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Dawson LP, Rashid M, Dinh DT, Brennan A, Bloom JE, Biswas S, Lefkovits J, Shaw JA, Chan W, Clark DJ, Oqueli E, Hiew C, Freeman M, Taylor AJ, Reid CM, Ajani AE, Kaye DM, Mamas MA, Stub D. No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score. Circ Cardiovasc Interv 2024; 17:e013738. [PMID: 38487882 DOI: 10.1161/circinterventions.123.013738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI. METHODS We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005-2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006-2020; external validation cohort). RESULTS A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment-elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively. CONCLUSIONS The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.
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Affiliation(s)
- Luke P Dawson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - Diem T Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jason E Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia (J.L.)
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - William Chan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Medicine, Melbourne University, Victoria, Australia (W.C.)
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (D.J.C.)
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health Ballarat, Victoria, Australia (E.O.)
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia (E.O.)
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia (C.H.)
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia (M.F.)
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Centre of Clinical Research and Education, School of Public Health, Curtin University, Perth, Western Australia, Australia (C.M.R.)
| | - Andrew E Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - David M Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
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Bilen MN, Barman HA, Dogan O, Ebeoglu AO, Çetin I, Erdoğan A, Atıcı A. The triglyceride-glucose index as a predictive marker for coronary slow flow phenomenon. Eur Rev Med Pharmacol Sci 2024; 28:3016-3023. [PMID: 38708458 DOI: 10.26355/eurrev_202404_36015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The triglyceride-glucose index (TyG) has been proposed as a marker of insulin resistance (IR) and has shown associations with cardiovascular diseases. This study aimed to investigate the relationship between the TyG and the coronary slow flow phenomenon (CSFP) and explore the index's potential as a predictor of this condition. PATIENTS AND METHODS A total of 187 patients who underwent coronary angiography were included; of these, 91 patients were diagnosed with CSFP, and 96 patients with normal coronary flow served as a control group. The TyG was calculated using fasting triglyceride and glucose levels. RESULTS The results showed that the TyG was significantly higher in the CSFP group compared with the control group (p < 0.001). Additionally, the TyG exhibited a moderate positive correlation with the thrombolysis-in-myocardial-infarction frame count in coronary arteries (p < 0.001). A multivariate logistic regression analysis revealed that the TyG, along with gender, ejection fraction, and uric acid, remained significant predictors of CSFP (p < 0.05). CONCLUSIONS This study's findings suggest that the TyG may serve as a useful marker for identifying individuals at risk of CSFP and provide insights into the potential role of IR in its pathophysiology.
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Affiliation(s)
- M N Bilen
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
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3
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Jia M, Jin F, Li S, Ren C, Ruchi M, Ding Y, Zhao W, Ji X. No-reflow after stroke reperfusion therapy: An emerging phenomenon to be explored. CNS Neurosci Ther 2024; 30:e14631. [PMID: 38358074 PMCID: PMC10867879 DOI: 10.1111/cns.14631] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete microcirculatory reperfusion failure after the achievement of full patency of a former obstructed large vessel, known as the "no-reflow phenomenon" or "microvascular obstruction," was first reported in the 1960s and was later detected in both experimental models and patients with stroke. The no-reflow phenomenon (NRP) was reported to result from intraluminal occlusions formed by blood components and extraluminal constriction exerted by the surrounding structures of the vessel wall. More recently, an emerging number of clinical studies have estimated the prevalence of the NRP in stroke patients following reperfusion therapy, ranging from 3.3% to 63% depending on its evaluation methods or study population. Studies also demonstrated its detrimental effects on infarction progress and neurological outcomes. In this review, we discuss the research advances, underlying pathogenesis, diagnostic techniques, and management approaches concerning the no-reflow phenomenon in the stroke population to provide a comprehensive understanding of this phenomenon and offer references for future investigations.
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Affiliation(s)
- Milan Jia
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Feiyang Jin
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Sijie Li
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Mangal Ruchi
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
| | - Yuchuan Ding
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
| | - Wenbo Zhao
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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Li ZP, Chen J, Xin Q, Pei XY, Wu HL, Tan ZX. Triglyceride glucose-body mass index as a novel predictor of slow coronary flow phenomenon in patients with ischemia and nonobstructive coronary arteries (INOCA). BMC Cardiovasc Disord 2024; 24:60. [PMID: 38243161 PMCID: PMC10797862 DOI: 10.1186/s12872-024-03722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The triglyceride glucose-body mass index (TyG-BMI index) has been suggested as a novel predictor of insulin resistance. However, its predictive value for slow coronary flow phenomenon (SCFP) in patients with ischemia and nonobstructive coronary arteries (INOCA) remains unclear. METHODS We consecutively recruited 1625 patients with INOCA from February 2019 to February 2023 and divided them into two groups based on thrombolysis in myocardial infarction (TIMI) frame counts (TFCs): the SCFP group (n = 79) and the control group. A 1:2 age-matched case-control study was then performed. The TyG-BMI index was calculated as ln [plasma triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. RESULTS TyG-BMI index in the SCFP group (218.3 ± 25.2 vs 201.0 ± 26.5, P < .001) was significantly higher than in the normal controls. TyG-BMI index also increased with the number of coronary arteries involved in the SCFP. Multivariate logistic regression analysis showed that TyG-BMI, BMI, and TG were independent predictors for SCFP. Receiver operating characteristic (ROC) curve analysis showed that when the TyG-BMI index was above 206.7, the sensitivity and specificity were 88.6% and 68.5%, respectively, with an AUC of 0.809 (95% CI: 0.756-0.863, P = .027). Combined BMI with TG, the TyG-BMI index had a better predictive value for SCFP than BMI and TG (P < .001). CONCLUSION The TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.
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Affiliation(s)
- Zhi-Peng Li
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Juan Chen
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Qi Xin
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Xiao-Yang Pei
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Hong-Li Wu
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Zhi-Xu Tan
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China.
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5
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Zhang Y, Jiang M, Gao Y, Zhao W, Wu C, Li C, Li M, Wu D, Wang W, Ji X. "No-reflow" phenomenon in acute ischemic stroke. J Cereb Blood Flow Metab 2024; 44:19-37. [PMID: 37855115 PMCID: PMC10905637 DOI: 10.1177/0271678x231208476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
Acute ischemic stroke (AIS) afflicts millions of individuals worldwide. Despite the advancements in thrombolysis and thrombectomy facilitating proximal large artery recanalization, the resultant distal hypoperfusion, referred to "no-reflow" phenomenon, often impedes the neurological function restoration in patients. Over half a century of scientific inquiry has validated the existence of cerebral "no-reflow" in both animal models and human subjects. Furthermore, the correlation between "no-reflow" and adverse clinical outcomes underscores the necessity to address this phenomenon as a pivotal strategy for enhancing AIS prognoses. The underlying mechanisms of "no-reflow" are multifaceted, encompassing the formation of microemboli, microvascular compression and contraction. Moreover, a myriad of complex mechanisms warrant further investigation. Insights gleaned from mechanistic exploration have prompted advancements in "no-reflow" treatment, including microthrombosis therapy, which has demonstrated clinical efficacy in improving patient prognoses. The stagnation in current "no-reflow" diagnostic methods imposes limitations on the timely application of combined therapy on "no-reflow" post-recanalization. This narrative review will traverse the historical journey of the "no-reflow" phenomenon, delve into its underpinnings in AIS, and elucidate potential therapeutic and diagnostic strategies. Our aim is to equip readers with a swift comprehension of the "no-reflow" phenomenon and highlight critical points for future research endeavors.
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Affiliation(s)
- Yang Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miaowen Jiang
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yuan Gao
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- China-America Institute of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- China-America Institute of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wu Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China-America Institute of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Kim SE, Choi KH, Song YB. An unusual no-reflow phenomenon due to neointimal tissue embolization during drug eluting balloon intervention in stent restenosis: A case report. Catheter Cardiovasc Interv 2023; 102:481-485. [PMID: 37465845 DOI: 10.1002/ccd.30771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023]
Abstract
Acute coronary syndrome is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI), along with various devices, have been technically developed to dramatically improve mortality risk in patients with acute myocardial infarction. However, no-reflow phenomenon still remains a problematic complication during a PCI, even in the era of drug eluting stents. There are various hypotheses and mechanisms for no-reflow phenomenon, but none have been confirmed. Treatment for no-reflow phenomenon also depends on various underlying conditions, but have not yet shown effective improvement. We presented a case of no-reflow phenomenon caused by an unusual cause.
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Affiliation(s)
- Sung Eun Kim
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Hong Choi
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Beijnink CWH, Woelders ECI, van Geuns RJM. No-Reflow After Primary PCI: Will Distal Intracoronary Medication Do the Trick? Cardiovasc Revasc Med 2023; 47:5-7. [PMID: 36682836 DOI: 10.1016/j.carrev.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Casper W H Beijnink
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eva C I Woelders
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Kumar D, Ahmed I, Bardooli F, Saghir T, Sial JA, Khan KA, Farooq F, Chachar TS, Karim M, Kumar H, Bai R, Qamar N. Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention. Cardiovasc Revasc Med 2023; 47:1-4. [PMID: 36266151 DOI: 10.1016/j.carrev.2022.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/28/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to compare TIMI flow after administering intracoronary (IC) medications through various routes for the treatment of slow flow/no-reflow during primary PCI. METHODS Two independent parallel cohorts of the patients who underwent primary PCI for STEMI and developed slow/no-reflow were recruited. Selection of cohort was based on the route of administration of IC medications as proximal or distal. Post administration TIMI follow was compared between the two cohorts. RESULTS A total of 100 patients were included in both, proximal and distal, cohort. Distribution of angiographic, clinical and demographic characteristics was not significant between the two cohorts except prevalence of hypertension, and diabetes mellitus. Frequency of hypertension, and diabetes mellitus were 45 % vs.70 %; p < 0.001 and 28 % vs. 44 %; p = 0.018 among patients in distal and proximal cohort respectively. Final TIMI III flow was achieved in significantly higher number of patients in distal cohort with the frequency of 88 % vs. 76 %; p = 0.027 as compared to proximal cohort. CONCLUSION Administration of IC medication via distal route is observed to be more effective for the treatment of slow flow/no-reflow during primary PCI. Distal route via export catheter or perforated balloon technique should be preferred wherever feasible.
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Affiliation(s)
- Dileep Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | - Iftikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Fawaz Bardooli
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Cardiac Centre (KMCC), Bahrain
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Fawad Farooq
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | | | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Qin X, Qin H, Li Z, Xue S, Huang B, Liu X, Wang D. Luteolin alleviates ischemia/reperfusion injury-induced no-reflow by regulating Wnt/β-catenin signaling in rats. Microvasc Res 2022; 139:104266. [PMID: 34688627 DOI: 10.1016/j.mvr.2021.104266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/01/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 12/21/2022]
Abstract
The no-reflow phenomenon induced by ischemia-reperfusion (I/R) injury seriously limits the therapeutic value of coronary recanalization and leads to a poor prognosis. Previous studies have shown that luteolin (LUT) is a vasoprotective factor. However, whether LUT can be used to prevent the no-reflow phenomenon remains unknown. Positron emission tomography perfusion imaging, performed to detect the effects of LUT on the no-reflow phenomenon in vivo, revealed that LUT treatment was able to reduce the no-reflow area in rat I/R models. In vitro, LUT was shown to reduce the hypoxia-reoxygenation injury-induced endothelial permeability and apoptosis. The levels of malondialdehyde, reactive oxygen species and NADPH were also measured and the results indicated that LUT could inhibit the oxidative stress. Western blot analysis revealed that LUT protected endothelial cells from I/R injury by regulating the Wnt/β-catenin pathway. Overall, we concluded that the use of LUT to minimize I/R induced microvascular damage is a feasible strategy to prevent the no-reflow phenomenon.
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Affiliation(s)
- Xichun Qin
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Hao Qin
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Zhimin Li
- Xuzhou Central Hospital, 99 West Huaihai Road, Xuzhou 221006, Jiangsu, China
| | - Song Xue
- Department of Cardiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Bing Huang
- Department of Cardiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Xiucheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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Aslan B, Işık F, Akyüz A, İnci Ü, Karadeniz M. Prolonged P Wave Peak Time May Be a Sign of LV Diastolic Dysfunction in the Coronary Slow Flow Phenomenon. Int J Clin Pract 2022; 2022:4626701. [PMID: 35685567 PMCID: PMC9159160 DOI: 10.1155/2022/4626701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The coronary slow flow phenomenon (CSFP) is an atherosclerotic process that causes ischemia at the microvascular level. The CSFP may affect P wave durations, especially P wave peak time (PWPT), by microvascular ischemia, left ventricular diastolic dysfunction, and changes in the left atrial dimension. Therefore, in the present study, we aimed to assess PWPT in the CSFP. METHOD One hundred and ninety-five patients were included in this single-center, retrospective study. Ninety patients were enrolled in the CSFP group and 105 patients in the control group. PWPT was defined as the duration between the beginning and peak of the p wave and obtained from the leads Dıı and V ı. RESULTS The mean age of the study population was 48.5 ± 9.5, and 108 (55.3%) of the patients were female. We found PWPT was longer in the CSFP group than in the control group. Correlation analysis showed a positive correlation between PWPT in both leads (D II, V ı) and left atrial anterior-posterior diameter, mean TIMI frame count (TFC), and E/e. A significant relationship was observed between mean TFC, E/e, EF, heart rate, and PWPT in lead D ıı (β coefficient = 0.33, 95% CI 0.44-1.33, p < 0.001, β coefficient = 0.23, 95% CI 0.25-1.85, p=0.01, β coefficient = -0.140, 95% CI -1.04--0.53, p=0.03, and β coefficient = -0.13, 95% CI -0.29--0.014, p=0.03, respectively) in multivariable linear analysis. CONCLUSION In the present study, we found prolonged PWPT in patients with the CSFP and found a relationship between PWPT and mean TFC.
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Affiliation(s)
- Burhan Aslan
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Diyarbakır, Turkey
| | - Ferhat Işık
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Diyarbakır, Turkey
| | - Abdurrahman Akyüz
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Diyarbakır, Turkey
| | - Ümit İnci
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Diyarbakır, Turkey
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11
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Hu X, Wang W, Ye J, Lin Y, Yu B, Zhou L, Zhou Y, Dong H. Effect of GP IIb/IIIa inhibitor duration on the clinical prognosis of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction with no-/slow-reflow phenomenon. Biomed Pharmacother 2021; 143:112196. [PMID: 34560551 DOI: 10.1016/j.biopha.2021.112196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/01/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) accompanied by the no-/slow-reflow phenomenon, the maintenance duration of GP IIb/IIIa inhibitor (GPI) is controversial. We compare the efficacy and safety of short- and long-term GPI infusion in STEMI patients with the no-/slow-reflow phenomenon. METHODS From June 2016 to December 2019, we continuously included patients with on-set STEMI who underwent pPCI, accompanied by the no-/slow-reflow, during interventional procedures at Guangdong Provincial People's Hospital and Zhuhai Golden Bay Hospital. The hemorrhage events, heart function, and major adverse cardiovascular events (MACE) were compared between < 24 h and ≥ 24 h GPI duration groups. The Kaplan-Meier curve was used to estimate the 1-year MACE-free survival at different GPI utility times. RESULTS In total, 127 patients were divided into two groups based on the duration of tirofiban use (less and more than 24 h). There was no significant difference between two groups in terms of baseline characteristics, plaque condition, and coronary physiological function. The two groups showed similar in-hospital MACE (1 [1.85%] vs. 4 [5.48%], p = 0.394) and 1-year MACE-free survival (log-rank test p = 0.9085). The 1-year MACE remained consistent between the two groups in all subgroups of different risk factors of no-/slow-reflow. There was no significant difference in heart function and in-hospital hemorrhage events (3.7% vs. 1.37%, p = 0.179). CONCLUSION In the real world, prolonging the duration of GPI may not significantly improve the clinical outcome in patients with STEMI with no-/slow-reflow.
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Affiliation(s)
- Xiangming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Weimian Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Jingguang Ye
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519040, Guangdong, China.
| | - Yan Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Shantou University Medical College, Shantou 515041, Guangdong, China.
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China.
| | - Langping Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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12
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Huyut MA. Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients. Arq Bras Cardiol 2021; 116:856-864. [PMID: 34008803 PMCID: PMC8121461 DOI: 10.36660/abc.20190905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE). OBJECTIVES This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI). METHODS This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. The patients were divided into two groups, the CSFP group (n=221) and the CNP group (n=25), regarding the angiographic characteristics of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. Patients were followed for one-year. A p-value of <0.05 was considered significant. RESULTS CNP was observed in 2.91%, and CSFP was observed in 25.75% of the patients. Clinical endpoints analyzed that stroke was significantly higher in the CNP group than in the CSFP group (6 (24%) vs. 6 (2.70%), p<0.001) and MACE was significantly higher in the CNP group than in the CSFP group (11 (44%) vs. 51 (23.10%), p=0.022). Forward conditional logistic regression analysis demonstrated that body mass index (BMI) (OR=1.11, 95%CI: 1.00-1.24, p=0.038) and baseline heart rate (HR) (OR=0.923, 95%CI: 0.88-0.96, p<0.001) were the independent predictors of CNP in NSTEMI. CONCLUSION CNP patients have worse clinical outcomes and a higher risk of stroke compared with CSFP patients in NSTEMI. (Arq Bras Cardiol. 2021; 116(5):856-864).
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Affiliation(s)
- Mustafa Ahmet Huyut
- Yeni Yuzyil UniversityFaculty of MedicineDepartment of CardiologyIstambulTurquiaYeni Yuzyil University, Faculty of Medicine, Department of Cardiology, Istambul – Turquia.
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Huang Q, Zhang F, Chen S, Dong Z, Liu W, Zhou X. Clinical characteristics in patients with coronary slow flow phenomenon: A retrospective study. Medicine (Baltimore) 2021; 100:e24643. [PMID: 33578588 PMCID: PMC10545414 DOI: 10.1097/md.0000000000024643] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Coronary slow flow phenomenon (CSFP) is a coronary artery disease in which coronary angiography shows no obvious stenosis, but there is a delay in blood flow perfusion. The etiopathogenic mechanisms of CSFP are still unclear. The aim of the present study was to investigate the role of clinical characteristics in patients with CSFP, and to provide a reference for exploring the potential mechanisms of CSFP. Patients with angiographically normal epicardial arteries were enrolled (145 patients with CSFP and 145 normal controls). Collected clinical information and laboratory indexes, which measured by peripheral venous blood samples before coronary angiography. Logistic regression analysis was performed for statistical analysis. The present study found 19 clinical and laboratory indexes with statistical differences between the two groups in univariate analysis. Multivariate analysis showed that monocyte count, haemoglobin, serum creatinine and globulin were independent predictors of CSFP. Moreover, the monocyte count, haemoglobin, creatinine and globulin levels were significantly higher in the CSFP patients than the controls, with positive associations between these parameters and the extent of CSFP. In addition, ROC analysis showed the diagnostic value of the above indexes for CSFP.
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Affiliation(s)
- Qiaojuan Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University
| | - Fan Zhang
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Siyu Chen
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University
| | - Zhaoying Dong
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University
| | - Weiwei Liu
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University
| | - Xiaoli Zhou
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University
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Liu F, Huang R, Li Y, Zhao S, Gong Y, Xu Z. In-Hospital Peak Glycemia in Predicting No-Reflow Phenomenon in Diabetic Patients with STEMI Treated with Primary Percutaneous Coronary Intervention. J Diabetes Res 2021; 2021:6683937. [PMID: 33506051 PMCID: PMC7811415 DOI: 10.1155/2021/6683937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 01/04/2023] Open
Abstract
Although percutaneous coronary intervention (PCI) significantly improves the prognosis for myocardial infarction, the no-reflow phenomenon is still the major adverse complication of PCI leading to increased mortality, especially for the patients with ST-segment elevation myocardial infarction (STEMI) combined with diabetes. To reduce the occurrence of no-reflow, prognostic factors must be identified for no-reflow phenomenon before PCI. A total of 262 participants with acute STEMI and diabetes were recruited into our cardiovascular center and underwent primary PCI for the analyses of prognostic factors of no-reflow. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI): the normal flow and no-reflow groups, and related factors were analyzed with different statistical methods. In the present investigation, the in-hospital peak glycemia was significantly higher in the no-reflow group than the normal flow group, while more narrowed vessels, higher level of initial TIMI flow, were observed in the patients of the no-reflow group. A multivariate logistic regression analysis further demonstrated that peak glycemia was an independent predictor for no-reflow in the diabetic patients with STEMI. Our data indicated the importance of the proper control of glucose before PCI for the diabetic patients with STEMI before PCI to reduce the occurrence of the no-reflow after operation.
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Affiliation(s)
- Fang Liu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Rui Huang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Ya Li
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Surui Zhao
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Yue Gong
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Zesheng Xu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
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Salama AM, Khalil WA, Al-Zaky M, Abdallah SH, Kandil NT, Abdelsabour A, Shaker AM, Hasanein MT, Luciani GB, Azzazy HME. MicroRNA-208a: a Good Diagnostic Marker and a Predictor of no-Reflow in STEMI Patients Undergoing Primary Percutaneuos Coronary Intervention. J Cardiovasc Transl Res 2020; 13:988-995. [PMID: 32458401 DOI: 10.1007/s12265-020-10020-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/28/2020] [Indexed: 01/06/2023]
Abstract
MicroRNA-208a is a cardiac specific oligo-nucleotide. We aimed at investigating the ability of microRNA-208a to diagnose myocardial infarction and predict the outcome of primary percutaneuos coronary angiography (PCI). Patients (n = 75) presented by chest pain were recruited into two groups. Group 1 (n = 40) had ST elevation myocardial infarction (STEMI) and underwent primary PCI: 21 patients had sufficient reperfusion and 19 had no-reflow. Group 2 (n = 35) had negative cardiac troponins (cTns). Plasma microRNA-208a expression was assessed using quantitative polymerase chain reaction and patients were followed for occurrence of in-hospital major adverse cardiac events (MACE). MicroRNA-208a could diagnose of MI (AUC of 0.926). After primary PCI, it was superior to cTnT in prediction of no-reflow (AUC difference of 0.231, P = 0.0233) and MACE (AUC difference of 0.367, P = 0.0053). Accordingly, circulating levels of miR-208a can be used as a diagnostic marker of MI and a predictor of no-reflow and in-hospital MACE. Graphical abstract Receiver operating curve analysis of no-reflow prediction of miRNA208a, CK-MB and hs-Troponin T. MicroRNA-208a shows significantly higher prediction of no-reflow as compared to routine cardiac biomarkers.
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Affiliation(s)
- Aboubakr Mohamed Salama
- Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
- Department of Cardiac Surgery, Verona University, Verona, Italy.
- Department of Biotechnology, School of Science and Engineering, American University in Cairo, Cairo, Egypt.
| | - Wael Ali Khalil
- Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Manar Al-Zaky
- Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Somia Hassan Abdallah
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Talaat Kandil
- Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Ahmed Abdelsabour
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mesbah Taha Hasanein
- Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | - Hassan M E Azzazy
- Department of Chemistry, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
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Oktaviono YH, Hutomo SA, Al-Farabi MJ. No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera: A case report. Medicine (Baltimore) 2020; 99:e19288. [PMID: 32118741 PMCID: PMC7478610 DOI: 10.1097/md.0000000000019288] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored. PATIENT CONCERN A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet. DIAGNOSIS Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV. INTERVENTIONS We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy. OUTCOMES The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI. LESSONS Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Suryo Ardi Hutomo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
- School of Healthcare Managemenent, University College London, Bloomsbury, London, United Kingdom
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Zhao J, Zhang Y, Huang Z, Wu F, Li N, Liang C. Association between impaired cutaneous microvascular endothelial function and lectin-like oxidized low-density lipoprotein receptor-1 in patients with coronary slow flow. Microvasc Res 2020; 129:103984. [PMID: 31954703 DOI: 10.1016/j.mvr.2020.103984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although increasing studies indicate coronary slow flow (CSF) is a systemic microvascular disorder, whether there is impaired cutaneous microvascular endothelial function in CSF patients remains unclear. This study was designed to test the hypothesis that the cutaneous microvascular endothelial function of CSF patients is impaired and correlates with lectin-like oxidized low-density lipoprotein receptor-1(LOX-1). METHODS 39 patients with CSF and 45 controls with normal coronary flow were enrolled. Velocity of coronary flow was quantitatively identified by thrombolysis in myocardial infarction frame count (TFC) method. LSCI system was used to assess subjects' cutaneous blood flow at rest and during PORH. Serum soluble LOX-1(sLOX-1) level was measured in all study subjects. RESULTS PORH-induced vasodilation was significantly reduced in CSF group in comparison with control group (0.26 ± 0.10 vs 0.35 ± 0.07 APU/mmHg, P < 0.001) and negatively correlated with the mean TFC for three coronary arteries (r = -0.385, P = 0.016). Serum sLOX-1 level in CSF group was significantly increased (582.93 ± 74.89 vs 483.64 ± 51.38 pg/ml, P < 0.001) and positively correlated with mean TFC(r = 0.467, P = 0.003).PORH response amplitudes had a significantly negative relationship with serum sLOX-1 level in CSF patients (r = -0.588, P < 0.001). CONCLUSION These data suggest that cutaneous microvascular endothelial function is impaired in patients with CSF, which is closely associated with increased LOX-1 expression.
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Affiliation(s)
- Jian Zhao
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanda Zhang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhigang Huang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Wu
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Na Li
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Chun Liang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang C, Hu S, Feng N, Li J, Wang Y, Dong H, Sun R, Yu H, Li L, Qin Y, Feng X, Li Z, Afolabi A, Syed I, Zhang S, Guagliumi G, Jia H, Yu B. Classification of Culprit Ruptured Plaque Morphologies in Patients With STEMI: An OCT Study. JACC Cardiovasc Imaging 2019; 12:2077-2079. [PMID: 31326474 DOI: 10.1016/j.jcmg.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/06/2019] [Accepted: 04/11/2019] [Indexed: 11/15/2022]
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Mehta HH, Morris M, Fischman DL, Finley JJ, Ruggiero N, Walinsky P, McCarey M, Savage MP. The Spontaneous Coronary Slow-Flow Phenomenon: Reversal by Intracoronary Nicardipine. J Invasive Cardiol 2019; 31:42-45. [PMID: 30555052] [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: 06/09/2023]
Abstract
OBJECTIVE An under-recognized cause of chest pain, the coronary slow-flow (CSF) phenomenon is characterized by delayed coronary opacification during diagnostic angiography in the absence of epicardial coronary artery disease (CAD). Given its angiographic resemblance to no-reflow during percutaneous coronary intervention, a condition associated with microvascular spasm responsive to calcium-channel blockers, we hypothesized that spontaneous CSF may similarly be reversed by intracoronary (IC) nicardipine. METHODS The effect of IC nicardipine was evaluated in 30 patients. CSF was defined as spontaneously delayed flow (<TIMI 3) during diagnostic coronary angiography in the absence of obstructive epicardial CAD or other conditions associated with impaired flow. Nicardipine was administered as a 200 μg IC bolus, after which repeat angiography was performed. Coronary flow before and after nicardipine was evaluated by TIMI flow grade and corrected TIMI frame count (TFC) assessments. RESULTS The study population consisted of 22 men and 8 women (mean age, 54 ± 11 years). Clinical presentation was rest angina in 21 patients (70%). At baseline, CSF with <TIMI 3 flow was observed in 49 vessels. TFC was prolonged (>27) in 68/90 vessels (76%). IC nicardipine produced markedly accelerated coronary filling, which was corroborated by TFC analysis. TFC was 47 ± 17 before vs 15 ± 5 after nicardipine (P<.001). All vessels demonstrated TIMI 3 flow and TFC <28 after nicardipine treatment. CONCLUSIONS IC nicardipine appears highly effective in reversing spontaneous CSF. These findings implicate microvascular spasm in the pathogenesis of CSF. Future studies of oral calcium-channel blockers in the long-term management of CSF are needed.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael P Savage
- Cardiac Catheterization Laboratory, Thomas Jefferson University Hospital, 111 South 11th Street, Gibbon Building, Ste 6210, Philadelphia, PA 19107 USA.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
- Department of Cardiology, St Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, Japan.
| | - Yasuaki Koga
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Hideki Tashiro
- Department of Cardiology, St Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, Japan
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22
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Negishi Y, Ishii H, Suzuki S, Aoki T, Iwakawa N, Kojima H, Harada K, Hirayama K, Mitsuda T, Sumi T, Tanaka A, Ogawa Y, Kawaguchi K, Murohara T. The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction. Medicine (Baltimore) 2017; 96:e9297. [PMID: 29390391 PMCID: PMC5815803 DOI: 10.1097/md.0000000000009297] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The usefulness of distal protection devices is still controversial. Moreover, there is no report on thrombus evaluation by using optical coherence tomography (OCT) for determining whether to use a distal protection device. The aim of the present study was to investigate the predictor of filter no-reflow (FNR) by using OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was observed in 13 cases (52%). In the comparisons between cases with or without the FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid pool + thrombus index showed significant differences. In multivariate analysis, lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438, 95% CI 1.001 - 2.064, P < .05). The optimal cut-off value of lipid pool + thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%, specificity 75.0%). Moreover, when adding the evaluation of thrombus length to that of lipid pool length, the prediction accuracy of FNR further increased (IDI 0.14: 0.019-0.25, P = .023).The longitudinal length of the lipid pool plus thrombus was an independent predictor of FNR and the prediction accuracy improved by adding the thrombus to the lipid pool. These results might be useful for making intraoperative judgment about whether filter devices should be applied in primary PCI for STEMI.
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Affiliation(s)
- Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshijiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Sumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogawa
- Department of Cardiology, Komaki City Hospital, Aichi, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Garg P, Kidambi A, Swoboda PP, Foley JRJ, Musa TA, Ripley DP, Erhayiem B, Dobson LE, McDiarmid AK, Fent GJ, Haaf P, Greenwood JP, Plein S. The role of left ventricular deformation in the assessment of microvascular obstruction and intramyocardial haemorrhage. Int J Cardiovasc Imaging 2016; 33:361-370. [PMID: 27785677 PMCID: PMC5344946 DOI: 10.1007/s10554-016-1006-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/20/2016] [Indexed: 12/30/2022]
Abstract
In the setting of acute ST-elevation myocardial infarction (STEMI), it remains unclear which strain parameter most strongly correlates with microvascular obstruction (MVO) or intramyocardial haemorrhage (IMH). We aimed to investigate the association of MVO, IMH and convalescent left ventricular (LV) remodelling with strain parameters measured with cardiovascular magnetic resonance (CMR). Forty-three patients with reperfused STEMI and 10 age and gender matched healthy controls underwent CMR within 3-days and at 3-months following reperfused STEMI. Cine, T2-weighted, T2*-imaging and late gadolinium enhancement (LGE) imaging were performed. Infarct size, MVO and IMH were quantified. Peak global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and their strain rates were derived by feature tracking analysis of LV short-axis, 4-chamber and 2-chamber cines. All 43 patients and ten controls completed the baseline scan and 34 patients completed 3-month scans. In multivariate regression, GLS demonstrated the strongest association with MVO or IMH (beta = 0.53, p < 0.001). The optimal cut-off value for GLS was −13.7% for the detection of MVO or IMH (sensitivity 76% and specificity 77.8%). At follow up, 17% (n = 6) of patients had adverse LV remodeling (defined as an absolute increase of LV end-diastolic/end-systolic volumes >20%). Baseline GLS also demonstrated the strongest diagnostic performance in predicting adverse LV remodelling (AUC = 0.79; 95% CI 0.60–0.98; p = 0.03). Post-reperfused STEMI, baseline GLS was most closely associated with the presence of MVO or IMH. Baseline GLS was more strongly associated with adverse LV remodelling than other CMR parameters.
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Affiliation(s)
- Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Wang Y, Ma C, Zhang Y, Guan Z, Liu S, Li Y, Yang J. Layer-specific analysis of left ventricular myocardial contractility in patients with coronary slow-flow phenomenon. J Clin Ultrasound 2016; 44:429-436. [PMID: 27086730 DOI: 10.1002/jcu.22357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterized by delayed coronary opacification in the absence of significant epicardial coronary stenosis. We previously reported impaired left ventricular (LV) function in patients with CSFP. However, the LV wall comprises three myocardial layers whose contractility can be differently affected. Therefore, we evaluated layer-specific (endocardial, mid-myocardial, and epicardial) LV myocardial contractility and assessed its relationships with the number of affected coronary arteries and their flow. METHODS We studied 60 patients with CSFP and 46 controls. CSFP was diagnosed by thrombolysis in myocardial infarction frame count. Echocardiography was performed within 72 hours after the coronary angiography. LV layer-specific longitudinal strain (LS) was measured using two-dimensional speckle-tracking echocardiography. RESULTS AND CONCLUSIONS The LS of all three myocardial layers was lower in patients with CSFP than in controls. In patients with CSFP, LS of all three myocardial layers and transmural LS gradient correlated negatively with the number of affected coronary arteries and the mean thrombolysis in myocardial infarction frame count. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:429-436, 2016.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yan Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yuling Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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25
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Ahn SJ, Park KH, Ryoo NK, Hong JH, Jung C, Yoon CH, Han MK, Woo SJ. No-Reflow Phenomenon in Central Retinal Artery Occlusion: Incidence, Risk Factors, and Clinical Implications. PLoS One 2015; 10:e0142852. [PMID: 26599539 PMCID: PMC4658076 DOI: 10.1371/journal.pone.0142852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the incidence and risk factors of the no-reflow phenomenon in central retinal artery occlusion (CRAO) patients and to determine its effects on visual and anatomic outcomes. METHODS In 102 eyes with CRAO in which arterial recanalization was obtained within 1 week from baseline, fluorescein angiography images obtained at baseline and 1 week were retrospectively reviewed. The no-reflow phenomenon in the retina was defined as macular capillary nonperfusion following arterial recanalization on fluorescein angiographs. We investigated the incidence and risk factors for the no-reflow phenomenon and compared the anatomical and visual outcomes between eyes with and without the phenomenon. RESULTS Among the 102 CRAO eyes with arterial recanalization, 39 exhibited the no-reflow phenomenon, resulting in an incidence of 38.2%. The incidence among the eyes with treatment-induced and spontaneous recanalization was 43.4% and 15.8%, respectively, and it increased with the CRAO stage. CRAO stage and increased central macular thickness were risk factors for the phenomenon, with an odds ratio of 4.47 [95% confidence interval (CI), 1.19-16.8; P = 0.027] and 1.69 (95% CI, 1.12-2.55; P = 0.012) per 100-μm increase, respectively. The visual outcome was significantly poorer and retinal atrophy and photoreceptor disruption was greater in eyes with the no-reflow phenomenon than in those without. CONCLUSIONS The no-reflow phenomenon may occur after arterial recanalization in approximately one-third of CRAO patients and can affect anatomical and visual outcomes. This phenomenon may provide an additional explanation regarding the permanent retinal damage and vision loss in eyes with CRAO.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Na-Kyung Ryoo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Zencirci AE, Zencirci E, Değirmencioğlu A, Erdem A, Karakuş G, Özden K, Karadeniz F, Buturak A, Belen E, Tipi F, Eren M. Predictive Value of the No-Reflow Phenomenon and Epicardial Adipose Tissue for Clinical Outcomes After Primary Percutaneous Coronary Intervention. Hellenic J Cardiol 2015; 56:311-319. [PMID: 26233771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION The determinants of clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI) are still being debated. The aim of this study was to investigate the prognostic value of the no-reflow phenomenon and epicardial adipose tissue (EAT) thickness for clinical outcomes in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. METHODS The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) who underwent successful pPCI. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon and further subdivided according to the tertile of EAT thickness (Group I <5.1 mm, Group II ≥5.1 mm). We assessed the composite and separate occurrence of major adverse cardiac events. RESULTS Throughout the 3-year follow up, the number of admissions for heart failure was significantly higher in patients with no-reflow (n=5 [20%] vs. n=1 [1%], p=0.003) and in female patients (n=4 [26%] vs. n=2 [2%], p=0.004). In the subgroup analysis, group I patients with no-reflow showed a higher frequency of admission for heart failure (n=4 [44%] vs. n=1 [6%], p=0.04). However, multivariate logistic regression analysis demonstrated that only no-reflow and female sex independently predicted admission for heart failure (OR: 19.3, 95%CI: 1.4-269.7, p=0.03, and OR: 24.9, 95%CI: 2.2-288.8, p=0.01, respectively). CONCLUSION No-reflow and female sex are independent predictors of admission for heart failure in the longterm follow up of patients with STEMI. However, EAT thickness is not associated with clinical outcomes after pPCI.
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Affiliation(s)
- Aycan Esen Zencirci
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Li J, Wu L, Tian X, Zhang J, Shi Y. Intravascular ultrasound observation of the mechanism of no-reflow phenomenon in acute myocardial infarction. PLoS One 2015; 10:e0119223. [PMID: 26035818 PMCID: PMC4452793 DOI: 10.1371/journal.pone.0119223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 01/23/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To study the mechanism of the no-reflow phenomenon using coronary angiography (CAG) and intravascular ultrasound (IVUS). Methods A total of 120 patients with acute myocardial infarction (AMI) who successfully underwent indwelling intracoronary stent placement by percutaneous coronary intervention (PCI). All patients underwent pre- and post-PCI CAG and pre-IVUS. No-reflow was defined as post-PCI thrombolysis in myocardial infarction (TIMI) grade 0, 1, or 2 flow in the absence of mechanical obstruction. Normal reflow was defined as TIMI grade 3 flow. The pre-operation reference vascular area, minimal luminal cross-sectional area, plaque cross-sectional area, lesion length, plaque volume and plaque traits were measured by IVUS. Results The no-reflow group was observed in 14 cases (11.6%) and normal blood-flow group in 106 cases (89.4%) based on CAG results. There was no statistically significant difference in the patients’ medical history, reference vascular area (no-flow vs. normal-flow; 15.5 ± 3.2 vs. 16.2 ± 3.3, p> 0.05) and lesion length (21.9 ± 5.1 vs. 19.5 ± 4.8, p> 0.05) between the two groups. No-reflow patients had a longer symptom onset to reperfusion time compared to normal blood-flow group [(6.6 ± 3.1) h vs (4.3 ± 2.7) h; p< 0.05] and higher incidence of TIMI flow grade< 3 (71.4% vs 49.0%, p< 0.05). By IVUS examination, the no-reflow group had a significantly increased coronary plaque area and plaque volume compared to normal blood-flow group [(13.7 ± 3.0) mm2 vs (10.2 ± 2.9) mm2; (285.4 ± 99.8) mm3 vs (189.7 ± 86.4) mm3; p< 0.01]. The presence of IVUS-detected soft plaque (57.1% vs. 24.0%, p< 0.01), eccentric plaque (64.2% vs. 33.7%, p< 0.05), plaque rupture (50.0% vs. 21.2%, p< 0.01), and thrombosis (42.8% vs. 15.3%) were significantly more common in no-reflow group. Conclusion There was no obvious relationship between the coronary risk factors and no-reflow phenomenon. The symptom onset to reperfusion time, TIMI flow grade before stent deployment, plaque area, soft plaques, eccentric plaques, plaque rupture and thrombosis may be risk factors for the no-reflow phenomenon after PCI.
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Affiliation(s)
- Junxia Li
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
- * E-mail:
| | - Longmei Wu
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Xinli Tian
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Jian Zhang
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Yujie Shi
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
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Simsek H, Sahin M, Gunes Y, Akdag S, Akil MA, Akyol A, Gumrukcuoglu HA, Yaman M. A novel echocardiographic method as an indicator of endothelial dysfunction in patients with coronary slow flow. Eur Rev Med Pharmacol Sci 2013; 17:689-693. [PMID: 23543453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis. AIM To assess endothelial function in patients with CSF and the correlation of AVP with FMD. MATERIALS AND METHODS FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography. RESULTS Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1±8.4 vs. 53.7±12.7 cm/s, p < 0.001) and FMD (5.6±3.2 vs. 17.6±4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001). CONCLUSIONS Transthoracic echocardiographic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function.
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Affiliation(s)
- H Simsek
- Cardiology Department, Yuzunci Yil University, Van, Turkey.
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Harrison RW, Aggarwal A, Ou FS, Klein LW, Rumsfeld JS, Roe MT, Wang TY. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol 2013; 111:178-84. [PMID: 23111142 DOI: 10.1016/j.amjcard.2012.09.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/01/2012] [Accepted: 09/01/2012] [Indexed: 11/19/2022]
Abstract
Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3% of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic shock were clinical variables independently associated with the development of no-reflow (p <0.001). The angiographic factors independently associated with no-reflow included longer lesion length, higher risk class C lesions, bifurcation lesions, and impaired preprocedure Thrombolysis In Myocardial Infarction flow (p <0.001). No-reflow was associated with greater in-hospital mortality (12.6% vs 3.8%, adjusted odds ratio 2.20, 95% confidence interval 1.97 to 2.47, p <0.001) and unsuccessful lesion outcome (29.7% vs 6.6%, adjusted odds ratio 4.70, 95% confidence interval 4.28 to 5.17, p <0.001) compared to patients without no-reflow. In conclusion, the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes.
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30
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Zencir C, Cetin M, Güngör H, Karaman K, Akgüllü C, Eryılmaz U, Avcil M. Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow flow phenomenon. Turk Kardiyol Dern Ars 2013; 41:691-6. [PMID: 24351942 DOI: 10.5543/tkda.2013.51882] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Cemil Zencir
- Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
| | - Mustafa Cetin
- Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Hasan Güngör
- Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Kayıhan Karaman
- Department of Cardiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Cağdaş Akgüllü
- Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ufuk Eryılmaz
- Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Mücahit Avcil
- Department of Emergency Medicine, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
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31
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Hong YJ, Jeong MH, Ahn Y, Mintz GS, Kim SW, Lee SY, Kim SY, Cho JG, Park JC, Kang JC, Weissman NJ. Intravascular ultrasound analysis of plaque characteristics and postpercutaneous coronary intervention catheterization outcomes according to the remodeling pattern in narrowed saphenous vein grafts. Am J Cardiol 2012; 110:1290-5. [PMID: 22835407 DOI: 10.1016/j.amjcard.2012.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/16/2022]
Abstract
We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm(2) vs 0.42 ± 1.07 mm(2), p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm(3) vs 0.34 ± 0.74 mm(3), p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Cohort Studies
- Confidence Intervals
- Coronary Angiography/methods
- Coronary Circulation/physiology
- Coronary Restenosis/diagnostic imaging
- Coronary Restenosis/mortality
- Coronary Restenosis/therapy
- Coronary Stenosis/diagnostic imaging
- Coronary Stenosis/mortality
- Coronary Stenosis/therapy
- Female
- Follow-Up Studies
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/physiopathology
- Graft Occlusion, Vascular/therapy
- Humans
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- No-Reflow Phenomenon/diagnostic imaging
- Odds Ratio
- Plaque, Atherosclerotic/diagnostic imaging
- Retrospective Studies
- Risk Assessment
- Saphenous Vein/diagnostic imaging
- Saphenous Vein/transplantation
- Survival Rate
- Time Factors
- Treatment Outcome
- Ultrasonography, Interventional
- Vascular Patency/physiology
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Gwangju, South Korea
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De Bruyne B, Muller O. Computed tomography coronary angiography, percutaneous coronary intervention, and (S)low flow. JACC Cardiovasc Interv 2012; 5:644-5. [PMID: 22721659 DOI: 10.1016/j.jcin.2012.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/13/2012] [Indexed: 11/16/2022]
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Hong YJ, Jeong MH, Ahn Y, Kang JC, Mintz GS, Kim SW, Lee SY, Kim SY, Pichard AD, Satler LF, Waksman R, Weissman NJ. Intravascular ultrasound findings that are predictive of no reflow after percutaneous coronary intervention for saphenous vein graft disease. Am J Cardiol 2012; 109:1576-81. [PMID: 22440118 DOI: 10.1016/j.amjcard.2012.01.383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the relation between intravascular ultrasound (IVUS) findings and the no-reflow phenomenon and long-term outcome after percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions. No reflow was defined as Thrombolysis In Myocardial Infarction grade 0, 1, or 2 flow after PCI. Of 311 patients who underwent IVUS before and after stenting, no reflow was observed in 39 patients (13%). Degenerated SVG (62% vs 36%, p = 0.002), IVUS-detected intraluminal mass (82% vs 43%, p <0.001), culprit lesion multiple plaque ruptures (23% vs 6%, p <0.001), and tissue prolapse (51% vs 35%, p = 0.043) were observed more frequently in patients with no reflow. In multivariate logistic regression analysis, an intraluminal mass (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.98 to 10.49, p = 0.001), culprit lesion multiple plaque ruptures (OR 3.46, 95% CI 1.46 to 8.41, p = 0.014), and degenerated SVGs (OR 3.17, 95% CI 1.17 to 6.56, p = 0.024) were the independent predictors of no reflow after PCI. At 5-year clinical follow-up, rates of death (14, 36%, vs 55, 20%, p = 0.036) and myocardial infarction (13, 33%, vs 52, 19%, p = 0.039) were significantly higher in the no-reflow group. However, rate of target vessel revascularization was not significantly different between the 2 groups (15, 38%, vs 90, 33%, p = 0.3). IVUS-detected intraluminal mass, multiple plaque ruptures, and degenerated SVGs were associated with no reflow in SVG lesions after PCI. In conclusion, no reflow was associated with poor long-term clinical outcomes after PCI for SVG lesions.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Seoul, Korea
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Mazurek T. [Epicardial adipose tissue and coronary artery flow. Does location matter?]. Kardiol Pol 2012; 70:910. [PMID: 22992999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Zhao B, Li J, Luo X, Zhou Q, Chen H, Shi H. The role of von Willebrand factor and ADAMTS13 in the no-reflow phenomenon: after primary percutaneous coronary intervention. Tex Heart Inst J 2011; 38:516-522. [PMID: 22163125 PMCID: PMC3231536] [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 prospectively studied the correlations between plasma levels of von Willebrand factor and its cleaving protease--a disintegrin and metalloproteinase with thrombospondin type I motif, member 13 (ADAMTS13)--in 126 patients who did or did not develop no-reflow phenomenon after primary percutaneous intervention for acute ST-segment-elevation myocardial infarction. Quantitative plasma levels of von Willebrand factor and ADAMTS13 were measured by immunoturbidometric assay.Angiographic no-reflow was observed in 46 (37%) of the 126 patients. At admission, plasma levels of von Willebrand factor were significantly higher in the no-reflow group (P < 0.001), but levels of ADAMTS13 at admission were similar in the 2 groups (P = 0.143). At logistic regression, after adjustment for serum creatinine, left ventricular ejection fraction, high-sensitivity C-reactive protein, and N-terminal pro B-type natriuretic peptide, plasma von Willebrand factor level at admission (≥ 5,531 mU/mL) was still the predictive factor for the no-reflow phenomenon. The area under the receiver operating characteristics curve was 0.785.Our results suggest that high von Willebrand factor level is related to the no-reflow phenomenon in such a way that it might be a predictor of the phenomenon.
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Affiliation(s)
- Bilian Zhao
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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Valgimigli M, Campo G, Malagutti P, Anselmi M, Bolognese L, Ribichini F, Boccuzzi G, de Cesare N, Rodriguez AE, Russo F, Moreno R, Biondi-Zoccai G, Penzo C, Díaz Fernández JF, Parrinello G, Ferrari R. Persistent coronary no flow after wire insertion is an early and readily available mortality risk factor despite successful mechanical intervention in acute myocardial infarction: a pooled analysis from the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) trials. JACC Cardiovasc Interv 2011; 4:51-62. [PMID: 21251629 DOI: 10.1016/j.jcin.2010.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVES These studies sought to investigate the impact on mortality of coronary flow after passage of the wire through the culprit vessel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing mechanical reperfusion. BACKGROUND Reduced spontaneous coronary flow before percutaneous coronary intervention influences mortality in patients with STEMI. Response to vessel wiring in patients with an occluded coronary artery before intervention might further discriminate outcomes irrespective of pre- and post-intervention coronary flow. METHODS Data from the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) trials were pooled: of 919 index procedures, 902 films (98%) were technically adequate for core laboratory TIMI (Thrombolysis In Myocardial Infarction) flow determination. RESULTS TIMI flow grade 0 was present before percutaneous coronary intervention in 59% of infarct vessels, TIMI flow grade 1 to 2 was found in 21%, whereas the remainder of infarct arteries presented with TIMI flow grade 3. In 49% of patients who showed persistent TIMI flow grade 0 after wire insertion (AWI), mortality was higher at 30 days (5.3%) and 1 year (9.4%) compared with patients in whom TIMI flow grade before percutaneous coronary intervention was either >0 (0.8%; p < 0.003 and 3.6%, p < 0.008) or improved from 0 AWI (1.5%, p < 0.04 and 3.6%, p < 0.02). After correcting for multiple imbalances, including baseline and final flow, persistent TIMI flow grade 0 AWI remained associated at 30 days to 2-fold (risk ratio [RR]: 2.1, 95% confidence interval [CI]: 1.08 to 5.00; p = 0.038) and at 1 year to almost 3-fold increases of mortality (RR: 2.7, 95% CI: 1.3 to 5.6; p = 0.008). CONCLUSIONS STEMI patients displaying persistent no-flow AWI have a lower survival rate despite an apparently successful mechanical intervention. As an early marker for high residual mortality risk, persistent no-flow AWI may qualify STEMI patients for dedicated pharmacomechanical treatment strategies.
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Affiliation(s)
- Marco Valgimigli
- Cardiovascular Institute, University of Ferrara, Ferrara, Italy.
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Nie SP, Geng LL, Wang X, Zhang XS, Yang Y, Liu BQ, Li J, Qiao Y, Liu XM, Luo TY, Dong JZ, Liu XH, Ma CS. Can transthoracic Doppler echocardiography be used to detect coronary slow flow phenomenon? Chin Med J (Engl) 2010; 123:3529-3533. [PMID: 22166625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Coronary slow flow phenomenon (CSFP) is an important, angiographic clinical entity but is lacking non-invasive detecting techniques. This study aimed to elucidate the value of transthoracic Doppler echocardiography (TTDE) in the diagnosis and monitoring of coronary slow flow in left anterior descending (LAD) coronary artery. METHODS We consecutively enrolled 27 patients with CSFP in LAD detected by coronary arteriography from August 2009 to April 2010. Thirty-eight patients with angiographically normal coronary flow served as control. Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) was used to document coronary flow velocities. All subjects underwent TTDE within 24 hours after coronary angiography. LAD flow was detected and the coronary diastolic peak velocities (DPV) and diastolic mean velocities (DMV) were calculated. RESULTS Sixty of 65 (92.3%) subjects successfully underwent TTDE. Baseline clinical characteristics were similar between the two groups. Coronary DPV and DMV of LAD were significantly lower in the CSFP group than in the control group ((0.228 ± 0.029) m/s vs. (0.302 ± 0.065) m/s, P = 0.000; (0.176 ± 0.028) m/s vs. (0.226 ± 0.052) m/s, P = 0.000, respectively). There was a high inverse correlation between CTFC and coronary DPV and DMV (r = -0.727, P = 0.000; r = -0.671, P = 0.000, respectively). Receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) was less than one half for coronary DPV (AUC = 0.104) and DMV (AUC = 0.204), respectively. CONCLUSIONS In patients with CSFP, there is a high inverse correlation between CTFC and coronary diastolic flow velocities in the LAD coronary artery, as measured by TTDE. The value of TTDE in the monitoring and evaluation of coronary flow in patients with CSFP deserves further investigation.
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Affiliation(s)
- Shao-Ping Nie
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
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Jim MH, Yiu KH, Ko RLY, Ho HH, Siu CW, Chow WH. Manual aspiration prior to stenting does not reduce the incidence of filter no reflow in saphenous vein graft lesions protected by FilterWire EX/EZ. Acute Card Care 2010; 12:92-95. [PMID: 20677906 DOI: 10.3109/17482941.2010.490194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The beneficial role of manual thrombus aspiration in thrombus-containing lesions has been proven in acute myocardial infarction but data is lacking in saphenous vein graft lesions. METHODS From January 2004 to December 2008, 74 consecutive post-bypass patients underwent percutaneous coronary interventions to 76 saphenous vein graft lesions under the protection of FilterWire EX/EZ. Among them, the latest 25 consecutive patients with 25 lesions were treated with manual aspiration before stenting. The incidence of filter no reflow was compared between patients with and without manual aspiration pretreatment. RESULTS No major difference in demography, clinical, lesion, and procedure characteristics, and in-hospital outcome has been observed between the two patient groups. Most importantly, the incidence of filter no reflow has not been reduced (32.0% versus 19.6%, P = 0.26) by manual aspiration, even among thrombus-containing lesions (63.2% versus 64.7%, P = 1.00). The absence of diabetes mellitus is found to be the independent predictor for the occurrence of filter no reflow. CONCLUSIONS Adjunctive manual thrombus aspiration fails to reduce the filter no reflow, and probably has no additional benefit in saphenous vein graft lesions already protected by FilterWire EX/EZ.
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Affiliation(s)
- Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong.
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Affiliation(s)
| | - J. J. Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | - J. W. Jukema
- Leiden University Medical Center, Leiden, The Netherlands
| | - M. J. Schalij
- Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- Sajad A Hayat
- Department of Cardiovascular medicine and Institute of Postgraduate Medical and Education Research, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK
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Heper G, Korkmaz ME, Kilic A. Reperfusion arrhythmias: are they only a marker of epicardial reperfusion or continuing myocardial ischemia after acute myocardial infarction? Angiology 2007; 58:663-70. [PMID: 17989422 DOI: 10.1177/0003319707308891] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular reperfusion injury which can be seen as no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function. No-reflow phenomenon (thrombolysis in myocardial infarction [TIMI] <or=2 flow) is frequently observed in patients after mechanical or medical reperfusion procedures for acute myocardial infarction (AMI). The authors hypothesized that reperfusion arrhythmias (or peri-infarct arrhythmias) may be related to continuing myocardial ischemia. They documented all arrhythmia episodes in patients with AMI and compared arrhythmia rates in different therapy groups. They also compared arrhythmia rates according to TIMI flow achieved and those after MI. The highest arrhythmia rate was detected in patients to whom thrombolytic therapy was given for AMI (64%). The arrhythmia rate was lower in patients with primary PCI performed for AMI (46.2%) than in those receiving thrombolytic therapy. The arrhythmia rates according to therapy modalities for AMI were significantly different (p < 0.01). The achieved mean TIMI flow with primary PCI (2.46 +/-0.21 ) was higher than the mean flow achieved after thrombolytic therapy (2.12 +/-0.16). When compared to the arrhythmia rate according to TIMI flow, it was shown that the lowest arrhythmia rate was found in patients with TIMI 3 flow (17.2%) achieved with any procedure after AMI. The arrhythmia rate was 84% in patients with TIMI 2 flow and 33.3% with TIMI 0-1 flow (p <0.001). The arrhythmia rate was appreciably lower after 48 hours of MI. This finding suggests that the continuing myocardial ischemia represented by TIMI flow at the coronary angiography after acute myocardial infarction may have an important role in the pathogenesis of reperfusion arrhythmias.
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