Thrombolysis In Myocardial Infarction Frame Count Research Articles

Assessment of TIMI frame count pre- and post- intracoronary acetylcholine administration in patients with angina and non-obstructive coronary arteries (ANOCA)

Abstract Background Patients with Angina and unobstructed coronary arteries (ANOCA) represent a diagnostic challenge. Current ESC guidelines on the management of patients with chronic coronary syndrome recommend intracoronary spasm testing and coronary spasm represents a frequent diagnosis in such patients. Previous studies have shown that coronary artery flow assessments during acetylcholine testing frequently show non-uniform results. Purpose The aim of the present study was to assess changes in TIMI Frame Count (a quantitative method for the assessment of coronary artery flow) pre- and post- intracoronary acetylcholine testing in patients with ANOCA. Methods From 2007 to 2018, a total of 141 consecutive patients (51.8% female, mean age 61 ± 13.2 years) were included in the study. Among them, 63 patients (45%) presented with myocardial infarction with unobstructed coronary arteries, while 78 patients (55%) presented with stable angina and unobstructed coronaries. Following diagnostic angiography, all patients underwent intracoronary acetylcholine testing using a standardized protocol. TIMI frame count (TFC) was measured both for LAD and LCX before and after ACh injection, and post nitroglycerine injection. All counted frames were adjusted to a frame rate of 30 frames per second (fps). Furthermore, TFC of the LAD was divided by 1.7 to obtain the corrected TFC (cTFC). Results Of all 141 patients, coronary spasm was found in 98 patients (70%) during ACh testing (44% epicardial and 56% microvascular spasm). In the spasm cohort, the median cTFC in the LAD pre-ACh was 21.8 fps (quartiles: 16.3 – 30.0), decreased to 12.9 fps (8.8 - 19.2) post-ACh, and increased to 15.9 fps (10.6 - 21.3) post-nitro. The difference in the LAD between pre-ACh and post-ACh was statistically significant (p < 0.001). In the LCX the median TFC was 26.5 fps (15.0 – 40.5) pre-ACh, decreased to 16.0 fps (11.5 - 28.5) post-ACh and reached 24.0 fps (15.5 - 33.3) post-nitro. Again, this reduction from pre-ACh to post-ACh was statistically significant (p < 0.001). In the negative spasm cohort median cTFC for the LAD was 22.9 fps (16.0 – 18.2) pre-Ach, 15.3 fps (9.4 – 24.7) post-ACh and 15.8 fps (10.6 - 24.7) post-nitro, TFC for LCX was 24.0 fps (18.0 - 36.0) pre-ACh, 18.0 fps (12.0 – 33.0) post-ACh and 24.0 fps (12.0 – 34.0) post-nitro. The change in cTFC/TFC pre-ACh compared to post-ACh was statistically significant for both coronary arteries (LAD, p=0.012; LCX p=0.005, Table 1). Interestingly, in the spasm cohort 22% of LAD and 32% of LCX vessels showed higher TFC post-ACh compared to pre-ACh (Figure 1). Conclusions In patients with ANOCA and coronary spasm assessment of TIMI frame count reveals a hetereogeneous response. The majority of cases shows a decrease in TFC suggesting an increase in flow despite coronary spasm. This interesting finding allows speculations about the presence of coronary shunts.Figure 1

Comparison of fully angiography-derived versus a hybrid of angiography and pressure-wire-derived approach to assess coronary microvascular resistance: the OxAMI-Hybrid study

Abstract Background Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory. We investigate here a novel approach, IMRhybrid, using a combination of pressure-wire-based assessment of distal coronary pressure (Pd) and an angiography-derived surrogate of coronary flow. Methods Patients were enrolled to the OxAMI-Hybrid study. The accuracy of IMRhybrid was assessed in diagnosing CMD using fully pressure wire and bolus thermodilution Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMRhybrid was then compared against a fully angiography-derived index of microvascular resistance (IMRangio). Based on previous work, angiography-derived IMR, IMRangio, was calculated as IMRangio = Quantitative Flow Ratio (QFR) ado x Pahyperaemia x TIMI Frame Count (TFC) hyperaemia / Frame Rate. Conversely, IMRhybrid was expressed as IMRhybrid = Pdhyperaemia x TFChyperaemia / Frame Rate, where frame rate was fixed at 15 frame per second for both indices. In both cases, TFC/frame rate represented angiography-derived mean transit time, mTt in hyperaemia. Results 60 patients were enrolled prospectively, of which 28 with acute coronary syndrome and 32 with stable coronary artery disease. A total of 66 vessel analyses were performed. Both IMRhybrid and IMRangio correlated with IMR (rho=0.51, p <0.001 and rho=0.51, p <0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (83.3% and 75.4% respectively) with a receiver operator curve (ROC) analyses showing an AUC of 0.82 and 0.81 respectively (p for comparison= 0.97). Conclusion Both approaches, IMRhybrid and IMRangio provide viable and comparable methods of assessing CMD which correlate with bolus thermodilution-based IMR, retaining good diagnostic accuracy. IMRhybrid is a simple alternative to conventional bolus thermodilution-based IMR, offering the advantage of being suitable with any pressure wire system.A: IMR, B: QFR, C: TFCA+C: IMRhybrid, B+D: IMRangio

Diagnostic accuracy of automatic quantitative flow ratio for hemodynamic assessment of coronary artery stenosis: prospective observational study

Abstract Background Quantitative flow ratio (QFR) is a method for evaluating fractional flow reserve (FFR) without the use of an invasive coronary pressure wire or pharmacological hyperemic agent. Automatic QFR (auto QFR) is a recently developed, simpler method of calculating QFR that uses a patient-specific TIMI (Thrombolysis in Myocardial Infarction) frame count, but with automatically specified start and end frames. Although the previous studies demonstrated that contrast QFR is more accurate than fixed QFR, there is no evidence for auto QFR. Purpose The aim of this study was to evaluate the diagnostic performance of auto QFR, fixed QFR, and contrast QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFR ≤0.80. Methods This prospective, multicentre trial enrolled patients suspected with coronary artery disease undergoing diagnostic coronary angiography with an indication for to perform invasive FFR. QFR was calculated at a blinded core laboratory. The primary endpoint was the diagnostic accuracy of auto QFR, fixed QFR, and contrast QFR to determine hemodynamically significant coronary stenosis using invasive FFR (≤0.80) as a reference standard. Results A total of 325 vessels from 274 patients were analysed. Mean FFR was 0.82±0.09, mean auto QFR was 0.80±0.12, and mean contrast QFR was 0.82±0.11, respectively. The overall diagnostic accuracy for identifying an FFR of ≤0.80 was highest by contrast QFR (81.5%), followed by fixed QFR (79.1%), and auto QFR (77.5%). The AUC was higher for contrast QFR (AUC 0.885; 95% CI: 0.845-0.925) than fixed QFR (AUC 0.856; 95% CI: 0.812-0.900) or auto QFR (AUC 0.854; 95% CI: 0.806-0.901), but did not differ significantly between fixed QFR and auto QFR (Figure). Conclusions There was no significant difference in AUC between fixed and auto QFR, but the accuracy of contrast QFR was significantly higher compared to both QFRs. Auto QFR has the advantage of faster computation time while using patient-specific coronary flow, but accuracy still needs to be improved.

Corrected timi frame count : time to replace the TIMI flow?

Abstract Background Thrombolysis In Myocardial Infarction (TIMI) flow grade had been widely accepted method for evaluating coronary artery perfusion following Percutaneous Coronary Intervention (PCI). Besides, TIMI flow used to predicts outcome in ST Elevation Acute Coronary Syndrome (STEACS) underwent Primary PCI (PPCI). However, its subjective nature has led to the exploration of more objective measures such as the Corrected TIMI Frame Count (CTFC), which quantifies coronary flow by counting the number of cine frames required for contrast to reach distal coronary landmarks. Purpose This study aims to assess the predictive value of CTFC in comparison with TIMI flow grades for clinical outcomes in STEACS undergoing PPCI, and whether CTFC could serve as a superior prognostic tool. Methods We retrospectively analyzed data from electronic medical record, involving STEACS patients underwent PPCI. Post-procedure, patient with TIMI flow grades 3, CTFC was measured. Patients were followed up during hospitalization for major adverse cardiac events (MACE), including death, myocardial infarction, and revascularization. Statistical analyses were performed to correlate CTFC with clinical outcomes. Result A total of 263 patients with TIMI flow 3 were analyzed, 54.5% patient with CTFC ≤27 and >27 respectively. MACE was 5.3% and 21% in the CTFC ≤27 and >27In the regression model analysis indicates a significant relationship between CTFC and MACE was found. The correlation coefficient (R) was observed at 0.417, with the model explaining 17.4% of the variance in MACE occurrence (R Square = .174), and an Adjusted R Square of .171, indicating a modest but significant predictive power. The ANOVA confirmed the model's statistical significance with an F value of 55.067 (p < .001). This suggests that CTFC is a significant predictor of MACE in patients post-PPCI with TIMI 3 flow, underscoring its potential utility in clinical prognostication. Conclusion CTFC appears to be a promising tool in assessing coronary flow post-PCI and may be considered as a additional for TIMI flow grading in predicting clinical outcomes in ACS patients. Further large-scale studies are warranted to validate these findings and to explore the integration of CTFC into clinical practice

Latent cytomegalovirus infection associates with impairments in myocardial reperfusion, left-ventricular function, and quality of life after ST-elevation myocardial infarction

Abstract Introduction Cytomegalovirus (CMV) is a ubiquitous herpesvirus affecting the majority of adults in European countries. CMV influences T-lymphocyte biology throughout life. We have previously associated CMV status with adverse left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) in a single-centre study. In this study, we aimed to assess the external validity of these findings. Methods This study is a retrospective analysis of 354 patients presenting with STEMI, who were recruited to A Trial of Low-Dose Adjunctive Alteplase During Primary PCI (T-TIME) and had blood samples archived. The participants underwent immediate coronary angiography and percutaneous coronary intervention (PCI), serial cardiovascular magnetic resonance (CMR) imaging at 2-7 days and 3 months post-STEMI, and serial assessment of health-related quality of life with the standardised EQ-5D visual analogue scale (VAS). CMV IgG titre was measured in cryopreserved samples from each patient, and patients were categorised as CMV negative, low-positive or high-positive. All analyses were adjusted for infarct location. Results Of 354 patients, 175 (49.4%) were CMV IgG titre negative, 89 (25.1%) were low-positive and 90 (25.4%) were high-positive. CMV+ patients were older (62.5 vs 58.7 years) and more likely to be non-White (6.7% vs 2.3%). CMV+ patients displayed several adverse outcomes. First, myocardial reperfusion was impaired. Thrombolysis in myocardial infarction (TIMI) flow grade 3 after PCI, indicating complete reperfusion, was less common in CMV+ patients (76.0% vs 84.6%; p=0.042). CMV+ patients also had a higher TIMI frame count after PCI (p=0.021), and non-significantly less ST-segment resolution at 60 minutes (38.8% vs 48.4%; p=0.066). Impaired myocardial reperfusion appeared to lead to impaired LV function, with LV ejection fraction (LVEF) measured on early CMR lower in CMV+ patients (42.6% vs 45.3%, p=0.004). At 3 months, LV function remained impaired in CMV+ patients (LVEF: 47.8% vs 49.7%; p=0.035). This was mirrored by CMV+ patients displaying higher NT-pro BNP levels at 2-7 days (1381 vs 1172pg/mL, p=0.097) and 3 months (575 vs 338pg/mL, p=0.021). Finally, impaired LV function appeared to affect quality of life. Over 3 months, in contrast to CMV-negative patients, those with the highest CMV IgG experienced almost no improvement in quality of life, measured by change in the EQ-5D VAS (negative: +9.93; high-positive: +0.70; p=0.0002). Conclusion CMV+ patients with STEMI experience worse outcomes, with impaired reperfusion, persistently reduced LV function and less improvement in health-related quality of life over 3 months. We hypothesise that the effect of CMV is mediated through immune activation. Future research should explore the mechanisms by which CMV-specific lymphocytes interact with myocardial reperfusion and repair post-STEMI.

Coronary slow flow as measured by corrected TIMI frame counts is associated with impaired microvascular resistance

Abstract Background The Coronary Slow Flow Phenomenon (CSFP) reflects an increased resting microvascular resistance and has been defined as a corrected thrombolysis in myocardial infarction frame count (cTFC) >27 in the in the absence of obstructive coronary artery disease (CAD). However, there is limited and conflicting data on the diagnostic utility of CTFC with respect to gold standard coronary haemodynamic parameters; namely coronary flow reserve (CFR) and hyperaemic microvascular resistance (hMR). Purpose To evaluate the relationship between angiography-derived cTFC and the coronary haemodynamic parameters (CFR and hMR). Methods Patients with angina and non-obstructive CAD (< 50% epicardial stenosis; ANOCA) underwent comprehensive functional coronary angiography utilising a dual sensor-tipped pressure-doppler flow wire during adenosine infusion for investigation of coronary microvascular impairment, and acetylcholine provocative testing for the diagnosis of coronary artery spasm. Results In 103 patients who underwent functional coronary angiography, 60 patients had CSFP and this was associated with low flow velocity and higher microvascular resistance at rest as compared with patients without CSFP (19.2 ± 7.3 versus 22.6 ± 6.7, p=0.024; and 5.9 ± 2.0 versus 4.6 ± 1.7, p=0.009, respectively). Whilst cTFC was poorly associated with CFR (r= 0.058, p= 0.564), there was a relatively strong, positive correlation with hMR (r=0.258, p=0.008). Furthermore, receiver operating characteristic analyses demonstrated that CTFC poorly predicts an impaired CFR <2.5 (AUC, 0.479 [0.36-0.59]) but does predict an impaired hMR >2.5 (AUC, 0.623 [0.51-0.74] p=0.037). Conclusion In patients with ANOCA, cTFC is associated with coronary microvascular dysfunction as measured by microvascular resistance during hyperaemia. This data suggests the cTFC may be a surrogate marker for impaired microvascular resistance.cTFC versus hMR

Angiographic Outcomes in STEMI Patients: Evaluating Pre-dilatation and Thrombus Aspiration Effects

Introduction ST-elevation myocardial infarction (STEMI) poses significant challenges in cardiovascular care, necessitating rapid and effective reperfusion strategies. The present study assesses the angiographic outcomes of pre-dilatation and thrombus aspiration (PD+TA) versus conventional treatment without thrombus aspiration (NOTA) in patients undergoing PPCI for STEMI. Methods This prospective cohort study included a total of 155 patients, with 78 assigned to the PD+TA group and 77 to the NOTA group. Baseline demographics, cardiovascular risk factors, and angiographic assessments including TIMI flow, TMPG flow, corrected TIMI frame count (CTFC), ST segment changes, and ejection fraction were compared between the groups. Results The PD+TA group exhibited significantly lower systolic (p-value: 0.021) and diastolic blood pressures (p-value: 0.046), better glucose control (p-value: 0.015), and a more pronounced reduction in ST segment elevation (p-value: 0.027) compared to the NOTA group. Although ejection fraction at presentation was similar between groups, the PD+TA group (52.29±8.80%) demonstrated a statistically significant improvement at one-month follow-up from NOTA (49.14±8.20%). TIMI 3 and TMPG 3 flow rates were comparable between groups before and after drug administration, with significant improvements in CTFC observed in the PD+TA group. Conclusion Pre-dilatation and TA during PPCI for STEMI patients may lead to improved acute angiographic outcomes, including enhanced myocardial reperfusion and reduced ischemic burden. The significant improvement in ejection fraction at one-month follow-up further supports the potential benefits of PD+TA in cardiac function recovery. Larger studies with longer-term follow-up are needed to validate these findings and determine the broader clinical implications of TA in STEMI management. Clinical trial registration: CTRI/2019/02/017520, 7th February 2019, https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=Mjk5Mjc=&Enc=&userName=CTRI/2019/02/017520

Benefits of recombinant human brain natriuretic peptide to improve ventricular function and hemodynamics in patients with ST-elevation myocardial infarction.

Abstract. This study aimed to assess the impact of recombinant human brain natriuretic peptide (rh-BNP) on ventricular function and hemodynamics in post-ST-segment elevation myocardial infarction (STEMI). We compared the outcomes of 65 STEMI patients treated with rh-BNP to an equal cohort given tirofiban following percutaneous coronary intervention (PCI). Data collected pre- and post-intervention included biochemical markers, TIMI (Thrombolysis In Myocardial Infarction) grade, hemodynamics, thrombotic score (TS), left ven-tricular ejection fraction (LVEF), high-sensitivity C-reactive protein (CRP) levels, liver and kidney function, and ECG. The TIMI level (p=0.03), the ratio of TIMI myocardial perfusion grade III (p=0.04), and the thrombus score (p<0.001) in the rh-BNP group after the intervention markedly exceeded those in the tirofiban group. After correction, the TIMI frame count (CTFC) (p=0.02), the incidence of slow flow (p=0.02), thrombus score (p<0.001), stent length (p=0.02) as well as times of administration of sodium nitroprusside medication in the rh-BNP group were markedly below those in the tirofiban group (p=0.01). Creatine ki-nase (CK) (p<0.001), CK-MB (p=0.01), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) (p<0.02) in the rh-BNP group were markedly below those the in tirofiban group 24 hours after intervention; and the sum-STR (p<0.03) immediately after intervention markedly exceeded that in the tirofiban group. No significant differences were found in major cardiac adverse events (MACE) between the treatments. At the 30-day follow-up, rh-BNP showed a more effective enhancement of blood flow status, with the safety profiles of both treatments be-ing comparable. The findings suggest that the rh-BNP has significant potential for treating PPCI-related slow flow.

The predictors of coronary slow flow in patients undergoing coronary angiography

BackgroundA new challenge in coronary artery disease treatment has emerged, where specific populations exhibit ischemic symptoms without any obstruction in the epicardial coronary artery. Instead, they exhibit slow coronary contrast flow, referred to as coronary slow flow (CSF). This study aims to identify several predictors of CSF.ResultsThis case–control study was conducted at the Regional General Hospital of West Nusa Tenggara Province in Indonesia from December 2016 to February 2024. The study involved sixty subjects, with 30 in each group of CSF and normal epicardial coronary artery angiogram (NECA). CSF is enforced by the TIMI frame count (TFC) greater than 27 frames. Among all the predictors studied, coronary artery diameter (p < 0.001) and random blood sugar (p = 0.049) were found to affect the CSF significantly. In the multivariate analysis, coronary artery diameter remained a significant predictor (adjusted OR 10.08, 95% CI 2.64–38.50, p < 0.001), with an optimal cut-off point of more than 3.56 mm, a sensitivity of 76.7%, and a specificity of 70.7% (AUC = 0.787, p < 0.001).ConclusionThe coronary artery diameter strongly predicts CSF in patients undergoing coronary angiography.

Coronary Slow Flow as Measured by Corrected TIMI Frame Counts is Associated With Impaired Microvascular Resistance

Coronary Slow Flow as Measured by Corrected TIMI Frame Counts is Associated With Impaired Microvascular Resistance

Adiponectin and Paraoxonase-1 Correlation With Thrombolysis in Myocardial Infarction Frame Count With Coronary Slow Flow Phenomenon

Objectives: Coronary slow flow phenomenon (CSFP) is an important angiographic entity, with no clear-cut etiology. The effects of adiponectin (APN) and paraoxonase-1 (PON-1) have been proven in microvascular disease pathophysiology, endothelial dysfunction and atherosclerosis. The present study aimed to determine the correlation between APN and PON-1 and CSFP. Methods: Subjects who were undergone coronary angiography and met the inclusion and exclusion criteria were included in this study. The study subjects were divided into the following groups: 40 subjects without coronary artery disease (CAD) and CSFP, 22 patients without CAD but with CSFP, 29 patients with CAD &lt; 50% and without CSFP, 22 patients with CAD (50-90%) but without CSFP and 16 patients with CAD and CSFP. Coronary flow rates of the participants with slow flow diagnosis were determined by thrombolysis in myocardial infarction (TIMI) frame count method. The serum levels of APN and PON-1 were measured by ELISA kit. Results: There were no significant differences between groups in serum levels of APN. No significant correlation was observed between APN serum concentration and corrected TIMI frame count (TFC) (r=0.17, P=0.29). The PON-1 serum concentration in patients with CAD (50-90%) and without CSFP was significantly lower than the other groups (P&lt;0.01). There was a near significant correlation between PON-1 serum levels and corrected TFC in left anterior descending coronary artery (r=0.32, P=0.08). Discussion: The present study has demonstrated no significant correlation between the serum concentration of APN and PON-1 and corrected TFC, so we need more extensive studies in this regard with larger sample size.

Extended Balloon Inflation Technique for Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction during Stent Deployment

Background: Primary percutaneous coronary intervention (PPCI) is the preferred method for treating ST-segment elevation myocardial infarction (STEMI), but the no-reflow phenomenon remains a significant challenge. This study investigates the efficacy of prolonged balloon inflation during stent deployment to reduce the incidence of no-reflow. Objective: To assess whether extending the duration of balloon inflation during stent deployment in PPCI reduces the incidence of the no-reflow phenomenon compared to the conventional rapid inflation and deflation strategy. Methods: This randomized controlled trial enrolled 122 patients at the National Institute of Cardiovascular Diseases, Pakistan, from February 2023 to January 2024. Patients were randomly assigned to either prolonged balloon inflation (PBSG) or conventional deployment (CDSG). Results: The mean age in the PBSG was 59.83±10.10 years, and in the CDSG, it was 60.39±10.16 years. Male participants comprised 51.6%. The PBSG showed significantly lower immediate TIMI flow grades less than 3 (4.9% vs. 26.2%, P = 0.00), no-reflow incidence (0% vs. 26.2%, P = 0.00), corrected TIMI frame counts (36.96±4.25 vs. 46.13±6.82, P = 0.00), and higher ST-segment resolution ≥50% (77.0% vs. 57.4%, P = 0.02). Additionally, 59.0% in the PBSG achieved an MBG of 3 compared to 16.4% in the CDSG (P = 0.00). Conclusion: Prolonged balloon inflation during stent deployment in PPCI significantly reduces the no-reflow phenomenon and improves myocardial perfusion in patients with STEMI.

Epicardial fat volume is associated with primary coronary slow-flow phenomenon in patients with severe aortic stenosis undergoing transcatheter valve implantation

BackgroundPrimary coronary slow flow (CSF) is defined as delayed opacification of the distal epicardial vasculature during coronary angiography in the absence of relevant coronary artery stenoses. Microvascular disease is thought to be the underlying cause of this pathology. Epicardial fat tissue (EFT) is an active endocrine organ directly surrounding the coronary arteries that provides pro-inflammatory factors to the adjacent tissue by paracrine and vasocrine mechanisms. The aim of the present study was to investigate a potential association between EFT and primary CSF and whether EFT can predict the presence of primary CSF.MethodsBetween 2016 and 2017, n = 88 patients with high-grade aortic stenosis who were planned for transcatheter aortic valve implantation (TAVI) were included in this retrospective study. EFT volume was measured by pre-TAVI computed tomography (CT) using dedicated software. The presence of primary CSF was defined based on the TIMI frame count from the pre-TAVI coronary angiograms.ResultsThirty-nine of 88 TAVI patients had CSF (44.3%). EFT volume was markedly higher in patients with CSF (142 ml [IQR 107–180] vs. 113 ml [IQR 89–147]; p = 0.009) and was strongly associated with the presence of CSF (OR 1.012 [95%CI 1.002–1.021]; p = 0.014). After adjustment, EFT volume was still an independent predictor of CSF (OR 1.016 [95%CI 1.004–1.026]; p = 0.009).ConclusionPrimary CSF was independently associated with increased EFT volume. Further studies are needed to validate this finding and elucidate whether a causal relationship exists.

C-20 | Assessing the Relationship between TIMI Frame Count and Index of Microvascular Resistance in Hemodynamically-Stratified Subgroups of Patients with Ischemia and Nonobstructive Coronary Arteries

C-20 | Assessing the Relationship between TIMI Frame Count and Index of Microvascular Resistance in Hemodynamically-Stratified Subgroups of Patients with Ischemia and Nonobstructive Coronary Arteries

Correlation Between Corrected TIMI Frame Count with the Extent of Myocardial Fibrosis on ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Microvascular injury after primary percutaneous coronary intervention (PPCI) reperfusion contributes to necrosis propagation. Corrected TIMI Frame Count (CTFC) is a surrogate marker of microvascular dysfunction and can stratify in-hospital mortality risk in patients with final TIMI flow 3. The extent of myocardial fibrosis after STEMI is associated with a higher incidence of major cardiovascular events. This study aimed to determine the relationship between CTFC in the infarct-related artery and myocardial fibrosis area based on cardiac magnetic resonance (CMR) in STEMI patients undergoing PPCI.Methods: This retrospective cohort study included 31 STEMI patients who had undergone PPCI and CMR examination between days 60 and 75 after STEMI as the sample. CTFC was measured in the infarct-related artery from post-PPCI angiogram recordings. Myocardial fibrosis area was measured from late gadolinium enhancement CMR (LGE-CMR) imaging results.Results: In this study, the mean age was 51.61±10.49 years, 90.3% were male, non-anterior infarction location was 58.1%, mean total ischemic time was 489.48±228.33 minutes, mean CTFC was 27.4±9.3 frames, and mean myocardial fibrosis was 18.33±7.87%. There was no significant correlation found between CTFC and myocardial fibrosis (p=0.530), however total ischemic time had a positive and significant correlation with myocardial fibrosis (p=0.025, r=0.403).Conclusion: CTFC in the infarct-related artery is not correlated with myocardial fibrosis area in STEMI patients undergoing PCI.

Predictors of non-obstructive coronary slow flow in poorly controlled type 2 diabetes mellitus: a cross-sectional study

BackgroundCoronary slow flow (CSF) can occur due to various factors, such as inflammation, small vessel disease, endothelial dysfunction, and inadequate glucose control. However, the exact pathological mechanisms behind CSF remain incompletely understood.The objective of this study was to identify the risk factors associated with slow coronary flow in individuals with Type 2 Diabetes Mellitus (T2DM) who have non-obstructive coronary artery disease (CAD) and experience CSF.MethodsWe conducted a prospective cohort study involving 120 patients with T2DM who were referred for invasive coronary angiography due to typical chest pain or inconclusive results from non-invasive tests for myocardial ischemia. Using a 2 × 2 design, we categorized patients into groups based on their glycemic control (adequate or poor) and the presence of CSF (yes or no), defined by a TIMI frame count > 27. All patients had non-obstructive CAD, characterized by diameter stenosis of less than 40%. We identified many variables associated with CSF.ResultsOur investigation revealed no significant differences in age, sex, family history of coronary artery disease, ECG ischemia abnormalities, or echocardiographic (ECHO) data between the groups. In patients with adequate glycemic control, hypertension increased the risk of CSF by 5.33 times, smoking by 3.2 times, while dyslipidemia decreased the risk by 0.142. Additionally, hematocrit increased the risk by 2.3, and the platelet-to-lymphocyte ratio (PLR) increased the risk by 1.053.Among patients with poor glycemic control, hematocrit increased the risk by 2.63, and the Neutrophil-to-Lymphocyte Ratio (NLR) by 24.6. Notably, NLR was positively correlated with glycemic control parameters in T2DM patients with CSF.ConclusionsIn T2DM patients with CSF, various factors strongly correlate with glycemic control parameters and can be employed to predict the likelihood of CSF. These factors encompass hypertension, smoking, increased body mass index (BMI), elevated platelet count, hematocrit, NLR, PLR, and C-reactive protein (CRP).Trial registrationRegistry: ZU-IRB (ZU-IRB#9419–3-4-2022), Registered on: 3 April 2022, Email: IRB_123@medicine.zu.edu.eg.

Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact.

Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25-40) vs. 40 (35-45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12-48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.

Asymmetric Dimethylarginine Is Associated with the Phenomenon of Coronary Slow Flow in Patients with Nonvalvular Atrial Fibrillation

Introduction: Coronary slow flow phenomena (CSFP) are associated with endothelial and blood component abnormalities in coronary arteries. Asymmetric dimethylarginine (ADMA) can damage the endothelium of the heart or blood vessels in patients with non-valvular atrial fibrillation (NVAF), causing changes in levels of biological indicators. Our aim was to analyze the relationship between ADMA and CSFP in NVAF patients. Methods: We consecutively enrolled 134 patients diagnosed with NVAF and underwent coronary angiography, 50 control patients without a history of atrial fibrillation and with normal coronary angiographic flow were included at the same time. Based on the corrected TIMI frame count (CTFC), the NVAF patients were categorized into two groups, CTFC ≤27 frames and CTFC >27 frames. Plasma ADMA, P-selectin (p-sel), von Willebrand factor (vWF), D-dimer (D-Di), plasminogen activator inhibitor 1 (PAI-1), and nitric oxide (NO) were detected by ELISA in the different groups. Results: We found that plasma ADMA levels were significantly higher among NVAF patients in the CTFC >27 grade group compared with the control or CTFC ≤27 group. In addition, the levels of blood cells and endothelium-related biomarkers (NO, P-selectin, vWF, D-Di, and PAI-1) were significantly altered and correlated with ADMA levels. Multifactorial analysis showed that plasma ADMA (odd ratio [OR; 95% CI]: 1.65 [1.21–2.43], p < 0.001) and left atrial internal diameter (OR [95% CI]: 1.04 [1.02, 1.1], p < 0.001) could be used as independent risk factors for the development of CSFP in patients with NVAF. The ROC curves of ADMA can predict the development of CSFP in NVAF patients. The minimum diagnostic concentration for the development of CSFP in patients was 2.31 µmol/L. Conclusion: Our study demonstrated that CSFP in NVAF patients was associated with high levels of ADMA and left atrial internal diameter. Therefore, aggressive preoperative detection and evaluation of ADMA and left atrial internal diameter can help deal with the intraoperative presence of CSFP.

Triglyceride glucose-body mass index as a novel predictor of slow coronary flow phenomenon in patients with ischemia and nonobstructive coronary arteries (INOCA)

BackgroundThe 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.MethodsWe 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.ResultsTyG-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).ConclusionThe TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.

Coronary slow flow and its correlation with reduced left ventricle global longitudinal strain: a case–control study

BackgroundCoronary slow flow (CSF) often links to inflammation and endothelial function disturbance. While conventional ejection fraction measurements fall short in identifying myocardial dysfunction, left ventricular global longitudinal strain (LV GLS) has shown superior efficacy in this regard. Our study aimed to explore subclinical left ventricular systolic dysfunction by assessing LV GLS in patients diagnosed with coronary slow flow (CSF).MethodsThe study included sixty patients with CSF and sixty control individuals without CSF. Coronary angiography employed the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) to identify CSF. LV GLS values were evaluated and compared between the two groups.ResultsSignificantly reduced LV GLS was evident in the CSF group compared to the control group (− 16.18 ± 1.25 vs. − 19.34 ± 1.33, p < 0.001). A notable correlation (r = 0.492, p < 0.001) between LV GLS and TFC was observed in the CSF group. Multivariate logistic regression analysis highlighted reduced LV-GLS (OR 2.2, 95% CI 1.57–3.09, p < 0.001) and smoking (OR 11.55, 95% CI 3.24–41.2, p < 0.001) as significant predictors for CSF presence. The receiver operating characteristic curve established that an LV GLS value of ≥ − 17.8% accurately predicted the presence of CSF (AUC: 0.958, 95% CI: 0.924–0.991, p < 0.001) with 90% specificity and 91.7% sensitivity.ConclusionOur study indicates that reduced LV GLS is associated with CSF presence, offering a valuable means to early detect subclinical left ventricular systolic dysfunction in high-risk patients susceptible to heart failure.Trial registration: ZU-IRB#7038/12-7-2021 Registered 12 July 2021, email: IRB_123@medicine.zu.edu.eg.