Coronary Slow Flow Research Articles

Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow

This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.

Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector.

Serum total bilirubin (STB) is recently more regarded as an antioxidant with vascular protective effects. However, we noticed that elevated STB appeared in unstable angina pectoris (UAP) patients with diffused coronary lesions. We aimed to explore STB's roles in UAP patients, which have not been reported by articles. 1120 UAP patients were retrospectively screened, and 296 patients were finally enrolled. They were grouped by Canadian Cardiovascular Society (CCS) angina grades. The synergy between PCI with TAXUS stent and cardiac surgery score (SYNTAX score) and corrected thrombolysis in myocardial infarction flow count (CTFC) were adopted to profile coronary features. The results showed that STB, mean platelet volume (MPV), hs-CRP, fasting blood glucose (FBG), red blood cell width (RDW), and CTFC elevated significantly in the CCS high-risk group. STB (B = 0.59, 95% CI: 0.39-0.74, P < 0.01) and MPV (B = 0.86, 95% CI: 0.42-1.31, P < 0.01) could indicate SYNTAX score changes for these patients. STB (≥21.7 μmol/L) could even indicate a coronary slow flow condition (AUC: 0.88, 95% CI: 0.84-0.93, P < 0.01). Moreover, UAP patients with elevated STB had a lower event-free survival rate by the Kaplan-Meier curve. STB ≥21.7 μmol/L could reflect a poor coronary flow status and indicate 1-year poor outcomes for these patients (HR: 2.01, 95% CI: 1.06-3.84, P < 0.01). Elevated STB in UAP patients has a close relationship with changes in SYNTAX score. STB (over 21.7 μmol/L) could even indicate a coronary slow flow condition and poor outcomes for the UAP patients.

Relationship between uric acid/ albumin ratio and coronary slow flow

Objectives: Although the pathophysiology of coronary slow flow is not fully understood, evidence suggesting endothelial dysfunction and subclinical widespread atherosclerosis in genesis has grown in recent years. Our aim in this study is to investigate the relationship between uric acid/ albumin ratio and coronary slow flow. Methods: One hundred and five coronary slow flow patients (determined by the Thrombolysis in Myocardial Infarction-frame count method) and one-hundred patients with normal coronary low were included retrospectively. The uric acid/ albumin ratio was investigated in all patients participating. Results: In the logistic regression analysis, it was revealed that high uric acid levels, uric acid/ albumin ratios, and male gender were independent predictors for coronary slow flow. Among these parameters, the uric acid/ albumin ratio was the best predictor of coronary slow flow. Based on the receiver operating characteristics (ROC) analysis, the cut-off value of uric acid/ albumin ratio ≥ 0.57 was found to predict coronary slow flow with 68.3% sensitivity and 68.7% specificity. In multivariate logistic regression analysis, high uric acid levels (OR: 2.22; 95% CI (1.551-3.200), p &amp;lt; 0.001), high serum uric acid/ albumin ratio (OR: 37.7 95% CI (8.176-234.387), p &amp;lt; 0.001), male gender (OR: 0.157; 95% CI (0.078-0.318), p &amp;lt; 0.001) were independent predictors of coronary slow flow. Conclusions: High uric acid/ albumin ratio was detected as an independent predictor for coronary slow flow. Larger studies are needed to elucidate its role in the pathophysiology of coronary slow flow.

Evaluation of Arterial Stiffness and Subfoveal Choroidal Thickness in Patients with Coronary Slow Flow.

Coronary slow flow may not only affect the coronary arteries, but it may also be a vascular problem affecting the rest of the arterial system. The aim of this study was to determine peripheral arterial stiffness and the thickness of the choroid layer in patients with slow coronary flow. Fifty consecutive patients (age, 54.3 ± 11.4 years, 38 male) with coronary slow flow and 25 consecutive patients (age, 50.5 ± 9.9 years, 16 male) with normal coronary arteries both documented by coronary angiography were included. Arterial stiffness parameters were measured noninvasively using a Mobil-O-Graph arteriography system. The choroidal thickness was assessed using the enhanced depth imaging optical coherence tomography method. The patients with coronary slow flow had significantly higher peripheral systolic blood pressure, peripheral pulse pressure, central pulse pressure, and pulse wave velocity (PWV) and significantly thinner choroidal thickness compared to the controls. Thrombolysis in myocardial infarction frame count was positively correlated with PWV (r: 0.237, p = 0.041) and negatively correlated with choroidal thickness (r: -0.249, p = 0.031). There was also a negative correlation between PWV and mean choroidal thickness (r: -0.565, p < 0.001). Linear regression analysis showed that coronary slow flow was an independent predictor of both PWV and choroidal thickness when adjusted by age and sex. The acceleration of average peripheral arterial PWV with a thinning of choroidal thickness in patients with coronary slow flow may support the idea that this phenomenon may be a coronary presentation of a systemic microvascular disorder.

Long-Term Change in Flow Rates in Patients with Coronary Slow Flow

Introduction: Coronary slow flow (CSF) is a condition characterized by impaired blood flow rates in the coronary arteries. It can result in severe cardiovascular outcomes. There is no sufficient evidence regarding the certain etiology and reversibility of slow flow patterns and changes in frame counts with long-term management. Methods: We retrospectively enrolled 48 patients with chronic coronary syndrome and CSF who underwent a second angiography. A corrected coronary frame rate (CFR) >27 was defined as CSF. We created 3 groups according to the change in CSF status as the improved, not changed, and worsened groups. We compared the CFR and CSF status of the patients between the first and second angiographies within a median of 2.6 years. Results: We determined a nonsignificant change in cCFR in left anterior descending (LAD) artery (34.4 [18.9] vs. 31.59 [10.3], p = 0.35), circumflex (Cx) artery (42.84 [12.56] vs. 40.66 [13.2], p = 0.35), and right coronary artery (RCA) (57.80 [30.13] vs. 50.32 [19.5], p = 0.11). In the comparison of CSF status of LAD (75% vs. 63%, p = 0.27), Cx (96% vs. 83%, p = 0.09), RCA (94% vs. 94%, p = 1.0) between first and second angiographies, there was no significant change. In the comparison of the 3 groups according to the improvement of CSF status, there was no significant difference in demographic features, change in laboratory parameters, and time between the groups. Conclusion: There was no significant change in the median CFR and CSF status in the overall group between the two angiographies after 3 years.

Ranolazine improved left ventricular diastolic functions and ventricular repolarization indexes in patients with coronary slow flow.

Coronary slow flow (CSF) is a condition commonly encountered during angiography. Recent studies have shown the adverse effects of CSF on left ventricular diastolic functions. CSF reportedly increases the novel ventricular repolarization parameters. Ranolazine is a preparation with a prominent anti-anginal activity that has positive effects on anti-arrhythmic and diastolic parameters. In this context, this study was carried out to investigate the effects of ranolazine on left ventricular diastolic functions and repolarization in patients with CSF. Forty-six patients with CSF and 29 control subjects were included in the patient and control groups, respectively. Both groups received ranolazine for one month and were evaluated using 12-lead electrocardiography, conventional echocardiography, and tissue Doppler imaging at the baseline and after one month of ranolazine treatment. Corrected P, QT dispersion, and Tp-e interval values were significantly higher in the patient group than in the control group. There was a significant decrease in isovolumic relaxation time (IVRT) and deceleration time (DT) values after the ranolazine treatment compared to the baseline values in the patient group but not the control group. A significant increase was observed in the mean E and A velocities and the mean E/A ratio after the ranolazine treatment compared to the baseline values in the patient group. Additionally, there was a significant difference between the Tp-e interval and corrected P dispersion values measured after the ranolazine treatment compared to the baseline values in the patient group but not in the control group. This study's findings demonstrated that ranolazine positively affected impaired diastolic functions and repolarization parameters, particularly in patients with CSF.

Relationship Between Systemic Immune-inflammation Index and Coronary Slow Flow

Relationship Between Systemic Immune-inflammation Index and Coronary Slow Flow

Evaluation of left ventricular function in patients with coronary slow flow: A systematic review and meta-analysis.

Coronary slow flow (CSF) is an angiographic finding defined as delayed distal vessel perfusion without severe stenosis of the epicardial coronary arteries. However, definite alterations in left ventricular (LV) function in patients with CSF remains inconsistent. This study aimed to clarify the changes in LV function in patients with CSF and explore the factors that may influence LV function. PubMed, Embase, and Cochrane Library databases were systematically searched. Standardized mean differences and 95% confidence intervals (CI) for the LV function parameters were calculated. Subgroup analysis, meta-regression analysis, and correlation analysis were performed to explore the factors influencing LV function. Twenty-two studies (1101 patients with CSF) were included after searching three databases. In patients with CSF, LV ejection function in patients with CSF was marginally lower (61.8%; 95% CI: 61.0%, 62.7%), global longitudinal strain was decreased (-18.2%; 95% CI: -16.7%, -19.7%). Furthermore, left atrial diameter, left atrial volume index, and E/e' were significantly increased, while E/A and e' were significantly decreased. The mean thrombolysis in myocardial infarction frame count (TFC) was linearly associated with LV function; the larger the mean TFC, the greater the impairment of LV function. Left ventricular systolic and diastolic functions were impaired in patients with CSF, and this impairment was aggravated with increasing mean TFC.

The expression levels of PPAR-α/γ and UCP1/2 on the slow coronary flow phenomenon; results from a case-control study.

The slow coronary flow (SCF) phenomenon is considered a coronary artery disorder. Because of the critical function of peroxisome proliferator-activated receptors (PPARs) in regulating the oxidative stress and inflammatory reactions in cardiovascular disease, The aim of the current study was to investigate the expression of the genes for uncoupling proteins 1 and 2 (UCP1 and UCP2), peroxisome proliferator-activated receptors and (PPAR- PPAR-), and PPAR- in SCF patients. In this case-control study, coronary angiography examination was used to analyze 35 individuals with SCF and 35 subjects with normal coronary flow (NCF). SCF was diagnosed using the TIMI (thrombolysis in myocardial infarction frame count) method. The SCF phenomenon is thought to be the TIMI > 27. In the peripheral blood mononuclear cells (PBMCs), the messenger ribonucleic acid (mRNA) expression levels of the PPAR-, PPAR-, UCP1, and UCP2 genes were evaluated. UCP1 and UCP2 expression levels were significantly higher in the SCF group compared to the NCF group (P = 0.034 and P0.001, respectively). The PPAR- and PPAR- levels were found to be significantly lower in the SCF group compared to the NCF group (P = 0.015, P0.001, respectively). According to the results of the logistic regression analysis, high UCP1 and UCP2 levels and low PPAR- and PPAR- levels are each independent predictors of the SCF phenomenon. This research provided evidence about the potential role of PPAR-α, PPAR-γ, UCP1, and UCP2 as biomarkers in SCF. More investigations are suggested to assess the functions of these factors in SCF patients mechanistically.

Evaluation of the relationship between clinical and laboratory risk factors in atherosclerosis patients with coronary slow flow: a case–control analysis

BackgroundCoronary slow flow (CSF) is an angiographic entity distinguished by the delayed filling of the epicardial coronary arteries in the lack of significant obstructive artery disease. The pathological causes are still unknown. This study aimed to elucidate the relationship between clinical and laboratory-related risk factors in atherosclerosis patients diagnosed with CSF.ResultsThe research encompassed a study group of 142 individuals, with a mean age of 52.47 ± 10.62, and a male representation of 47.7%. A thorough statistical analysis was conducted, indicating that there were no noteworthy variations in age, gender, smoking history, hematocrit, blood sugar, and HDL levels between the groups of cases and controls (P > 0.05). Subsequent analysis of the data indicated that there were significant differences in history of hypertension, LDL, and BMI measurements between the groups of subjects who were designated as cases and those who were designated as controls. Our study revealed that male gender, a history of hypertension, and BMI were identified as independent predictors of CSF (P < 0.05).ConclusionsAfter modeling regression, we were able to conclude that male gender, BMI, and history of hypertension are reliable predictors of slow coronary flow. These findings add to our growing understanding of the complex interplay between clinical and laboratory risk factors in the development and progression of CSF.

Homocysteine levels in patients with coronary slow flow phenomenon: A meta-analysis.

With the development of coronary angiography, more and more attention has been paid to coronary slow flow phenomenon (CSFP). Recent studies have found that the correlation between homocysteine (Hcy) levels and CSFP was contradictory, so we conducted this meta-analysis to investigate the correlation. By March 2022, studies that meet the research requirements were identified by searching multiple databases including Embase, Web of Science, and PubMed. We included studies evaluating the correlation between Hcy levels and CSFP. Random or fixed effect meta-analyses were performed according to heterogeneity among included studies. A leave-out method and subgroup analyses were conducted to determine the source of heterogeneity. Thirteen studies involving 625 CSFP and 550 subjects were included. After pooling data from each study, Hcy levels were higher in the CSFP groups (standard mean difference [SMD], 1.45; 95% CI, 0.94 to 1.96, P < .00001) than in the control group. In the meta-analysis, there was significant heterogeneity (I2 = 93%), which was further explored through leave-out method and and subgroup analyses. Specifically, pooling data from studies with a mean thrombolysis in myocardial infarction (TIMI) frame count ≥ 46 (SMD, 1.31; 95% CI, 1.00 to 1.63, P < .00001) resulted in no heterogeneity (0%), indicating that the TIMI frame count ≥ 46 was the source of heterogeneity. Our study found that elevated Hcy levels are strongly associated with CSFP. More importantly, the association was stronger in CSFP patients with mean TIMI frame count ≥ 46.

Association between Serum Galectin-3 and Growth Differentiation Factor-15 Levels and Coronary Slow Flow Phenomenon.

Coronary slow flow phenomenon (CSFP) is characterized by delay in the progression of contrast material in the coronary tree that is not accompanied by significant coronary artery narrowing. Pathophysiologic pathways underpinning CSFP still remain poorly understood. To evaluate the relationship between serum galectin-3 (GAL-3) and growth differentiation factor-15 (GDF-15) levels with CSFP. Fifty CSFP patients and 40 subjects with normal coronary arteries were included in this retrospective study. The patients' serum GDF-15 and GAL-3 concentration levels were measured using relevant kits. Thrombolysis in myocardial infarction frame count (TFC) of each patients was determined. We did not find any differences with respect to clinical and demographic features between the two groups. GDF-15 and GAL-3 concentration levels were significantly higher in the patients with CSFP. Moreover GDF-15 and GAL-3 concentration levels were positively correlated with TFC (GDF-15; r = 0.448, GAL-3; r = 0.642, p < 0.001 for both). Multivariate logistic regression showed that GAL-3 and GDF-15 were predictors of the CSFP. Similarly, GDF-15 and GAL-3 were the only predictors of TFC. More specifically, GDF-15 and GAL-3 concentration levels of 182.18 pg/mL and 8.58 ng/mL predicted CSFP with sensitivities of 76% and 87.5%, respectively, and specificities of 84% and 75%, respectively. GDF-15 and GAL-3 levels were increased in the CSFP patients and predicted the presence and severity of CSFP. Thus, these two biomarkers might prove useful in relation to the diagnosis of CSFP.

Coronary slow flow is not an adverse prognostic factor in MINOCA patients in the 5-year follow-up

Introduction: The research aimed to compare the characteristics and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients with coronary slow flow (CSF) vs. normal coronary flow (no CSF) in a 5-year follow-up. Material and methods: Between 2010–2015 were identified 111 patients as having final MINOCA diagnosis and available calculated corrected TIMI frame count (cTFC). CSF was defined as cTFC greater than 27 frames per second in any of the three coronary arteries. The primary endpoint was the 5-year major adverse cardiovascular events rate, defined as cardiac death, myocardial infarction, or hospitalization due to angina. Results: The mean cTFC was 28.9 ± 6.1 frames per second (median: 28, IQR 24–33; min-max: 19–58). 62 (55.9%) patients had normal coronary flow, and 49 (44.1%) had CSF. Patients did not differ in sex (females no CSF vs. CSF: 58% vs. 61%, p = 0.7) or age (63 ± 15 years vs. 63 ± 13 years, p = 0.8). Patients with CSF characterized higher rates of chronic kidney disease (0 vs. 8.2%, p = 0.035). No statistically significant difference was observed for any of the analysed points. MACE rates for no CSF vs. CSF were 9.6% vs. 14.3% (HR 0.80, 95% CI 0.28–2.96, p = 0.7), respectively. Conclusions: CSF was not associated with a higher risk of adverse events among MINOCA patients at five years.

A Novel “Mean Platelet Volume-Age-Total Protein-Hematocrit (MAPH)” Score for Blood Viscosity: Predictive Capabilities for Coronary Slow-Flow Phenomenon

A Novel “Mean Platelet Volume-Age-Total Protein-Hematocrit (MAPH)” Score for Blood Viscosity: Predictive Capabilities for Coronary Slow-Flow Phenomenon

Evaluation of triglyceride-glucose index in coronary slow flow patients

Aim Triglyceride glucose index (TyG index) is a surrogate marker for insulin resistance. No studies have evaluated the TyG index in patients with coronary slow flow phenomenon (CSFP). We investigated TyG index values in CSFP and evaluated whether it had a predictive value for the diagnosis of CSFP.Material and Methods 132 CSFP patients and 148 subjects with normal coronary arteries were included in the study. Thrombo-lysis in myocardial infarction frame count (TFC) of each patient was calculated. Demographic, clinical features, information regarding medication use and biochemical variables of the patients were obtained from hospital records.Results TyG index of patients with CSFP and normal coronary flow were 9.02 (8.65-9.42) and 8.69 (8.39-9.18), respectively (p&lt;0.001). Mean TFC showed positive correlation with the TyG index, glucose, triglyceride, and hemoglobin concentration (r=0.207, r=0.138, r=0.183, r=0.179 and p&lt;0.001, p=0.020, p=0.002, p=0.003, respectively) and negative correlation with high density lipoprotein-cholesterol (HDL-C) level (r=-0.292, p&lt;0.001). Receiver operating characteristic curve analysis of TyG index demonstrated that the value of 8.68 predicted CSFP curve analysis of TyG index demonstrated that the value of 8.68 predicted CSFP with sensitivity of 74.2 % and specificity of 58.6 %. In multivariate logistic regression analysis, HDL-C, hemoglobin and the TyG index were the independent predictors of CSFP.Conclusions Our findings supported the hypothesis that insulin resistance play role in CSFP.

Investigation of the Relationship Between Triglycerides-Glucose İndex and Coronary Slow Flow: A Retrospective Case-Control Study.

Coronary slow flow (CSF) refers to delayed distal vessel opacification in the absence of epicardial coronary artery stenosis. The etiopathogenic mechanism of CSF is still unclear. This study investigates the relationship between CSF and the triglyceride-glucose (TyG) index. The study sample consisted of 118 CSF patients and 105 patients with normal coronary flow (NCF). The coronary flow rate was measured via the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method in all patients. The TyG index was calculated as the logarithm of the [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)]/2 value. A significance level of < 0.05 was adopted as statistically significant. The TyG index, low-density lipoprotein (LDL), body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR) and TFC values, male ratio, and the ratio of smokers were higher, whereas high-density lipoprotein (HDL) levels were significantly lower in the CSF group compared to the NCF group (p<0,05). The correlation analysis revealed that CSF was significantly correlated with TyG index, BMI, NLR, and HDL values. The strongest of these correlations was between CSF and TyG index (r= 0.57, p<0.001). Additionally, the multivariate analysis revealed that TyG index, BMI, NLR ratio, and male gender were independent predictors for CSF (p<0.05). Receiver operating characteristic (ROC) curve analysis indicated that a cut-off value of ≥ 9.28 for the TyG index predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.868 and 95% Confidence Interval (CI): 0.823-0.914]. The findings of this study revealed a very strong relationship between CSF and TyG index.

Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study

AimCoronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP. MethodsThis single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA2DS2-VASc, M-CHA2DS2-VASc, CHA2DS2-VASc-HS, R2-CHA2DS2-VASc, M-R2-CHA2DS2-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP. ResultsThe mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA2DS2-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2–3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA2DS2-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001). ConclusionWe showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA2DS2-VASc-HS score had the best discriminative ability.

Relationship between inflammatory markers and coronary slow flow in type 2 diabetic patients

BackgroundDiabetes is a serious and quickly expanding global health problem. Cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. Coronary slow flow (CSF) is characterised by delayed distal perfusion during coronary angiography with normal coronary arteries.This study aimed to investigate the correlation between CSF and inflammatory markers regarding glycemic status in T2DM.MethodsThis cross-sectional study included 120 patients who were divided equally into 4 groups according to their glycemic control and presence or absence of coronary slow flow: Group I included patients with T2DM with good glycemic control without CSF; Group II included patients with T2DM with good glycemic control and CSF; Group III included patients with T2DM with poor glycemic control without CSF; and Group IV included patients with T2DM with poor glycemic control and CSF. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), platelets, hematocrit, and haemoglobin were also evaluated as risk factors for coronary slow flow.ResultsThis study showed that body mass index (BMI), hematocrit level, NLR, and CRP demonstrated a moderate but significant correlation (r = 0.53) with CSF in poorly controlled T2DM. NLR cutoff > 2.1 could predict CSF in poorly controlled T2DM with a modest sensitivity and specificity. A 1.9 increase in HbA1c increases the likelihood of coronary slow flow. Dylipidemia increases the likelihood of coronary slow flow by 0.18 times. Other predictors for coronary slow flow include NLR, PLR, CRP, platelets, hematocrit, and hemoglobin. The effect of the predictors is still statistically significant after being adjusted for glycemic status, age, and sex (p < 0.001).ConclusionsPoor glycemic control increases the incidence of CSF. This supports the hypothesis that CSF is related to endothelial dysfunction as poor glycemic control causes endothelial dysfunction due to inflammation.Trial registrationZU-IRB#9419–3-4–2022 Registered 3 April 2022, email. IRB_123@medicine.zu.edu.eg.

Assessment of Left Ventricular Functions by Two-Dimensional Speckle Tracking Echocardiography in Patients with Coronary Slow-Flow Phenomenon.

Background: Coronary slow flow phenomenon (CSFP) is a medical challenge, especially regarding its diagnosis. The use of speckle tracking seems to provide a clue for diagnosis. However, its role is not well addressed.&#x0D; Aim of the work: To assess the value of the left ventricle's global longitudinal strain by 2D speckle tracking to detect subclinical left ventricular systolic dysfunction in patients with the slow coronary flow.&#x0D; Patients and methods: This study was performed between May and September 2020 at the cardiology department, Al-Azhar University Hospital (New Damietta). Thirty patients are known to have slow coronary flow based on a previous coronary angiographic examination, and 30 healthy participants with the same demographic match (age and sex) as a control group were included. Patients were classified into two groups: Group (A): Included 30 patients with a coronary slow flow. Group (B): Included 30 normal healthy adult persons served as a control group. All were assessed clinically and by radiological investigations. In addition, speckle tracking echocardiography was done for all patients.&#x0D; Results: In Doppler flow measures, E wave and E/A ratio showed significantly lower values in CSFP when compared with the control group (p= 0.02, 0.003 respectively). According to tissue velocity imaging (TVI), there is a similarity between both groups without any significant difference. Speckle tracking measurements demonstrate significantly lower value in patients with CSFP than the control group (p=0.003).&#x0D; Conclusion: In patients with CSF, LV systolic function detected during both conventional and tissue Doppler echocardiographic examinations was not affected, but 2D longitudinal strain demonstrated that LV systolic function was impaired. CSFP could impair LV diastolic function.

Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow.

Background and Objectives: Coronary slow flow (CSF) is an angiographic phenomenon characterized by the slow progression of an injected contrast agent during diagnostic coronary angiography in the absence of significant stenosis. Although CSF is a common angiographic finding, the long-term outcomes and mortality rates are still unknown. This study aimed to investigate the underlying causes of mortality over a 10-year period in patients diagnosed with stable angina pectoris (SAP) and CSF. Materials and Methods: This study included patients with SAP who underwent coronary angiography from 1 January 2012 to 31 December 2012. All patients displayed CSF despite having angiographically normal coronary arteries. Hypertension (HT), diabetes mellitus (DM), hyperlipidaemia, medication compliance, comorbidities, and laboratory data were recorded at the time of angiography. Thrombolysis in myocardial infarction (TIMI) frame count (TFC) was calculated for each patient. The cardiovascular (CV) and non-CV causes of long-term mortality were assessed. Results: A total of 137 patients with CSF (93 males; mean age: 52.2 ± 9.36 years) were included in this study. Twenty-one patients (15.3%) died within 10 years of follow-up. Nine (7.2%) and 12 (9.4%) patients died of non-CV and CV causes, respectively. Total mortality in patients with CSF was associated with age, HT, discontinuation of medications, and high-density lipoprotein cholesterol (HDL-C) levels. The mean TFC was associated with CV mortality. Conclusion: Patients with CSF exhibited a notable increase in cardiovascular-related and overall mortality rates after 10 years of follow-up. HT, discontinuation of medications, HDL-C levels, and mean TFC were associated with mortality in patients with CSF.