecipitation (RIP) assay and avidin-biotin pull-down assay. The relationship between ICAM-1 and miR-148b-3p was verified by luciferase reporter gene assay and avidin-biotin pull-down assay. Results This study showed that plasma sICAM-1, miR-148b-3p, and NEAT1 as independent predictors of a CSF diagnosis. Furthermore, plasma NEAT1 level showed superior diagnostic ability for CSF compared with sICAM-1 and miR-148b-3p. It was also shown that high expression of NEAT1 in oxygen-glucose deprivation (OGD)-treated human umbilical vein endothelial cells (HUVECs) functions as a competing endogenous RNA (ceRNA). By specifically binding miR-148b-3p, it weakened the negative regulatory effects of miR-148b-3p on the ICAM-1 target gene leading to upregulated expression of ICAM-1. This interaction was also shown to inhibit HUVEC proliferation and enhance apoptosis. Conclusion This study demonstrated for the first time the important mechanism of action of the NEAT1/miR-148b-3p/ICAM-1 axis in the progression of CSF disease, and indicated the potential of NEAT1, miR-148b-3p, and ICAM-1 as a new target for the diagnosis and treatment of CSF.
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Affiliation(s)
- Qing Zhu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Cuiting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xinxin Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yixue Xue
- Department of Neurobiology, School of Life Sciences, China Medical University, Shenyang, People's Republic of China.,Key Laboratory of Cell Biology, Ministry of Public Health of China, China Medical University, Shenyang, People's Republic of China.,Key Laboratory of Medical Cell Biology, Ministry of Education of China, China Medical University, Shenyang, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Abstract
Coronary slow flow (CSF) is an angiographic phenomenon with specific epidemiologic characteristics, associated clinical presentation, and prognosis. Although patients with CSF are diagnosed as having "normal coronary arteries," it seems appropriate to consider CSF as a distinct disease entity requiring specific treatment. The patient with CSF is usually male, smoker, obese, with a constellation of risk factors suggestive of metabolic syndrome. Unstable angina is the most common clinical presentation, with recurrent episodes of chest pain at rest associated with electrocardiographic changes often requiring readmission and reevaluation. Regarding definition and diagnosis, interventionists should first exclude possible "secondary" causes of CSF, use objective means for definition and then differentiate from other similar conditions such as microvascular angina. Although the phenomenon is generally benign, patients with CSF are severely symptomatic with recurrent episodes of chest pain and poor quality of life. Furthermore, acute presentation of the phenomenon is commonly life-threatening with ventricular tachyarrhythmias, conduction abnormalities, or cardiogenic shock. Acute treatment of CSF includes, but is not restricted to, intracoronary infusion of dipyridamole, adenosine, or atropine. Chronic management of patients with CSF encompasses dipyridamole, diltiazem, nebivolol, telmisartan, and/or atorvastatin associated with amelioration of angina symptoms, improved quality of life, and good prognosis.
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Affiliation(s)
- George Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Diah M, Lelo A, Lindarto D, Mukhtar Z. Plasma Concentrations of Adiponectin in Patients with Coronary Artery Disease and Coronary Slow Flow. Acta Med Indones 2019; 51:290-295. [PMID: 32041911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Adiponectin, an adipocyte-secreted hormone involved in energy homeostasis, has broad anti-inflammatory, antioxidant, and endothelium- and myocardial-protective effects, together with a potentially positive regulatory function in coronary microcirculation. Although the physiological role of adiponectin has not yet been fully elucidated, it may well be involved in the regulation of many of the inflammatory processes or lipid metabolisms that contribute to atherosclerosis. In this study we investigate the plasma concentration of adiponectin in patients with coronary artery disease (CAD), those with coronary slow flow (CSF) and in healthy subjects. METHODS this study was conducted according to a cross-sectional design involving 30 CAD, 30 CSF, and 30 healthy subjects. These subjects were sourced from the Dr. Zainoel Abidin Center Hospital, Banda Aceh, Indonesia, between December 2017 and February 2018. The plasma concentration of adiponectin was measured using enzyme-linked immunosorbent assay (ELISA) according to the manufacturer's specifications. RESULTS there were statistically significant differences at p<0.001 between the CAD, CSF, and healthy-subject groups in terms of age, sex, systolic blood pressure, total cholesterol, triglycerides, and creatinine. Mean plasma concentrations of adiponectin in patients with CAD were significantly lower than in patients with CSF and in healthy subjects (CAD: 3.40 (0.87) μg/ml; CSF: 4.58 (2.32) μg/ml; healthy subjects: 5.65 (4.87) μg/ml; P<0.001). CONCLUSION the findings suggest that low plasma adiponectin concentration is associated with atherosclerosis. Plasma concentrations of adiponectin may be related to the pathophysiology role of cardiovascular disease in both CAD and CSF patients.
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Affiliation(s)
- Muhammad Diah
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
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Kayapinar O, Ozde C, Kaya A. Relationship Between the Reciprocal Change in Inflammation-Related Biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin Ratios) and the Presence and Severity of Coronary Slow Flow. Clin Appl Thromb Hemost 2019; 25:1076029619835383. [PMID: 30857397 PMCID: PMC6714912 DOI: 10.1177/1076029619835383] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammation has been implicated in the pathogenesis of endothelial dysfunction, atherosclerosis, and microvascular coronary dysfunction. In this context, it is thought that fibrinogen, high-sensitive C-reactive protein (hsCRP), and albumin may be associated with the pathogenesis of coronary slow flow (CSF). We aimed to evaluate the ratios of fibrinogen-to-albumin and hsCRP-to-albumin in patients with CSF compared to patients with angiographically normal coronary arteries and stable coronary artery disease (CAD). In all, 65 patients with CSF, 65 patients with newly diagnosed stable CAD, and 65 control participants with angiographically normal coronary arteries were included. The coronary flow rates of all patients were determined by the Thrombolysis in Myocardial Infarction frame count method. Fibrinogen, hsCRP, and albumin levels were analyzed in all patients, and the fibrinogen-to-albumin and hsCRP-to-albumin ratios were calculated. The baseline characteristics of the 3 groups were similar. The plasma albumin level was significantly lower, whereas the fibrinogen and the hsCRP levels were significantly higher, in the CSF and CAD groups compared to the controls. The fibrinogen-to-albumin and hsCRP-to-albumin ratios were significantly higher in both the CSF and the CAD groups compared to the control group. The hsCRP-to-albumin ratio was positively correlated with the mean Thrombolysis in Myocardial Infarction frame count in the whole study population. According to the receiver–operating characteristic analysis, the efficacies of the fibrinogen-to-albumin and hsCRP-to-albumin ratios in predicting CSF were significant. The fibrinogen-to-albumin and hsCRP-to-albumin ratios, which were increased by a reciprocal change, suggest that inflammation may play a role in the pathogenesis of CSF.
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Affiliation(s)
- Osman Kayapinar
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Cem Ozde
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Adnan Kaya
- 1 Cardiology, Duzce University School of Medicine, Duzce, Turkey
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Demirci E, Çelik O, Kalçık M, Bekar L, Yetim M, Doğan T. Evaluation of homocystein and asymmetric dimethyl arginine levels in patients with coronary slow flow phenomenon. Interv Med Appl Sci 2019; 11:89-94. [PMID: 32148911 PMCID: PMC7044542 DOI: 10.1556/1646.11.2019.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have demonstrated that homocysteine and asymmetric dimethyl arginine (ADMA) levels were strongly associated with cardiovascular diseases including coronary artery disease. The aim of this study was to investigate the role of plasma homocysteine and ADMA levels in the pathogenesis of coronary slow flow (CSF) phenomenon. Methods Twenty-three patients with CSF and 25 controls with normal coronary flow were included in this study. The quantitative measurement of coronary blood flow was performed using the thrombolysis in myocardial infarction frame count method. Plasma homocysteine and ADMA levels were determined using enzymatic assays from venous blood samples. Results The patients with CSF had significantly higher plasma homocysteine levels than controls (16.2 ± 7.6 vs. 12.2 ± 2.2 μM/L; p = 0.023). The uric acid levels were significantly higher in CSF group than controls (5.4 ± 1.1 vs. 4.6 ± 0.9 mg/dl; p = 0.011). Plasma ADMA levels were also higher in the CSF group; however, this was not statistically significant (0.6 ± 0.1 vs. 0.5 ± 0.2 μM/L; p = 0.475). Conclusions Increased homocysteine and uric acid levels may play an important role in the pathogenesis of CSF. Further large scale studies are required to determine the relationship between ADMA levels and CSF.
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Affiliation(s)
- Erkan Demirci
- Department of Cardiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Çelik O, Demirci E, Aydın M, Karabag T, Kalçık M. Evaluation of ghrelin levels and endothelial functions in patients with coronary slow flow phenomenon. Interv Med Appl Sci 2017; 9:154-159. [PMID: 29201440 PMCID: PMC5700701 DOI: 10.1556/1646.9.2017.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Ghrelin has recently been reported to have beneficial effects on cardiac contractile functions and coronary blood flow. The main purpose of this study was to investigate the role of ghrelin in the pathogenesis of coronary slow flow (CSF) together with endothelial functions. Methods Twenty-five patients having normal coronary arteries with CSF and 25 controls with normal coronary flow were included into the study. The quantitative measurement of coronary blood flow was performed for each coronary artery using the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method. Ghrelin levels were measured using the enzyme-linked immunosorbent assay method from venous blood samples. Endothelial functions were evaluated from the brachial artery with the flow-mediated dilation (FMD) and nitrate-related dilation methods. Results There was a significant difference in terms of mean TFC values between the control and CSF groups (p < 0.001 for all coronary arteries). The mean FMD percentage among patients with CSF was lower than that of the control group (5.9 ± 0.8 vs. 10.7% ± 1.1%; p < 0.001). A moderate negative correlation was observed between the FMD percentages and the TFCs. There was no relationship between the TFC and ghrelin levels. Conclusion Plasma ghrelin levels seem to be uninfluential while impaired endothelial functions play an important role in the etiopathogenesis of CSF.
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Affiliation(s)
- Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Erkan Demirci
- Department of Cardiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mustafa Aydın
- Department of Cardiology, Bülent Ecevit University Hospital of Medicine, Zonguldak, Turkey
| | - Turgut Karabag
- Department of Cardiology, Bülent Ecevit University Hospital of Medicine, Zonguldak, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
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Yılmaz M, Dağlı MN, Uku Ö, Bilen MN, Korkmaz H, Erdem K, Kurtoğlu E. Focusing on a complete blood cell parameter: mean platelet volume levels may be a predictor of coronary slow flow. Vasc Health Risk Manag 2017; 13:255-261. [PMID: 28740398 PMCID: PMC5508812 DOI: 10.2147/vhrm.s126105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The relationship between increased mean platelet volume (MPV) and atherosclerosis is well known. In the present study, MPV in patients with coronary slow flow (CSF) and in cases with normal coronary anatomy (NCA) was investigated and compared with the aim of identifying the relationship between CSF and MPV. Patients and methods We studied 40 patients previously determined via coronary angiography as having NCA and 40 patients with CSF in the coronary blood stream, as identified by thrombolysis in myocardial infarction square. Thus, a total of 80 patients from the Elaziğ Education and Research Hospital (Elaziğ, Turkey) were included in the present study retrospectively and laboratory and anamnesis information was scanned into their files. The relationship between MPV and CSF was studied. Results MPV levels were observed to be significantly higher in the CSF group compared to the NCA group (10.05±1.3 and 8.6±0.6, p<0.001). In receiver operating characteristics analyses, it was determined that an MPV >9.05 measured in CSF patients at application had a predictive specificity of 77.5% and sensitivity of 77.5% for CSF (area under the curve: 0.825, 95% confidence interval [CI]: 0.726–0.924, p<0.0001). It was found that MPV level was an independent predictor of CSF (β=−600, p<0.001, 95% CI: −0.383 to −0.176). Conclusion MPV is increased in patients with CSF when compared to patients with NCA. This finding supports the fact that MPV could be a predictor of CSF.
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Affiliation(s)
- Mücahid Yılmaz
- Department of Cardiology, Elazığ Education and Research Hospital
| | | | - Ökkeş Uku
- Department of Cardiology, Elazığ Education and Research Hospital
| | | | - Hasan Korkmaz
- Department of Cardiology, FIRAT University School of Medicine, Elazığ
| | - Kenan Erdem
- Department of Cardiology, Sivas Hospital State, Sivas, Turkey
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Huang J, Yang Q, He L, Huang J. Role of TLR4 and miR-155 in peripheral blood mononuclear cell-mediated inflammatory reaction in coronary slow flow and coronary arteriosclerosis patients. J Clin Lab Anal 2017; 32. [PMID: 28407320 DOI: 10.1002/jcla.22232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/14/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To study the role of toll-like receptor 4 (TLR4) and MicroRNA-155 (miR-155) in the peripheral blood mononuclear cell (PBMC)-mediated inflammation in coronary slow flow (CSF) and coronary arteriosclerosis. METHODS Patients were divided into acute coronary syndrome (ACS), stable angina pectoris (SAP), CSF, and healthy control (HC) groups. The isolated PBMCs were treated with lipopolysaccharide (LPS)/and antagomiR-155. TLR4, miR-155, and the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1, and IL-10 were measured. RESULTS Before LPS intervention, the TLR4, TNF-α, IL-1, and IL-6 levels were higher and the level of miR-155, IL-10 was lower in the ACS group compared with the SAP, CSF, and HC groups. After exposure to LPS, the levels of TLR4, miR-155, TNF-α, IL-1, and IL-6 were increased and the level of IL-10 was decreased in the SAP and CSF groups compared with the HC group. But when over-expressing antagomiR-155 into PBMCs from SAP and CSF groups, the miR-155 expression, and TNF-α, IL-6, and IL-1 secretion increase induced by LPS were restrained. CONCLUSIONS TLR4, miR-155, and inflammatory cytokines may be closely related to ACS. LPS can induce TLR4, miR-155 expression and inflammatory response in SAP and CSF patients. AntagomiR-155 can inhibit this inflammatory response.
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Affiliation(s)
- Jiangyan Huang
- Department of Cardiology, First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Qin Yang
- Department of Cardiology, First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Longmiao He
- Department of Cardiology, First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Jun Huang
- Department of Cardiology, First Affiliated Hospital, Nanchang University, Nanchang, China
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Yılmaz M, Korkmaz H, Bilen MN, Uku Ö, Kurtoğlu E. Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow? J Int Med Res 2016; 44:1443-1453. [PMID: 28322100 PMCID: PMC5536743 DOI: 10.1177/0300060516664637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To determine whether neutrophil/lymphocyte ratio (NLR) differed between patients with isolated coronary artery disease (CAD), isolated coronary artery ectasia (CAE), coronary slow flow and normal coronary anatomy. Methods Patients who underwent coronary angiography were consecutively enrolled into one of four groups: CAD, coronary slow flow, CAE and normal coronary anatomy. Results The CAD (n = 40), coronary slow flow (n = 40), and CAE (n = 40) groups had similar NLRs (2.51 ± 0.7, 2.40 ± 0.8, 2.6 ± 0.6, respectively) that were significantly higher than patients with normal coronary anatomy (n = 40; NLR, 1.73 ± 0.7). Receiver operating characteristics demonstrated that with NLR > 2.12, specificity in predicting isolated CAD was 85% and sensitivity was 75%, with NLR > 2.22 specificity in predicting isolated CAE was 86% and sensitivity was 75%. With NLR > 1.92, specificity in predicting coronary slow flow was 89% and sensitivity was 75%. Multivariate logistic regression analyses identified NLR as an independent predictor of isolated CAE (β = −0.499, 95% CI −0.502, −0.178; P < 0.001), CAD (β = −0.426, 95% CI −1.321, −0.408; P < 0.001), and coronary slow flow (β = −0.430, 95% CI −0.811, −0.240; P = 0.001 Table 2). Conclusions NLR was higher in patients with CAD, coronary slow flow and CAE versus normal coronary anatomy. NLR may be an indicator of CAD, CAE and coronary slow flow.
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Affiliation(s)
- Mücahid Yılmaz
- 1 Department of Cardiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Hasan Korkmaz
- 2 Department of Cardiology, Fırat University School of Medicine, Elazığ, Turkey
| | - Mehmet Nail Bilen
- 1 Department of Cardiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Ökkeş Uku
- 1 Department of Cardiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Ertuğrul Kurtoğlu
- 1 Department of Cardiology, Elazığ Training and Research Hospital, Elazığ, Turkey
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Suner A, Cetin M. Is dipyridamole useful in improving left ventricular systolic and diastolic function in patients with coronary slow flow? Echocardiography 2016; 33:1472-1478. [PMID: 27343175 DOI: 10.1111/echo.13290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries without obstructive coronary disease. Previous studies have shown greater impairment of left ventricular (LV) systolic and diastolic function in patients with CSF. We aimed to examine the effect of dipyridamole on these functions. METHODS Our study included 40 patients with CSF and 40 subjects with normal coronary arteries. Conventional echocardiography Doppler imaging (CDI) and tissue Doppler echocardiography imaging (TDI) were used to evaluate LV systolic and diastolic function before and 2 months after treatment with dipyridamole. RESULTS Using CDI, we observed that early diastolic velocity (E) was significantly lower in patients with CSF, while late diastolic velocity (A), E/A ratio, isovolumic relaxation time, and myocardial performance index (MPI) were significantly higher in CSF patients compared with controls. Similarly, while early myocardial velocity (Em) was significantly lower, late myocardial velocity (Am), Em/Am ratio, isovolumic relaxation time (IRT), and MPI were significantly higher in CSF patients according to TDI measurements. Although there was no significant improvement in conventional Doppler parameters, there was significant normalization in tissue Doppler parameters after treatment with dipyridamole. CONCLUSION Left ventricular systolic and diastolic function may be negatively affected by CSF. Dipyridamole may improve these functions, especially at the tissue level.
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Affiliation(s)
- Arif Suner
- Cardiology Department, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Mustafa Cetin
- Cardiology Department, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Emrah A, Akın İİ, Servet İ, Muzaffer K, Fatih YM, Yeliz G, Çağan ES, Ahmet G, Alev K, Cevat K. Increased circulating soluble urokinase-type plasminogen activator receptor (suPAR) levels in patients with slow coronary flow. ACTA ACUST UNITED AC 2016; 1:e53-9. [PMID: 28905020 DOI: 10.5114/amsad.2016.60819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 11/17/2022]
Abstract
Introduction Slow coronary flow (SCF) is an angiographic phenomenon characterized by delayed opacification of epicardial coronary arteries without an obstructive coronary disease. Serum soluble urokinase-type plasminogen activator receptor (suPAR) levels seem closely related to atherosclerosis due to increased inflammation and prothrombotic state. We studied whether circulating suPAR is related to SCF. Material and methods The present study was cross-sectional and observational. It included 75 individuals who underwent coronary angiography with suspected CAD and had angiographically normal coronary arteries of varying coronary flow rates. The relationship between suPAR, C-reactive protein (CRP) and SCF was investigated. Forty patients with isolated SCF (mean age: 46.0 ±4.14 years) and 35 age- and gender-matched control participants with normal coronary flow (NCF) and normal coronary arteries (NCA) (mean age: 46.0 ±5.7 years) were included in the study. We used logistic regression analysis to determine the predictors of SCF. Results The clinical characteristics were not statistically significantly different between SCF and NCA groups. Serum suPAR level was significantly higher in the SCF group than the control group (2.5–5.4 ng/ml vs. 0.1–1.4 ng/ml; p < 0.001). Also the serum CRP level was higher in the CSF group than the control group (1.57 ±0.43 mg/l vs. 0.53 ±0.23 mg/l; p < 0.001). Conclusions This study revealed significantly increased serum suPAR levels in patients with SCF. Although we cannot draw conclusions on the underlying pathological process of SCF, we believe that these findings may be pioneering for further studies investigating the specific roles of circulating suPAR in the SCF phenomenon in the coronary vasculature.
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Kundi H, Gok M, Kiziltunc E, Topcuoglu C, Cetin M, Cicekcioglu H, Ugurlu B, Ulusoy FV. The Relationship Between Serum Endocan Levels With the Presence of Slow Coronary Flow: A Cross-Sectional Study. Clin Appl Thromb Hemost 2015; 23:472-477. [PMID: 26607436 DOI: 10.1177/1076029615618024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between endocan levels with the presence of slow coronary flow (SCF). METHODS In this cross-sectional study, a total of 88 patients, who admitted to our hospital, were included in this study. Of these, 53 patients with SCF and 35 patients with normal coronary flow were included in the final analysis. Coronary flow rates of all patients were determined by the Timi Frame Count (TFC) method. RESULTS In correlation analysis, endocan levels revealed a significantly positive correlation with high sensitive C-reactive protein and corrected TFC. In multivariate logistic regression analysis, the endocan levels were found as independently associated with the presence of SCF. Finally, using a cutoff level of 2.3, endocan level predicted the presence of SCF with a sensitivity of 77.2% and specificity of 75.2%. CONCLUSION In conclusion, our study showed that higher endocan levels were significantly and independently related to the presence of SCF.
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Affiliation(s)
- Harun Kundi
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Murat Gok
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunc
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Canan Topcuoglu
- 2 Biochemistry Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Hulya Cicekcioglu
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Burcu Ugurlu
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Feridun Vasfi Ulusoy
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C, Turak O, Aras D, Aydogdu S. Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb Hemost 2015; 22:476-82. [PMID: 26139836 DOI: 10.1177/1076029615594002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease. HYPOTHESIS We aimed to assess the relationship between MHR and SCF. METHODS Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF. RESULTS The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels (P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001). CONCLUSION Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation.
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Affiliation(s)
- Ugur Canpolat
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Elif Hande Çetin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Serkan Cetin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Selahattin Aydin
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboga
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Cagri Yayla
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Osman Turak
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Dursun Aras
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sinan Aydogdu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
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Akboga MK, Canpolat U, Balci KG, Akyel A, Sen F, Yayla C, Cay S, Aras D, Aydogdu S. Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow. Angiology 2015; 67:21-6. [PMID: 25725035 DOI: 10.1177/0003319715574625] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies showed that both inflammation and platelets have a role in development of slow coronary flow (SCF). Platelet to lymphocyte ratio (PLR) as an emerging inflammatory indicator was significantly associated with adverse cardiovascular events. Therefore, we aimed to assess the relationship between PLR and SCF. Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 221 as SCF group and n = 293 as control group). Patients who had thrombolysis in myocardial infarction frame counts (TFC) above the normal cutoffs were considered to have SCF. Both PLR and C-reactive protein (CRP) were significantly higher in the SCF group. In correlation analysis, PLR has a significantly positive correlation with the left anterior descending artery TFC (P = .001), circumflex artery TFC (P < .001), right coronary artery TFC (P < .001), and serum CRP level (P < .001). In multiple logistic regression analysis, PLR was independently associated with presence of SCF (odds ratio: 1.014, P < .001). In conclusion, higher PLR levels were significantly and independently related to the presence of SCF. Besides, PLR was positively correlated with serum CRP level as a conventional marker for systemic inflammation.
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Affiliation(s)
- Mehmet Kadri Akboga
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kevser Gulcihan Balci
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ahmet Akyel
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Fatih Sen
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Karaman K, Altunkaş F, Çetin M, Karayakali M, Arısoy A, Akar I, Zencir C, Aygüç B, Çelik A. New markers for ventricular repolarization in coronary slow flow: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Ann Noninvasive Electrocardiol 2014; 20:338-44. [PMID: 25267306 DOI: 10.1111/anec.12203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is characterized by normal or near-normal coronary arteries with delayed opacification of the distal vasculature that it may cause angina pectoris, acute myocardial infarction, life-threatening arrhythmias, and sudden cardiac death. The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with CSF by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. METHODS This study included 50 patients with CSF and 51 control subjects. Coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC). Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. RESULTS In electrocardiographic parameters analysis, QT, QTc, QTd, and QTcd were significantly increased in CSF patients compared with the control subjects (P < 0.001, P = 0.019, P < 0.001, P < 0.001, respectively). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in the CSF patients were significantly higher than those in the control subjects (Tp-e: 117 ± 21 milliseconds [ms] vs 96 ± 16 ms, P < 0.001; Tp-e/QT: 0.30 ± 0.06 vs 0.27 ± 0.06, P = 0.005; Tp-e/QTc: 0.27 ± 0.06 vs 0.24 ± 0.05, P < 0.001). In the multivariate analysis, increased Tp-e and Tp-e/QT ratio were associated with CSF. CONCLUSIONS Our study revealed that when compared to the control subjects, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc were significantly increased in the CSF patients.
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Affiliation(s)
- Kayihan Karaman
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Altunkaş
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Metin Karayakali
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Arif Arısoy
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ilker Akar
- Department of Cardiovascular Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Cemil Zencir
- Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Barış Aygüç
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ataç Çelik
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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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. Postepy Kardiol Interwencyjnej 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sunbul M, Erdogan O, Sari I. Asymptomatic ST segment elevation in the recovery phase of the exercise stress test due to slow coronary flow. Postepy Kardiol Interwencyjnej 2014; 10:53-6. [PMID: 24799931 DOI: 10.5114/pwki.2014.41471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/19/2013] [Accepted: 01/09/2014] [Indexed: 11/20/2022] Open
Abstract
Exercise-induced ST segment elevation without Q wave formation is rarely observed. Frequent causes are significant coronary stenosis, myocardial bridge and coronary vasospasm. Both exercise-induced ST segment elevation due to slow coronary flow and ST segment elevation in the recovery phase of the exercise stress test are very rare. We present a 49-year-old man with asymptomatic inferolateral ST segment elevation in the recovery phase of the exercise stress test due to slow coronary flow, which has not been reported previously. The learning points of the present paper are as follows: a) although significant coronary stenosis, myocardial bridge and coronary vasospasm are frequent causes of exercise-induced ST segment elevation, slow coronary flow might also cause it; b) one should keep in mind that ST segment elevation might also occur in the recovery phase; and c) ST segment elevation might be asymptomatic, as in the present case.
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Durmaz T, Keles T, Erdogan KE, Ayhan H, Bilen E, Bayram NA, Akcay M, Oz O, Albayrak Y, Ozdemir N, Bozkurt E. Coronary Slow Flow is Associated with Depression and Anxiety. Acta Cardiol Sin 2014; 30:197-203. [PMID: 27122789 PMCID: PMC4804858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/24/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND There is an established relationship between depression/anxiety disorders and cardiovascular morbidity and mortality which has been previously documented. However, there has been no study evaluating coronary slow flow in association with depression and anxiety. METHODS AND RESULTS A total of consecutive 90 patients were included in the study. All patients completed scoring scales for depression [Hamilton Rating Scale for Depression (HAMD)] and anxiety (STAI-1, State anxiety subscale of State-Trait Anxiety Inventory; STAI-2, Trait anxiety subscale of State-Trait Anxiety Inventory). Thereafter, they underwent selective coronary angiography and 2 groups were formed: coronary slow flow (n = 42), and normal coronary flow (n = 48). The two groups had comparable baseline characteristics. However, significant differences were found between coronary slow flow and normal coronary flow groups regarding depression (13.1 ± 8.2 and 6.9 ± 6.7, p < 0.001 for HAMD, respectively) and anxiety (46.2 ± 15.0 vs. 32.6 ± 9.9, p < 0.001 for STAI-1 and 51.0 ± 16.7 vs. 43.0 ± 10.7, p = 0.009 for STAI-2, respectively) scores. There were also significant positive correlations between depression/anxiety scores and TIMI frame counts of all major epicardial coronary arteries. In addition, after adjustment for smoking, hypertension, scoring scales, and the presence of depressive mood, all scoring scales and depressive mood were found to be independent risk factors for coronary slow flow in multivariable logistic regression analysis. CONCLUSIONS Significant association was found among coronary slow flow, depression/anxiety scores and depressive mood. KEY WORDS Anxiety; Coronary slow flow; Depression; Scale.
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Affiliation(s)
- Tahir Durmaz
- Department of Cardiology, Yildirim Beyazit University, Faculty of Medicine
| | - Telat Keles
- Department of Cardiology, Yildirim Beyazit University, Faculty of Medicine
| | | | - Huseyin Ayhan
- Department of Cardiology, Yildirim Beyazit University, Faculty of Medicine
| | | | | | - Murat Akcay
- Department of Cardiology, Yildirim Beyazit University, Faculty of Medicine
| | | | - Yakup Albayrak
- Department of Psychiatry, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Naci Ozdemir
- Department of Psychiatry, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Yildirim Beyazit University, Faculty of Medicine
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Demir M, Coşar S, Melek M. Evaluation of plasma eosinophil count and mean platelet volume in patients with coronary slow flow. Clinics (Sao Paulo) 2014; 69:323-6. [PMID: 24838897 PMCID: PMC4012242 DOI: 10.6061/clinics/2014(05)05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/11/2013] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The pathophysiology of coronary slow flow has not been clearly defined, although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis, have been reported. It is known that eosinophils play an important role in inflammation, endothelial dysfunction, and thrombosis. We aimed to compare the eosinophil counts of coronary slow flow patients versus healthy controls. METHODS This study included 50 coronary slow flow patients (19 males, mean age 65.6 ± 13.7 years) and 30 healthy controls (10 males, mean age 57.86 ± 11.6 years). These participants were evaluated using concurrent routine biochemical tests as well as neutrophil, lymphocyte, and eosinophil counts and mean platelet volume (MPV), which were obtained from the whole blood count. These parameters were compared between groups. RESULTS The baseline characteristics of the study groups were comparable. The coronary slow flow patients had a higher mean platelet volume and eosinophil count than the control group (8.38 ± 0.86 vs 6.28 ± 1.6 fL and 0.31 ± 0.42 vs 0.09 ± 0.05; p<0.001 and 0.008, respectively). CONCLUSION Our study demonstrated a relationship between eosinophil count and MPV in patients with coronary slow flow.
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Affiliation(s)
- Mehmet Demir
- Cardiology Department, Bursa Yüksek ?htisas Education and Research Hospital, Bursa, Turkey
| | - Selvi Coşar
- Cardiology Department, Bursa Yüksek ?htisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet Melek
- Cardiology Department, Bursa Yüksek ?htisas Education and Research Hospital, Bursa, Turkey
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Gazi E, Barutcu A, Altun B, Temiz A, Bekler A, Urfali M, Silan F, Colkesen Y, Ozdemir O. Intercellular adhesion molecule-1 K469E and angiotensinogen T207M polymorphisms in coronary slow flow. Med Princ Pract 2014; 23:346-50. [PMID: 24942509 PMCID: PMC5586901 DOI: 10.1159/000363451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/07/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate intercellular adhesion molecule-1 (ICAM1) and angiotensinogen (AGT) gene polymorphisms, as related to atherosclerosis and endothelial dysfunction, in coronary slow flow (CSF). SUBJECTS AND METHODS The participants in this study were 48 patients with CSF and 67 patients with normal coronary flow as controls. The K469E polymorphism of ICAM1 (rs5498) and the T207M polymorphism of AGT (rs4762) were determined using the polymerase chain reaction amplification method. RESULTS Baseline demographic parameters were similar in both groups. The mean thrombolysis in myocardial infarction frame count was significantly higher in patients with CSF (23.8 ± 5.1) compared to the controls (13.3 ± 2.6, p < 0.001). A significant association was found between the ICAM1 K allele and CSF (OR: 1.96, 95% CI: 1.15-3.35, p = 0.013). There was no difference in the frequency of AGT T207M genotypes in the patients with CSF and the control subjects. CONCLUSION This study showed that K469E polymorphisms of ICAM1 that play a role in atherosclerotic pathogenesis are related to CSF.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
- *Dr. Emine Gazi, MD, Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, TR-17100 Çanakkale (Turkey), E-Mail
| | - Ahmet Barutcu
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Adem Bekler
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mine Urfali
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Fatma Silan
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Aktoz M, Tatli E, Barutcu A, Ozkalayci F, Umit E, Altun A. Coronary slow flow and acute coronary syndrome in a patient with spinal cord injury. Tex Heart Inst J 2011; 38:433-436. [PMID: 21841878 PMCID: PMC3147186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report the case of a 55-year-old man who presented with acute coronary syndrome due to coronary slow flow after spinal cord injury. Data regarding the causes and clinical manifestations of coronary slow flow are inconclusive, but the autonomic nervous system is believed to be at least a contributing factor. The predominant vagal activity causes vasodilation and hemostasis, which can lead to acute coronary syndrome. We hereby call attention to hyperactive parasympathetic tonicity, which can lead to coronary slow flow and acute coronary syndrome in acute spinal cord injury patients.
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Affiliation(s)
- Meryem Aktoz
- Department of Cardiology, Trakya University, 22030 Edirne, Turkey.
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