Long-Term Prognosis in Patients with Coronary Slow Flow

Mikaeilvand, Amir; Hajizadeh, Reza; Bateni, Amin; Yahyapour, Zhivar

doi:10.18502/jthc.v17i4.11608

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…The proportion of patients with an abnormal CFR (17.4% versus 25.9%; P=0.398) and IMR (32.1% versus 43.5%; P=0.311) was not significantly different in patients with and without CSF (Figure 2A and 2B). Accordingly, CFR (median CFR, 4.0 [2.6-4.8] versus 3.5 [2.4-4.7]; P=0.581) and IMR (median IMR, 22 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] versus 20 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; P=0.103) values were also not significantly different in patients with versus without CSF (Figures S3 and S4). Overall, the proportion of patients with a diagnosis of CMD by invasive coronary function testing was not different in patients with versus without CSF (56.5% versus 45.7%; P=0.358; Figure 2C).…”

Section: Resultsmentioning

confidence: 99%

“…19 A study evaluating long-term clinical outcomes of CSF in INOCA reported a rate of cardiovascular events on the low end of that reported in previous INOCA studies, but no comparator group was included. [20][21][22][23] Mechanisms of CSF remain uncertain. A mechanistic study reported that CSF is associated with low resting coronary sinus oxygen saturation compared with individuals with atypical chest pain or recurrent chest pain with normal flow, suggestive of impaired resting flow.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Visual Estimates of Coronary Slow Flow Are Not Associated With Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction

Harkin,

Loftspring,

Beaty

et al. 2024

Circ: Cardiovascular Interventions

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Background: Coronary slow flow (CSF) by invasive coronary angiography is frequently understood to be an indicator of coronary microvascular dysfunction (CMD) in patients with ischemia with non-obstructive coronary arteries (INOCA). However, the relationship between visual estimates of CSF and quantitative wire-based invasive diagnosis of CMD is uncertain. Methods: We prospectively enrolled adults age ≥18 years with stable ischemic heart disease who were referred for invasive coronary angiography. Individuals with ≥50% epicardial coronary artery stenosis were excluded. Invasive coronary angiography was reviewed for CSF, defined as ≥3 cardiac cycles to opacify distal vessels with contrast. Coronary function testing was performed in the left anterior descending (LAD) coronary artery using bolus coronary thermodilution techniques to measure coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). Invasively determined CMD was defined as abnormal CFR (<2.5), abnormal IMR (≥25), or both. Results: Among 104 participants, the median age was 61.5 and 79% were female. The median CFR was 3.6 (IQR 2.5-4.7) and the median IMR was 21 (IQR 13.3-28.0). Overall, 24.0% of participants had abnormal CFR, 34.6% had abnormal IMR, and 48.1% had a final diagnosis of invasively determined CMD. CSF was present in 23 participants (22.1%). The proportions of patients with CMD (56.5% vs 45.7%, p=0.36), abnormal CFR (17.4% vs 25.9%, p=0.40) and abnormal IMR (43.5% vs. 32.1%, p=0.31) were not different in patients with versus without CSF. Conclusions: Among patients with INOCA, CSF was not associated with abnormal CFR, IMR, or either abnormal CFR or IMR. CSF is not a reliable angiographic surrogate of abnormal CFR or IMR as determined by invasive, wire-based physiology testing.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Visual Estimates of Coronary Slow Flow Are Not Associated With Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction

Harkin,

Loftspring,

Beaty

et al. 2024

Circ: Cardiovascular Interventions

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“…The association between the coronary slow flow/noreflow phenomenon (CSF/NRP) and sudden cardiac death, life-threatening cardiac arrhythmias, and recurrent acute coronary syndromes has been demonstrated in some studies [5][6][7][8]. Other studies, however, suggest a benign course without significant morbidity or mortality [9,10]. Nevertheless, there is still some disagreement regarding the course of CSF/NRP patients and their prognoses.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction

Bamarinejad,

Kermani-Alghoraishi,

Soleimani

et al. 2024

Coronary Artery Disease

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Background The coronary slow flow/no-reflow phenomenon (CSF/NRP) is a common complication of emergency percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI). Its long-term prognostic value, however, remains unclear. This study investigated the long-term outcome and prognostic value of CSF/NRP after emergency PCI for STEMI. Methods This retrospective, multicenter registry-based cohort study was conducted in STEMI patients who underwent emergency PCI between 2015 and 2016. Incidence of in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), and all-cause mortality during long-term follow-up were compared between CSF/NRP patients and the normal flow group. Cox proportional-hazards regression model was performed to identify the predictive impact of CSF/NRP in short- and long-term outcomes. Results A total of 649 STEMI patients were included in the study, of whom 193 (29.7%) developed CSF/NRP following emergency PCI. The CSF/NRP group had a higher incidence of in-hospital mortality than the non-CSF/NRP group (8.2 vs. 4.3%, P = 0.04). All-cause mortality incidence was also higher in the CSF/NRP group during 5-year follow-up (22.2 vs. 16.2%, P = 0.04). The Cox proportional hazards model adjusting for demographic and clinical variables identified the NRP as an independent predictor of 5-year cardiac mortality [hazard ratio: 1.89; 95% confidence interval (CI): 1.07–3.31; P = 0.02]. In a landmark analysis, no difference was seen in overall mortality among the two study groups between 1 month and 5-year follow-up (hazard ratio: 1.33; 95% CI: 0.80–2.21, P-value: 0.23). Kaplan–Meier analysis showed lower 3-year cumulative MACCE-free survival in the CSF/NRP group compared with the normal flow group (P = 0.02). Conclusion CSF/NRP in STEMI patients is associated with a worse short- and long-term prognosis. These results, however, are mostly related to the acute phase, and CSF/NRP had limited influence on clinical outcomes in early survivors of STEMI.

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“…CSFP mimics various clinical presentations, such as unstable angina, acute myocardial infarction, and ventricular tachycardia (3)(4)(5) .…”

Section: Introductionmentioning

confidence: 99%

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

Abd-Elhady

Attia

Bashandy³

2023

SJMS

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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. 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. 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. 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). 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.

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Long-Term Prognosis in Patients with Coronary Slow Flow

Cited by 3 publications

References 23 publications

Visual Estimates of Coronary Slow Flow Are Not Associated With Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction

Visual Estimates of Coronary Slow Flow Are Not Associated With Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction

Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction

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

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