Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries
Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027664 |
| _version_ | 1797905036353732608 |
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| author | Utkarsh Dutta Aish Sinha Ozan M. Demir Howard Ellis Haseeb Rahman Divaka Perera |
| author_facet | Utkarsh Dutta Aish Sinha Ozan M. Demir Howard Ellis Haseeb Rahman Divaka Perera |
| author_sort | Utkarsh Dutta |
| collection | DOAJ |
| description | Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor‐tipped guidewire during rest, adenosine‐mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty‐six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5±$$ \pm $$6.9 versus 20.2±$$ \pm $$6.9 cm/s; P=0.001 and 6.26±$$ \pm $$1.83 versus 5.36±$$ \pm $$1.83 mm Hg/cm/s; P=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%–0.50%] and 0.36 [95% CI, 0.23%–0.49%], respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited. |
| first_indexed | 2024-04-10T09:58:41Z |
| format | Article |
| id | doaj.art-3c499fe0cd814f28ab08de1af5c94dcb |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T09:58:41Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-3c499fe0cd814f28ab08de1af5c94dcb2023-02-16T10:55:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112110.1161/JAHA.122.027664Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary ArteriesUtkarsh Dutta0Aish Sinha1Ozan M. Demir2Howard Ellis3Haseeb Rahman4Divaka Perera5School of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKSchool of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKSchool of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKSchool of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKSchool of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKSchool of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College London London UKBackground Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor‐tipped guidewire during rest, adenosine‐mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty‐six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5±$$ \pm $$6.9 versus 20.2±$$ \pm $$6.9 cm/s; P=0.001 and 6.26±$$ \pm $$1.83 versus 5.36±$$ \pm $$1.83 mm Hg/cm/s; P=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%–0.50%] and 0.36 [95% CI, 0.23%–0.49%], respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.https://www.ahajournals.org/doi/10.1161/JAHA.122.027664anginaendothelial dysfunctionmicrovascular dysfunctionTIMI frame count |
| spellingShingle | Utkarsh Dutta Aish Sinha Ozan M. Demir Howard Ellis Haseeb Rahman Divaka Perera Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angina endothelial dysfunction microvascular dysfunction TIMI frame count |
| title | Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries |
| title_full | Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries |
| title_fullStr | Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries |
| title_full_unstemmed | Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries |
| title_short | Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries |
| title_sort | coronary slow flow is not diagnostic of microvascular dysfunction in patients with angina and unobstructed coronary arteries |
| topic | angina endothelial dysfunction microvascular dysfunction TIMI frame count |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027664 |
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