Evolution of Diastolic Dysfunction in Patients with Coronary Slow Flow Phenomenon and Acute Non-ST Segment Elevation Myocardial Infarction (original) (raw)
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Benha Medical Journal, 2024
Background: Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS) patients often present with complex cardiac pathophysiology, including coronary slow flow phenomenon (CSFP) and diastolic dysfunction (DD). This study aimed to better understand the short-term alterations and indicators of improved diastolic function in CSFP patients presenting with NSTEMI. Methods: This prospective research was conducted on 100 NSTE-ACS patients undergoing coronary angiography. Echocardiographic measures were employed to determine diastolic function, and the TIMI frame count approach was employed to determine the presence of CSFP. At the start of the study and after three months, clinical and angiographic data were gathered. Results: The mean age of the studied patients was 46 ±4 years. Significant improvements were noted in several diastolic function parameters at three months. At three months, there were significantly lower percentages of average E/Em > 14 (2% vs. 16%, p < 0.001), LAVI > 34 mL/m2 (46% vs. 76%, p < 0.001), lateral Em < 10 (61% vs. 76%, p < 0.001), and TR velocity (41% vs. 76%, p < 0.001) compared to baseline. Kaplan Meier analysis was done to calculate MACE-free survival. It showed that at 1.5 months, the MACE-free survival was 97.8% and 92.7% in those with improved and non-improved diastolic dysfunction, respectively. Conclusion: Our study shows the positive impact of diagnosing CSFP in NSTE-ACS patients, as it may lead to improved diastolic function over a relatively short period.
International Journal of Cardiology, 2009
Patients with coronary slow flow (CSF) present with a syndrome (often recurrent) of resting angina with no significant coronary stenoses. The nature of myocardial blood flow (MBF), MBF reserve and systemic arterial characteristics may contribute to symptoms in these patients but this has not been examined previously. This study sought to measure MBF, arterial stiffness and wave reflection in patients with CSF and controls. Ten patients with angiographically proven CSF and 20 controls underwent dipyridamole-exercise stress myocardial contrast echocardiography and arterial waveform analysis. MBF was quantified off-line from 10 mid and apical segments with calculation of myocardial blood volume (A), red cell velocity (beta) and their product, MBF, at rest and post-stress. MBF reserve was calculated as the ratio of peak stress to resting MBF. Central arterial pressure waveforms were derived by radial tonometry, with arterial wave reflection expressed by augmentation index. Arterial stiffness was determined by aortic and brachial pulse wave velocities. There was no significant difference between CSF and control groups in mean resting beta (0.56+/-0.24 versus 0.59+/-0.26), A (7.9+/-1.4 versus 7.9+/-5.2), MBF (4.3+/-1.8 versus 4.4+/-3.6), MBF reserve (3.7+/-2.0 versus 4.0+/-2.0), augmentation index (26+/-12 versus 23+/-9%), aortic (7.4+/-1.8 versus 7.4+/-1.5 m/s) or brachial (8.0+/-0.8 versus 8.1+/-1.3) pulse wave velocity (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.4 for all). Similarly, there were no significant haemodynamic differences between groups after exercise (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.2 for all). MBF, large artery stiffness and arterial wave reflection characteristics are normal in CSF patients between their acute episodes.
Coronary Slow Flow Phenomenon Clinical Findings and Predictors
Research in Cardiovascular Medicine, 2016
Background: In some patients with chest pain, selective coronary angiography reveals slow contrast agent passage through the epicardial coronary arteries in the absence of stenosis. This phenomenon has been designated the slow coronary flow (SCF) phenomenon. Objectives: In this study, we aimed to describe the demographic and clinical findings and presence of common atherosclerosis risk factors in patients with the SCF phenomenon. Patients and Methods: Between October 2014 and March 2015, demographic data, clinical histories, atherosclerosis risk factors, and laboratory and angiographic findings were recorded for all consecutive patients scheduled for coronary angiography and diagnosed with the SCF phenomenon, as well as a control group (patients with normal epicardial coronary arteries; NECA). SCF was diagnosed based on the thrombolysis in myocardial infarction frame count (TFC). A TFC > 27 indicated a diagnosis of SCF phenomenon. Results: Among the 3600 patients scheduled for selective coronary angiography, 75 (2%) met the SCF criteria. SCF and NECA patients did not exhibit statistically significant differences in traditional risk factors except for hypertension, which was more prevalent in SCF than NECA patients (52% versus 31%, P = 0.008). A multivariable analysis indicated a low body mass index, presence of hypertension, low highdensity lipoprotein cholesterol (HDL-c) level, and high hemoglobin level as independent predictors of the SCF phenomenon; of these, hypertension was the strongest predictor (odds ratio = 6.3, 95% confidence interval: 2.2-17.9, P = 0.001). Conclusions: The SCF phenomenon is relatively frequent, particularly among patients with acute coronary syndrome who are scheduled for coronary angiography. Hypertension, a low HDL-c level, and high hemoglobin level can be considered independent predictors of this phenomenon.
International Journal of Cardiology, 2006
Left ventricular (LV) diastolic dysfunction is a prominent cause of several cardiac symptoms and signs, even in patients with normal LV systolic function . Analysis of the mitral inflow and pulmonary venous velocity curves, has been widely used for the noninvasive assessment of LV filling abnormalities . Although novel methods as the tissue-Doppler and color m-mode echocardiography have provided useful insights into the study of diastolic dysfunction, none of the parameters, conventional or not, succeeded to detect accurately the type of LV diastolic dysfunction individually. It seems that technology advances overtook the late mitral inflow A-wave deceleration time (Adt), a simple parameter for the prediction of elevated LV end-diastolic pressure . The present study aimed to investigate the behavior and clinical value of Adt for the detection of the type of LV diastolic dysfunction in patients with acute myocardial infarction (AMI), a field still lacking in data.
Acute phase reactants in patients with coronary slow flow phenomenon
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010
Objective: In this study, we sought to investigate the serum levels of high sensitivity C-reactive protein (Hs-CRP), N-terminal pro-brain natriuretic peptide (NT proBNP), erythrocyte sedimentation rate, leukocyte, thyroid hormone and fibrinogen levels in patients with coronary slow flow phenomenon (CSFP). Methods: A total of 82 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (45 males and 37 females, mean age 59±11 years) and 34 patients with normal coronary arteries and normal coronary flow (19 males and 15 females, mean age 56±10 years) with similar risk profiles were included in this cross-sectional observational study. Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction (TIMI) frame count, serum level of Hs-CRP, NT proBNP, sedimentation, leukocyte, free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) and fibrinogen levels were measured. Statistical analysis was performed using t test for independent samples, Chi-square test and Pearson correlation analysis. Results: Hs-CRP (0.88±0.86 vs 0.36±0.35 mg/L, p<0.001) and NT proBNP (117.83±163.2 vs 47.33±30.6 ng/ml, p<0.01) were found to be significantly higher in patients with coronary slow flow compared with normal control group. There were no significant differences regarding thyroid hormones, fibrinogen, sedimentation rate and leukocyte count between two groups. The mean TIMI frame counts were positively correlated (r=0.454, p=0.001 and r=0.554, p=0.001, respectively) with plasma Hs-CRP levels and NT-proBNP levels. Conclusion: Hs-CRP and NT proBNP are significantly higher in patients with coronary slow flow compared with normal control group. Their increased levels are positively correlated with TIMI frame count.
Slow coronary flow and stress myocardial perfusion imaging. Different patterns in acute patients
Journal of Cardiovascular Medicine, 2006
Objective We investigated myocardial perfusion in acute patients with slow coronary flow (SCF) at angiography. Whether impaired myocardial perfusion occurs in acute patients with SCF is unknown. Methods We enrolled 28 consecutive patients with SCF in the epicardial coronary arteries with no evidence of significant stenosis. SCF affected a single coronary artery in 14 patients (group A) and all three coronary vessels in 14 others (group B). Coronary angiography was repeated after dipyridamole infusion and single photon emission computed tomography was performed using dipyridamole as the stress agent. The Thrombolysis in Myocardial Infarction frame count was measured in SCF vessels at baseline and after dipyridamole infusion. Results Mean Thrombolysis in Myocardial Infarction frame count significantly decreased after dipyridamole in both groups. At baseline, mean values of the single photon emission computed tomography score were 31.5 W 1.6 and 25.1 W 2.1 in groups A and B, respectively. After dipyridamole, they increased from 31.5 W 1.6 to 37.8 W 1.4 (P < 0.001) in group A, whereas a further decrease to 15.0 W 1.2 (P < 0.005) was observed in group B. Conclusions An opposite behavior of myocardial perfusion was observed after dipyridamole infusion: a normal response in patients with SCF affecting one single coronary artery versus an ischemic-like response in those with CSF affecting all three coronary arteries. J Cardiovasc Med 7:322-327 Q 2006 Italian Federation of Cardiology.
International Journal of the Cardiovascular Academy, 2016
Coronary Slow Flow Phenomenon (CSFP) is an angiographic phenomenon in which vessel opacification is delayed without any evidence of obstructive epicardial coronary disease. We aim to present, in this paper, extremely slow coronary flow along with its severe clinical manifestation. A 47-year-old male patient was admitted to our emergency department with ST elevation myocardial infarction caused by coronary slow flow. Oral Acetylsalicylic acid, nebivolol and atorvastatin therapy successfully resulted in complete resolution of his symptoms during the 18-month observation.
The Coronary Slow Flow Phenomenon
Chest Pain with Normal Coronary Arteries, 2013
CHAPTER 2: THE BENEFITS OF MIBEFRADIL IN THE CORONARY SLOW FLOW PHENOMENON 2.1 BACKGROUND 2.1.1 THE BENEFICIAL EFFECTS OF MIBEFRADIL ON ANGINA FREQUENCY 2.1.2 PAIN SENSITIVITY VERSUS ISCHAEMIA IN MICROVASCULAR DISORDERS 2.1.3 OBJECTIVE AND HYPOTHESES 2.1.4 ANGIOGRAPHIC ASSESSMENT OF CORONARY FLOW 2.1.5 MIBEFRADIL PHARMACOKINETICS 2.2 METHODS (1)-METHODOLOGICAL VALIDATION 2.2.1 LOCAL INSTITUTIONAL VALIDATION OF ANGIOGRAPHIC FLOW INDICES 2.2.2 SHORT TERM FLOW VARIABILITY IN THE CSFP 2.3 METHODS (2)-THE EFFECTS OF MIBEFRADIL ON ANGIOGRAPHIC FLOW INDICIES IN PATIENTS WITH THE CSFP 2.3.1 PATIENT SELECTION 2.3.2 STUDY PROTOCOL 2.3.3 DATA ANALYSIS 2.4 RESULTS 2.4.1 PATIENT CHARACTERISTICS 2.4.2 VESSEL CHARACTERISTICS AND HAEMODYNAMICS 2.4.3 ANGIOGRAPHIC FLOW ASSESSMENT 2.5 DISCUSSION 2.5.1 LIMITATIONS 2.6 CONCLUSIONS
Longitudinal left ventricular systolic function is impaired in patients with coronary slow flow
The International Journal of Cardiovascular Imaging, 2009
Slow coronary flow (SCF) is a well recognized clinical entity, characterized by delayed opacification of coronary arteries in the presence of normal coronary angiogram. There is currently no data evaluating myocardial systolic function in SCF phenomenon. This study was performed to evaluate regional and global systolic function using tissue Doppler imaging (TDI), strain (S) and strain rate imaging (SRI) in patients with slow coronary flow. A total of 35 patients with slow coronary flow and otherwise normal coronary arteries (mean age 48 +/- 7 years) (SCF group) and 21 patients with normal coronary angiograms (mean age 50 +/- 12 years) (control group) were included in the study. These patients were prospectively assessed for evaluation of regional and global left ventricular function by conventional echocardiography, systolic TDI, peak S, and peak systolic strain rates (SRs) There was a significant difference in peak SRs (-1.1 +/- 0.2 vs. -1.8 +/- 0.2 1/s, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.0001) but similar in systolic TDI (42 +/- 20 vs. 44 +/- 21 mm/s, P = 0.77) and S (20.7 +/- 7.7 vs. 23.7 +/- 8.8, P = 0.14) between groups. SRs showed a good correlation with mean TIMI frame count (r = -0.80, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.0001). As the number of coronary artery with SCF increased global strain rate decreased further. In case of one or two or three coronary artery with SCF global strain rates were 1.4 +/- 0.2; 1.1 +/- 0.3; 0.9 +/- 0.2 1/s, respectively, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.0001. Although ejection fraction was preserved, global and regional strain rate were decreased in SCF. In brief, there is an impairment in longitudinal left ventricular systolic function in patients with SCF.