Frame Count Method Research Articles

Impaired coronary blood flow may be related to elevated homocysteine levels in patients with metabolic syndrome.

Metabolic syndrome (MS) refers to a group of cardiovascular risk factors associated with endothelial dysfunction and impaired coronary blood flow (CBF). Homocysteine (Hcy) is another risk factor for the development of insulin resistance and endothelial dysfunction. However, the relationship between Hcy levels and CBF in patients with MS has not been investigated specifically. In the present study, we aimed to evaluate the relationship between Hcy levels and CBF in MS patients with normal coronary arteries. The study population included 36 patients with MS (20 males, 16 females; mean age = 55 ± 9 years) and 36 control subjects (20 males, 16 females; mean age = 51 ± 7 years). All subjects had angiographically proven normal coronary arteries. Plasma Hcy concentrations were evaluated after a fast of 12 h or longer. The CBF rates of all subjects were documented by the thrombolysis in myocardial infarction (TIMI) frame count method. The TIMI frame counts for each major epicardial coronary artery and mean TIMI frame count were found to be significantly higher in the MS group compared with the control group (left anterior descending coronary artery (LAD): 53 ± 26 vs. 39 ± 17; p = 0.01, left circumflex artery (LCx): 32 ± 12 vs. 26 ± 11; p = 0.01, right coronary artery (RCA): 33 ± 14 vs. 26 ± 12; p = 0.02, mean TIMI frame count: 39 ± 16 vs. 20 ± 12; p = 0.01). Plasma Hcy levels in patients with MS were significantly higher compared with controls (MS group = 11.6 ± 4 and control group = 9.6 ± 2.6; p = 0.01). Additionally, plasma Hcy levels were positively correlated with each calculated TIMI frame count value in the MS group (LAD, r: 0.28 and p = 0.006; LCx, r: 0.25 and p = 0.022; RCA, r: 0.26 and p = 0.042; mean TIMI frame count, r: 0.28 and p = 0.004). Plasma Hcy levels and TIMI frame counts were significantly higher in patients with MS. Impaired CBF in MS may be related to elevated levels of Hcy, even if Hcy levels are normal.

The association of neutrophil to lymphocyte ratio and TIMI frame count in primary percutaneous coronary intervention.

This study was sought to evaluate the relationship between admission neutrophil lymphocyte ratio (NLR) and estimated coronary flow by the TIMI frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). TFC of 262 consecutive STEMI patients were evaluated after PPCI. Admission NLR were calculated and TFC was determined after PPCI. According to admission NLR value, patients were divided in to two groups. NLR levels higher than 3.5 were defined "higher NLR" whereas lower than 3.5 were accepted as "lower NLR". TFC was significantly higher in patients with higher NLR (56.6±41.1 vs. 37.9±36.1, P<0.001). No-reflow phenomenon was more frequent in higher NLR group compared to lower NLR group (10.1% vs. 5.2%, P=0.001). In multivariate linear regression analysis admission NLR was an independent predictor of high TIMI frame count (B=2.24 95 % CI (1.17-3.31), P<0.001). Our findings suggest that admission NLR predicts coronary blood flow in means of TFC.

Evaluation of serum prolidase activity in patients with slow coronary flow.

IntroductionSlow coronary flow (SCF) is described as the slow passage of contrast to distal coronaries despite anatomically normal coronary arteries. It has been shown that increased serum prolidase activity (SPA) correlates with collagen turnover. Increased collagen turnover might be associated with the development of atherosclerotic plaques.AimTo investigate the relationship between serum prolidase activity and slow coronary flow.Material and methodsThis cross-sectional study included 40 SCF patients (mean age: 55.0 ±9.5 years, 20 females) and 40 controls (mean age: 53.9 ±8.2 years, 21 females) with normal coronary anatomy and normal coronary flow. The Thrombolysis in Myocardial Infarction (TIMI) frame-count (TFC) method was used for SCF diagnosis. Serum prolidase activity was measured spectrophotometrically, and the relevant parameters were compared between the groups.ResultsThere were no statistically significant differences between the SCF and control groups in terms of basic demographic, clinical, and laboratory data. However, the SPA was significantly higher in the SCF group compared to the control (702.7 ±13.8 and 683.9 ±13.2 respectively, p<0.001). Serum prolidase activity was significantly correlated with the mean TFC (r=0.463, p<0.001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 681.3.ConclusionsOur study showed that SPA was increased in SCF patients. The activity of this enzyme was significantly correlated with the mean TFC.

The association of serum albumin with coronary slow flow.

A number of inflammatory markers such as high-sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), and fibrinogen have been shown to be associated with coronary slow flow (CSF). Our aim was to investigate the relationship between albumin, a long-acting negative acute-phase protein, and CSF. A total of 106 patients with angiographically proven slow coronary flow and 57 control subjects with normal coronary flow were included in the study. Serum levels of Hs-CRP and albumin were measured. CSF was defined by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC) method. Serum albumin (s-albumin) was significantly lower in the CSF group (3.79 ± 0.3 vs 4.17 ± 0.3, p < 0.001), whereas Hs-CRP level was significantly higher in the CSF group compared with the controls (1.22 ± 0.79 vs 0.76 ± 0.44, p < 0.001). S-albumin and Hs-CRP were correlated with the mean TFC in the whole study population (r= - 0.574, p < 0.001; r = 0.376, p < 0.001, respectively). Hs-CRP and low s-albumin were found to be significant predictors of CSF in the multivariate analysis. The comparison of receiver-operating characteristics curves for s-albumin and Hs-CRP demonstrated that s-albumin was the strongest predictor of CSF. We found that s-albumin levels decreased and Hs-CRP levels increased in patients with CSF. S-albumin was also found to have superior predictive value than Hs-CRP for diagnosing CSF. S-albumin, an inexpensive and easily measurable laboratory variable, may be a useful predictor of CSF, especially when other reasons which alter its serum levels were excluded.

The relationship between coronary slow flow phenomenon and urotensin-II: A prospective and controlled study.

Objective:The underlying mechanism of coronary slow flow (CSF) has not yet been clarified, although many studies have been conducted to understand its pathophysiology. In this study, we investigated the role of a very potent vasoconstrictor, urotensin-II (UII), in the pathophysiology of CSF. This prospective and controlled investigation aimed to evaluate the association between CSF and serum levels of UII.Methods:Our study included 32 patients with slow flow in any coronary artery and 32 patients with normal coronary arteries. Coronary flow was calculated using the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method, and CSF was defined as TFC ≥39 for the left anterior descending artery, TFC ≥27 for the circumflex coronary artery, and TFC ≥24 for the right coronary artery. UII levels in blood samples obtained from both groups were measured by enzyme-linked immunosorbent assay (ELISA) method.Results:UII levels were significantly higher in the CSF group than in the control group [122 pg/mL (71-831), 95 pg/mL (21-635), respectively; p<0.001]. High-density lipoprotein (HDL) levels were lower in the CSF group, and leukocyte counts were significantly higher. A positive correlation between UII and mean TFC (r=0.524, p=0.002) was found in the CSF group. The multivariate logistic regression analysis determined that UII, HDL, and cigarette smoking were independent indicators in predicting CSF (OR=1.010, 95% confidence interval 1.002-1014, p=0.019; OR=0.927, 95% confidence interval 0.869-0.988, p=0.019; OR=5.755, 95% confidence interval 1.272-26.041, p=0.021, respectively).Conclusion:Serum UII levels were found to be significantly higher in the CSF group, suggesting that UII may be one of the underlying factors in the pathogenesis of CSF

Endothelial function and germ-line ACE I/D, eNOS and PAI-1 gene profiles in patients with coronary slow flow in the Canakkale population : multiple thrombophilic gene profiles in coronary slow flow : cardiovascular topic

SummaryBackgroundWe examined the effects of ACE, PAI-1 and eNOS gene polymorphisms on endothelial function. The genes are related to atherosclerosis and endothelial dysfunction in coronary slow flow (CSF).MethodsThirty-three patients with angiographically proven CSF and 48 subjects with normal coronary flow were enrolled in this study. Coronary flow patterns were determined by the thrombolysis in myocardial infarction (TIMI) frame count method. Endothelial function was assessed in the brachial artery by endothelium-dependent flow-mediated dilatation (FMD). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were determined by polymerase chain reaction (PCR) amplification.ResultsNo difference was found between the groups regarding age, heart rate and blood pressure. Males were more prevalent among patients with CSF than control subjects (58.8 vs 29.8%, p = 0.009). Mean TIMI frame counts were significantly higher in CSF patients (24.2 ± 4.0 vs 13.1 ± 2.5 fpm, p = 0.001). FMD was significantly lower in CSF patients than in the controls (4.9 ± 6.6 vs 7.9 ± 5.6%, p = 0.029). TIMI frame count and FMD were found to be negatively correlated in a correlation analysis (r = –0.269, p = 0.015). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were similar in the two groups.ConclusionsThis study showed that endothelial function was impaired in patients with CSF. PAI-1, ACE and eNOS polymorphisms were not related to CSF in our study population.

Endothelial nitric oxide synthase levels and their response to exercise in patients with slow coronary flow

SummaryBackgroundEndothelial dysfunction plays a key role in the aetiopathogenesis of slow coronary flow (SCF) even if there is no obstructive epicardial lesion. Reduced plasma levels of endothelial nitric oxide synthase (eNOS) are an important indicator of endothelial dysfunction. We aimed to determine plasma levels of eNOS and their relationship with exercise in patients with SCF.MethodsTwenty-two patients with SCF in at least one coronary artery and 17 healthy individuals were included in this study. The TIMI frame count method was used to determine SCF. Plasma levels of eNOS before and after effort were determined in the patient and control groups.ResultsBasal eNOS levels in the patient group were lower than in the control group (p = 0.040), and plasma eNOS levels after exercise decreased more significantly in the patient group compared to the control group (p = 0.002). Median decreases of eNOS in response to exercise were higher in the SCF group than in the control group (p < 0.001), and the decrease observed in the control group was not statistically significant (p = 0.35). There were significantly negative correlations between TIMI frame count and plasma levels of eNOS at baseline and after exercise (r = –0.51, p = 0.015, r = –0.58, p = 0.005, respectively). Moreover, there was also a positive correlation between the rate–pressure product and plasma levels of eNOS after exercise in patients with SCF (r = 0.494, p = 0.019).ConclusionOur findings indicate an important pathophysiological relationship between the severity of SCF in which endothelial dysfunction plays a role in its pathogenesis and the level of circulating plasma levels of eNOS.

High disturbed flow in stent-implanted region predicts target lesion revascularization after everolimus-eluting stent implantation in hemodialysis

Background: High disturbed coronary blood flow was reported to increase the risk of adverse events. The purpose of this study was to assess predictive values of coronary flow velocity (CFV) and an index of disturbed flow for target lesion revascularization (TLR) after everolimus-eluting stent (EES) implantation in hemodialysis (HD) patients. Methods and results: The study group consisted of 81HD patients with 100 coronary lesions (age 69.9±9.1 years, mean ± SD, 59 male) who underwent successful percutaneous coronary intervention (PCI) with EES implantation. The TIMI frame count method and quantitative digital angiographic analysis were performed based on the post-PCI angiogram. CFV (vessel length/TIMI frame count/15) and an index of disturbed flow (Reynolds number: velocity/diameter/density/viscosity) were measured both throughout the target vessel and in the stent-implanted region. Target lesion revascularization (TLR) occurred in 12 lesions (12.0%) at the follow-up period of 20.9±10.4 months. There were no significant differences between TLR group (12 lesions) and Non-TLR group (88 lesions) in terms of CFV and Reynolds number throughout the target vessel (195.4±66.8mm/sec vs. 159.8±56.6, p=0.17, 153.4±75.4 vs. 119.7±59.4, p=0.08, respectively). However, in the stent-implanted region, CFV and Reynolds number of the TLR group were significantly higher than the Non-TLR group (222.8±70.7mm/sec vs. 160.5±77.2, p=0.006, 186.1±65.7 vs. 132.4±71.2, p=0.01, respectively). Multivariate analysis showed that Reynolds number in the stent-implanted region after EES was an independent predictor of TLR in the HD patients (OR: 1.01, 95% CI: 1.00-1.023, p=0.02). Conclusion: In the stent-implanted region, CFV and Reynolds number were significantly higher in the TLR group than the Non-TLR group. High disturbed flow in stent-implanted region after EES may predict the risk of TLR in HD patients.

Effect of Chronic Pretreatment of Angiotensin‐Converting Receptor Blocker on No‐Reflow Phenomenon in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Angiotensin receptor blockers (ARBs) exert favorable effects on the vascular system, which are not directly related to hypertension lowering function. The no-reflow phenomenon determines the prognosis in patients after acute myocardial infarction (AMI). Early ARB treatment has many beneficial effects on the prognosis after AMI. In this study, we tested the hypothesis that ARB treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after infarction. We investigated 276 consecutive patients with AMI undergoing successful primary percutaneous coronary intervention (PCI). No-reflow was defined as thrombolysis in myocardial infarction (TIMI) flow grade <3, which was determined by the TIMI frame count method using angiographic images obtained just after PCI and stenting. Compared with patients without ARB treatment, patients with ARB had more frequently hypertension and ST resolution (P < 0.05), but no significant difference was found in the other clinical characteristics (age, sex, Hyperlipidaemia, Diabetes mellitus, etc) between the two groups. A total of 51 patients receiving chronic ARB treatment before admission have lower incidence of the no-reflow phenomenon than those without chronic ARB treatment (8.7% and 26.7%, P= 0.003). However, the incidence of the no-reflow phenomenon between the patients with and without hypertension had no significant difference. Multivariable logistic regression analysis revealed that ARB pretreatment was a significant predictor of the no-reflow phenomenon, whereas blood pressure was found to be insignificant. Chronic pretreatment of ARB is associated with the reduction of the no-reflow phenomenon in patients with reperfused AMI and could preserve microvascular integrity after AMI independent of blood pressure lowering, which may contribute to better functional recovery.

Effect of Chronic Pretreatment of Angiotensin-converting Receptor Blocker on No-Reflow Phenomenon in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Summary Aims: Angiotensin receptor blockers (ARBs) exert favorable effects on the vascular system, which are not directly related to hypertension lowering function. The no-reflow phenomenon determines the prognosis in patients after acute myocardial infarction (AMI). Early ARB treatment has many beneficial effects on the prognosis after AMI. In this study, we tested the hypothesis that ARB treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after infarction. Methods: We investigated 276 consecutive patients with AMI undergoing successful primary percutaneous coronary intervention (PCI). No-reflow was defined as thrombolysis in myocardial infarction (TIMI) flow grade <3, which was determined by the TIMI frame count method using angiographic images obtained just after PCI and stenting. Results: Compared with patients without ARB treatment, patients with ARB had more frequently hypertension and ST resolution (P < 0.05), but no significant difference was found in the other clinical characteristics (age, sex, Hyperlipidaemia, Diabetes mellitus, etc) between the two groups. A total of 51 patients receiving chronic ARB treatment before admission have lower incidence of the no-reflow phenomenon than those without chronic ARB treatment (8.7% and 26.7%, P= 0.003). However, the incidence of the no-reflow phenomenon between the patients with and without hypertension had no significant difference. Multivariable logistic regression analysis revealed that ARB pretreatment was a significant predictor of the no-reflow phenomenon, whereas blood pressure was found to be insignificant. Conclusion: Chronic pretreatment of ARB is associated with the reduction of the no-reflow phenomenon in patients with reperfused AMI and could preserve microvascular integrity after AMI independent of blood pressure lowering, which may contribute to better functional recovery.

THROMBOLYSIS IN MYOCARDIAL INFARCTION FRAME COUNT IN TAKOTSUBO CARDIOMYOPATHY

Takotsubo cardiomyopathy (TC) in its typical form, is characterizedby transient systolic dysfunction of the apical and/or mid segments ofthe left ventricle that mimic myocardial infarction (MI), but in the ab-sence of significant coronary artery disease [1–3]. Common triggeringfactorsincludeacutemedicalillness,severeemotionalorphysicalstresse.g., unexpected death of relatives, domestic violence, arguments, cata-strophic medicaldiagnoses,financialor gambling losses and naturaldi-sasters [2,3]. Pathogenesis remains unclear although catecholamine-mediated myocardial stunning, multivessel coronary vasospasm andabnormalities in coronary microvascular function have been proposedas possible explanations [2,3]. TC has strong female preponderancewith nearly 90% cases involvingpostmenopausal women [3,4]. Patientscommonly present with substernal chest pain. Electrocardiographicchanges include ST-segment elevation, T-wave inversion, QT-intervalprolongation, abnormal Q-waves or non-specific abnormalities [1–3].Elevations in cardiac biomarkers are typically less pronounced than inacute anterior ST-segment elevation myocardial infarction (STEMI)and coronary angiography does not revealobstructive coronary diseaseor plaquerupture correspondingto thewall motion abnormalitiesseenin this condition [1–4].MayoCliniccriteriaiscommonlyusedfordiagnosisandrequiresfol-lowing four conditions: a) transient hypokinesis, akinesis or dyskinesisoftheleftventricularmidsegmentswithorwithoutapicalinvolvement,b) absence of obstructive coronary disease or acute plaque rupture,c) new electrocardiographic abnormalities (ST-segment elevation and/orT-waveinversion)ormodestelevationincardiactroponin,andd)ab-sence of pheochromocytoma or myocarditis [5,6]. However thesecriteria are considered outmoded and newer versions have been pro-posed which suggest that myocarditis and TC can coexist and don'thave to be mutually exclusive [5,6]. Supportive measures are themain-stay of management. Patients generally receive aspirin, β-blockers,angiotensin-converting-enzyme inhibitors, and intravenous diuretics ifneeded. Hypotension in the setting of left ventricular outflow tract ob-struction may warrant use of beta-blockers and phenylephrine. In se-vere left ventricular dysfunction, inotropic agents or an intraaorticballoonpumpmayberequired [1–4].Prognosisisexcellent,withnearly95%ofpatientsexperiencingcompleterecoverywithin4–8weeks[3,4].Gibson et al. [7] introduced the TIMI frame count (TFC) method formeasuring coronary flow velocity from coronary angiograms. It is de-fined as ‘the number of frames required for contrast material to travelfrom the coronary ostium to the distal landmark’ [7]. The objective ofour study isto determineif TFC isa useful tool in determiningthecoro-nary flow in TC patients [8].Sixteen patients were identified at our institute with an apparentacute anterior-STEMI presentation but were subsequently diagnosedwith TC. They were retrospectively compared with randomly chosencontrolswithout coronary artery disease on angiography. Microcircula-tory analysis was done via calculation of TFC (Gibson technique) in allthree major vessels. Left anterior descending (LAD) artery values wereadjusted (by applying a correction factor) to get ‘corrected TIMI-Frame-Count’ (CTFC). This was done to compensate for the longerlengthofLADandcalculatedbydividingthenumberofframesrequiredfor the dye to pass through the LAD by 1.7. Data was analyzed usingExcel-2007 software. Mean ± Standard Deviation are given for quanti-tative variables (Table 1). Frequencies, percentages and graphs aregiven for qualitative variables (Table 2). Two-independent sample t-test was applied to observe group mean differences. p-Value of b0.05was considered to be statistically significant.Patients were divided into two groups viz. cases and controls. Caseshad 16 patients (all females), while controls had 15 (9 females; 6males). Mean ages of the cases and control groups were 68.31 ±10.88 years and 66.5 ± 14.28 years respectively. Mean-CTFC for LADin cases was 19.61 ± 5.77 and in controls it was 16.65 ± 2.41 (statisti-cally significant difference, p-value = 0.04 (table/Fig. 1)). Mean-CTFCfor Circumflex artery was 18.93 ± 3.87 and 18.06 ± 3.95 in cases andcontrols respectively (no statistically significant difference p-value =

Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow flow phenomenon

In this study, systolic and diastolic function parameters were measured with conventional and tissue Doppler echocardiography in coronary slow flow phenomenon (CSFP) patients and compared to those of a control group. Sixty patients (49 male; mean age 52.4±12.1) in whom CSFP was detected during coronary angiography study and 30 volunteers with normal coronary arteries (21 males; mean age 50.2±12.1) were included in this study. CSFP was determined using the TIMI frame count (TFC) method. TIMI frame count was calculated in each coronary artery using the TFC method. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. TFC correlation between diastolic function parameters was measured. Baseline demographic and laboratory results did not differ significantly between the groups. TIMI frame counts were greater in the CSFP group compared to controls (p<0.001). Left ventricular ejection fraction (65.93±8.06% vs 66.63±5.96%), E/A ratio (1.11±0.36 vs 1.22±0.33), and isovolumetric relaxation time (IVRT) (85±17 cm/s vs 84±13 cm/s) measured with conventional echocardiography showed no significant difference between the two groups. Em (7.0±2.1 cm/s vs 7.4±1.7 cm/s), Am (7.4±2.0 cm/s vs 7.0±1.4 cm/s) and E/Em (10±3 vs 10±1) measured with tissue Doppler echocardiography showed no significant difference between the two groups. Corrected TIMI frame count for the left descending coronary artery (cLAD) and mean TFC were not correlated with the E/A ratio, deceleration time (DT), IVRT, or E/Em ratio. Left ventricular systolic and diastolic functions were preserved in CSFP.

Documentation of impaired coronary blood flow by TIMI frame count method in patients with atrial fibrillation

BackgroundAtrial fibrillation (AF) is associated with impaired coronary flow and diminished myocardial perfusion. In the present study we aimed to evaluate coronary blood flow by means of Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) in patients with AF in the absence of obstructive coronary artery disease (CAD). MethodsThis prospective study initially enrolled 166 patients with AF and 332 age- and gender-matched control subjects without AF. After diagnostic coronary angiography, TFC was assessed in the participants without obstructive CAD, with 146 in the AF group and 150 in the control group. ResultsThe TFC for three major coronary arteries and the mean TFC were found to be significantly higher in AF patients compared to control subjects (34.1±10.4 vs. 25.0±10.4, 31.8±9.7 vs. 23.7±9.1, and 32.3±9.5 vs. 24.1±8.4 for each artery and 32.8±9.2 vs. 24.3±8.9 for mean TFC, p<0.001 for all comparisons). The mean TFC was 28.8±7.9 in patients with paroxysmal AF, 33.7±8.7 in those with persistent AF, and 39.0±8.8 in those with long-standing or permanent AF (p<0.01 for all comparisons). After multivariate analysis, we found that the presence of AF remains to be independently associated with mean TFC. In AF group, baseline heart rate, left ventricular ejection fraction, AF duration and left atrium diameter were found to be independently associated with mean TFC. ConclusionsPatients with atrial fibrillation in the absence of obstructive coronary artery disease have significantly higher TIMI frame counts for all three coronary vessels, indicating impaired coronary blood flow, compared to the control subjects without atrial fibrillation.

Echocardiographic Epicardial Adipose Tissue Predicts Subclinical Atherosclerosis

We examined the relationship between coronary flow rate and epicardial adipose tissue (EAT) in patients with slow coronary flow (SCF) and normal coronary arteries. The study included 40 consecutive patients with stable angina pectoris who had normal coronary arteries. All patients underwent echocardiography. To determine the SCF, thrombolysis in myocardial infarction (TIMI) frame count method was used. Half of the patients had SCF at least in 1 coronary artery. Thrombolysis in myocardial infarction frame counts, the mean TIMI frame count, and EAT thickness were significantly higher in patients with SCF. Slow coronary flow showed a significantly positive correlation with EAT thickness. Epicardial adipose tissue thickness was the only independent predictor of SCF. Our findings suggest that there is a significant correlation between the SCF and EAT. Therefore, echocardiographic EAT may become a predictor of subclinical atherosclerosis in patients with stable angina pectoris.

Endothelial Dysfunction and Increased Carotid Intima-Media Thickness in the Patients with Slow Coronary Flow

Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 ± 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 ± 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.

Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention

We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels > 198 mg/dL (11 mmol/L) were defined as hyperglycemic. Hyperglycemia was observed in 36 (29.8%) patients. The TFC was significantly higher in patients with hyperglycemia (70.75 [10-96] vs 56.87 [8-100], P = .04). No-reflow frequency was higher in the hyperglycemia group (44.4% vs 23.5%, P = .02). In multivariate linear regression analysis admission glucose was an independent predictor of high TFC (B = 0.21, P = .02). Our findings suggest that admission blood glucose is a predictor of TFC which reflects coronary blood flow.

Assessment of coronary blood flow in non-ischemic dilated cardiomyopathy with the TIMI frame count method

We aimed to evaluate coronary blood flow by means of the TIMI (Thrombolysis in Myocardial Infarction) frame count in patients with idiopathic dilated cardiomyopathy who had angiographically proven normal coronary arteries and compare the results with those of healthy subjects. This retrospective study included 62 patients with idiopathic dilated cardiomyopathy (34 men, 28 women; mean age 59.7 ± 10.6 years) and 62 control subjects without dilated cardiomyopathy (28 men, 34 women; mean age 56.6 ± 9.8 years). All patients and control subjects had angiographically proven normal coronary arteries. Dilated cardiomyopathy patients had a left ventricular ejection fraction =45%. The TIMI frame count was determined for each major coronary artery in each patient. Statistical analysis was performed using Student's t test, Chi-square test and Pearson correlation analysis. The TIMI frame counts for each major epicardial coronary artery were found to be significantly higher in patients with idiopathic dilated cardiomyopathy compared to control subjects (corrected TIMI frame count for left anterior descending coronary artery: 37.0 ± 12.5 vs 28.7 ± 11.6, respectively, p=0.001; left circumflex coronary artery: 37.7 ± 12.1 vs 31.0 ± 12.5, respectively, p=0.003; right coronary artery: 37.4 ± 12.6 vs 30.7 ± 11.6, respectively, p=0.003). Mean TIMI frame count had significant although weak positive correlation with left ventricular end-diastolic diameter (r=0.350, p=0.001) and left ventricular end-systolic diameter (r=0.358, p=0.001). We have shown that patients with idiopathic dilated cardiomyopathy and angiographically normal coronary arteries have higher TIMI frame counts for all three coronary vessels, indicating impaired coronary blood flow, compared to control subjects without dilated cardiomyopathy.

The relationship between coronary slow flow phenomenon and coronary calcium score

Coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed distal vessel opacification without any significant epicardial coronary artery disease. Several studies have suggested that CSFP might be a form of atherosclerosis. The present study was aimed to investigate the relationship between CSFP and coronary artery calcification, which is one of the clear-cut indicators of coronary atherosclerotic plaque, by using computerized tomography. Fifty-five patients were included in the study. The coronary arteries of all patients were shown by angiography to be normal. Coronary slow flow (CSF) patterns were evaluated by the thrombolysis in myocardial infarction frame count (TFC) method. Patients with normal coronary arteries and CSF were allocated into the CSF group, and patients with normal coronary arteries and normal coronary flow were allocated into the control group. Coronary artery calcium (CAC) score was measured in 28 patients with CSF and in 27 controls by 64-slice computerized tomography. The CSF and control groups were similar with respect to age, gender, smoking status, presence of hypertension and diabetes mellitus, cholesterol profiles, and Framingham risk scores (p>0.05). The CSF and control groups were not significantly different with respect to CAC score (p>0.05). Sub-group analysis of cardiac risk factors in patients with or without coronary artery calcification revealed that advanced age and low high density lipoprotein (HDL) levels were significantly associated with coronary artery calcification. There wasn't any relationship between coronary slow flow and cardiac risk factors or coronary calcium scores. In the present study, no association was found between the CSFP and calcified atherosclerosis. Additionally, it was demonstrated that, among the cardiac risk factors, advanced age and low HDL levels were associated with coronary artery calcification.

Coronary blood flow in patients with end-stage renal disease assessed by thrombolysis in myocardial infarction frame count method

Myocardial ischaemia in patients with end-stage renal disease (ESRD) develops both due to the epicardial coronary artery stenosis and to the microvascular injury. We aimed to evaluate coronary blood flow in ESRD patients by means of the thrombolysis in myocardial infarction (TIMI) frame count method (TFC). In patients with ESRD, implementation of the TFC as a marker of the coronary flow abnormalities have not been previously investigated. Thirty-nine ESRD patients on regular dialysis underwent elective coronary angiography. Coronary artery stenosis >75% was defined as significant. TFC for the three main coronary vessels was calculated. Higher TFC values reflected slower flow. In 19 patients (49%), significant epicardial coronary artery disease was found. Distribution of the TFC for the three main coronary arteries reflected prevalence for higher TFC values. Mean corrected TFC for the left anterior descending artery (LAD) was 34.7 +/- 16, for the circumflex artery (Cx) 41.5 +/- 25 and for the right coronary artery (RCA) 30.9 +/- 18 frames. For the three main coronary vessels, there were no statistically significant differences between the mean TFC values according to the presence or absence of the severe coronary artery stenoses on angiography (LAD: 30.2 +/- 12 vs 36.3 +/- 18; Cx: 41.5 +/- 20 vs 41.5 +/- 27; RCA: 34.9 +/- 16 vs 30.0 +/- 19, respectively). Our results demonstrate for the first time the reduction in blood flow velocity, assessed with TFC method, in the coronary arteries of ESRD patients. This phenomenon was observed regardless of the presence of the significant epicardial coronary artery stenosis. Therefore, TFC cannot be applied as a marker of significant coronary artery stenosis in ESRD population.

The effect of verapamil and nitroglycerin on the coronary slow flow phenomenon

Objective: The aim of this study was to assess the effect of nitroglycerin and verapamil on the coronary flow in patients with the coronary slow flow (CSF) phenomenon (CSFP). Design and methods: Sixty-four patients with CSF and no stenotic lesions during diagnostic coronary angiography were enrolled and divided into the nitroglycerin group (n=35) and verapamil group (n=29), and 29 patients with normal coronary flow were selected as normal. CSFP was defined as it required 4 or more beats for the contrast media to opacify the distal vasculature. Intracoronary injection of 100–400 μg nitroglycerin or verapamil was not given in patients with CSFP until the coronary flow improved. The coronary blood flow was evaluated by Thrombolysis in Myocardial Infarction frame count (TFC) method in this study. Results: There was no difference regarding the clinical characteristics among the three groups. The basic TFCs of the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were 78.28±19.40, 57.24±14.58, and 56.87±12.47 in the verapamil group, and were 70.84±21.66, 55.33±12.52, and 51.05± 15.35 in the nitroglycerin group, respectively, which were significantly higher than those in the normal controls (LAD 29.15±4.42, LCX 23.14± 3.48 and RCA 19.72±1.75, respectively). After the administration of drugs, the TFCs of LAD, LCX and RCA were 42.32±8.88, 36.65±6.78, and 30.32±5.94, respectively (vs. base, all P<0.05) in nitroglycerin group and 37.68±9.31, 31.50±11.30, and 24.58±4.40 respectively (vs. base, all P<0.05) in the verapamil group. The TFCs in both the two groups after the administration of drugs were still higher than that in normal controls (all P<0.05). The TFCs in the verapamil group had a larger decrease than those in the nitroglycerin group (P<0.05). Conclusions: Intracoronary administration of verapamil could result in more improvement of the coronary flow in patients with CSFP than after the administration of nitroglycerin, although the coronary flow was still slower than normal.