CORONARY SLOW FLOW AND CHA2 DS2 -VASC-HSF SCORE IN STABLE ISCHEMIC HEART DISEASE

Yıl 2024, , 1 - 7, 15.02.2024

Pelin Karaca Özer , Mustafa Lütfi Yavuz , Emre Yalçın , Elif Ayduk Govdelı , Mehmet Aydoğan , Samim Emet , Ali Elitok

https://doi.org/10.26650/JARHS2024-1348992

Öz

Objective: The coronary slow flow phenomenon (CSFP) and its causes are still not fully explained. We investigated the functionality and usefulness of the CHA2DS2-VASc-HSF score in the diagnosis of CSFP in stable ischemic heart disease.

Material and Methods: Patients with no obstructive coronary artery disease (CAD) and CSFP detected as a result of coronary angiography were included in the study. Patients with CSFP were compared with those without. Coronary blood flow velocity was evaluated by calculating the TIMI frame count (TFC) from coronary angiography images. In addition to the traditional CHADS scores of the patients, the CHA2DS2-VASc-HSF score was also calculated.

Results: According to our study results, the CHA2DS2-VASc-HSF score was higher in patients with CSFP than in those without (3.75±1.27 vs. 2.85±1.11; p<0.001). There was no difference between the CHADS2 and CHA2DS2-VASc scores of the two groups. In logistic regression models, Hs-troponin-T and CHA2DS2-VASc-HSF scores were determined as independent predictors of CSFP. CHA2DS2-VASc-HSF score and TFC were positively correlated in the CSFP group (r=0.848, p<0.001). The sensitivity of CHA2DS2-VASc-HSF was determined as 56%, the specificity was 74%, and the cut-off value was 3.5 in detecting the presence of CSFP.

Conclusion: This study shows the association of CHA2DS2-VASc-HSF score with CSFP, suggesting that it can be used to predict CSFP and its severity

Anahtar Kelimeler

CHA2DS2-VASc-HSF score, coronary slow flow, non-obstructive coronary artery

STABİL İSKEMİK KALP HASTALIĞINDA KORONER YAVAŞ AKIM VE CHA2 DS2 -VASC-HSF SKORU

Öz

Amaç: Koroner yavaş akım fenomeni (KYA) ve nedenleri hala tam olarak açıklanamamıştır. Bu çalışmada stabil iskemik kalp hastalığında KYA tanısında CHA2DS2-VASc-HSF skorunun işlevselliğini ve kullanışlılığı araştırıldı.

Gereç ve Yöntemler: Çalışmaya obstrüktif koroner arter hastalığı (KAH) olmayan ve koroner anjiyografi sonucunda KYA saptanan hastalar dahil edildi. KYA’lı hastalar olmayanlarla karşılaştırıldı. Koroner kan akış hızı, koroner anjiyografi görüntülerinden TIMI kare sayısı (TFC) hesaplanarak değerlendirildi. Hastaların geleneksel CHADS skorlarına ek olarak CHA2DS2-VASc-HSF skoru da hesaplandı.

Bulgular: KYA’lı hastalar olmayan hastalara kıyasla daha yüksek CHA2DS2- VASc-HSF skoruna sahipti (3,75±1,27’ye karşı 2,85±1,11; p<0,001). İki grubun CHADS2 ve CHA2DS2-VASc skorları arasında fark yoktu. Lojistik regresyon modellerinde, CHA2DS2-VASc-HSF skoru ve Hs-troponin-T, KYA’nın bağımsız belirleyicileriydi. CHA2DS2-VASc-HSF skoru ve TFC, KYA grubunda pozitif korelasyon gösterdi (r=0,848, p<0,001). CHA2DS2-VAScHSF’nin KYA’nın varlığını tespit etmede duyarlılığı %56, özgüllüğü %74, kesme değeri ise 3,5 olarak belirlendi.

Sonuç: Bu çalışma CHA2DS2-VASc-HSF skorunun KYA ile ilişkisini göstererek KYA ve ciddiyetini tahmin etmek için kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

CHA2DS2-VASc-HSF skoru, koroner yavaş akım, obstrüktif olmayan koroner arter

Kaynakça

• Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J 1972;84(1):66-71. google scholar
• Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93(5):879-88. google scholar
• Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology 2002;97(4):197-202. google scholar
• Fineschi M, Gori T. Coronary slow flow: description of a new “cardiac Y” syndrome. Int J Cardiol 2009;137(3):308-10. google scholar
• Yilmaz H, Demir I, Uyar Z. Clinical and coronary angiographic characteristics of patients with coronary slow flow. Acta Cardiol 2008;63(5):579-84. google scholar
• Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72. google scholar
• Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, et al. CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2017;23(2):132-8. google scholar
• Trantalis G, Aggeli K, Toutouzas K, Synetos A, Latsios G, Drakopoulou M, et al. The prognostic value of CHA2DS2-VASc and GRACE risk scores in patients with ACS. Hellenic J Cardiol 2019;60(5):305-8. google scholar
• Wang X, Pei C, Bai Y, Dai Q, Deng X, Liu Y, et al. Predictive Value of CHA2DS2-VASc Score for Ischemic Events in Patients Undergoing Percutaneous Coronary Intervention. Angiology 2019;70(9):878-86. google scholar
• Modi R, Patted SV, Halkati PC, Porwal S, Ambar S, Mr P, et al. CHA2DS2-VASc-HSF score - New predictor of severity of coronary artery disease in 2976 patients. Int J Cardiol 2017;228:1002-6. google scholar
• Uysal OK, Turkoglu C, Duran M, Kaya MG, Sahin DY, Gur M, et al. Predictive value of newly defined CHA2DS2-VASc-HSF score for severity of coronary artery disease in ST segment elevation myocardial infarction. Kardiol Pol 2016;74(9):954-60. google scholar
• Zhang QY, Ma SM, Sun JY. New CHA2DS2-VASc-HSF score predicts the no-reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2020;20(1):346. google scholar
• Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circ J 2012;76(4):936-42. google scholar
• Przybojewski JZ, Becker PH. Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in nonatherosclerotic coronary arteries: a case report. Angiology 1986;37(10):751-61. google scholar
• Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clin Cardiol 2008;31(8):352-5. google scholar
• Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J 2003;146(1):84-90. google scholar
• Yu J, Yi D, Yang C, Zhou X, Wang S, Zhang Z, et al. Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow. Curr Probl Cardiol. 2023;49(1 Pt B):102074. google scholar
• Erturk M, Caglar FN, Surgit O, Akturk IF, Somuncu U, Akgul O, Kurtar A, Isiksacan N, Caglar IM, Uslu N. High sensitive troponin-I in patients with slow coronary flow pattern. Kardiol Pol 2013;71(12):1245-50. google scholar
• Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. Corrigendum to: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42(40):4194. google scholar
• Moazenzadeh M, Azimzadeh BS, Zare J, Shokouhi M, Sheikhvatan M. Clinical features and main determinants of coronary slow flow phenomenon in Iranian patients. Eur J Cardiovasc Med 2010;(1):57-60. google scholar
• Sanati H, Kiani R, Shakerian F, Firouzi A, Zahedmehr A, Peighambari M, et al. Coronary Slow Flow Phenomenon Clinical Findings and Predictors. Res Cardiovasc Med 2016;5(1):e30296. google scholar
• Sanghvi S, Mathur R, Baroopal A, Kumar A. Clinical, demographic, risk factor and angiographic profile of coronary slow flow phenomenon: A single centre experience. Indian Heart J 2018;70 Suppl 3(Suppl 3):S290-4. google scholar
• Faramarzzadeh R, Fekrat F, Haghtalab A. Evaluation of the relationship between clinical and laboratory risk factors in atherosclerosis patients with coronary slow flow: a case-control analysis. Egypt Heart J 2023;75(1):61. google scholar
• Chaudhry MA, Smith M, Hanna EB, Lazzara R. Diverse spectrum of presentation of coronary slow flow phenomenon: a concise review of the literature. Cardiol Res Pract 2012;(2012):383181. google scholar
• Mukhopadhyay S, Kumar M, Yusuf J, Gupta VK, Tyagi S. Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in North Indian population: An observational study. Indian Heart J 2018;70(3):405-9. google scholar
• Arbel Y, Rind E, Banai S, Halkin A, Berliner S, Herz I, Mashav N, Thurm T, Keren G, Finkelstein A. Prevalence and predictors of slow flow in angiographically normal coronary arteries. Clin Hemorheol Microcirc 2012;52(1):5-14. google scholar
• Alvarez C, Siu H. Coronary Slow-Flow Phenomenon as an Underrecognized and Treatable Source of Chest Pain: Case Series and Literature Review. J Investig Med High Impact Case Rep 2018;6:2324709618789194. google scholar
• Ghaffari S, Tajlil A, Aslanabadi N, Separham A, Sohrabi B, Saeidi G, et al. Clinical and laboratory predictors of coronary slow flow in coronary angiography. Perfusion 2017;32(1):13-9. google scholar
• Rouzbahani M, Farajolahi S, Montazeri N, Janjani P, Salehi N, Rai A, et al. Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province. J Cardiovasc Thorac Res 2021;13(1):37-42. google scholar
• Almeida MCC, Castro ML. Triglycerides-Glucose Index and Coronary Slow Flow: A New Diagnostic Tool? Arq Bras Cardiol 2023;120(6):e20230373. google scholar