Functional coronary angiogram findings in angina with non-obstructive coronary arteries patients with coronary slow flow

IF 3.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2026-02-01 Epub Date: 2025-10-09 DOI:10.1016/j.ahj.2025.107287

Olivia Girolamo BMedSc , Muhammad Dzafir Ismail MBBS, MMed , Rosanna Tavella BSc, PhD , Eng Lee Ooi MBBS, PhD , Sivabaskari Pasupathy BSc, PhD , Sarena La BMedSc , Abdul Sheikh MBBS, MD , Christopher Zeitz MBBS, PhD , John Beltrame BSc, BMBS, PhD

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引用次数: 0

Abstract

Background

The Coronary Slow Flow Phenomenon (CSFP) is considered a coronary microvascular disorder and has been defined as a corrected thrombolysis in myocardial infarction frame count (cTFC) ≥25 frames. Recent invasive physiology studies have reported that cTFC is not a surrogate marker for coronary microvascular dysfunction (CMD), defined by an abnormal Coronary Flow Reserve (CFR), questioning the integrity of CSFP. This study evaluates the Functional Coronary Angiography (FCA) findings of patients with and without CSFP, as well as the relationship between cTFC and invasive coronary functional measures.

Methods

FCA utilizing a pressure-Doppler flow wire during adenosine infusion, and acetylcholine provocation, was undertaken in 103 patients with angina and non-obstructive coronary artery disease (<50% stenosis; ANOCA).

Results

The FCA findings revealed CMD (i.e. CFR<2) in 43%, inducible coronary artery spasm (58%) and microvascular spasm (13%) in patients with the CSFP (n = 69), which was similar to those without CSFP (n = 34). However, the CSFP patients had a lower resting coronary blood flow velocity (19 ± 7 vs 23 ± 7cm/s, P = .009) with higher resting microvascular resistance (5.8 ± 1.9 vs 4.4 ± 1.7mmHg/cm/s, P = .006) and higher hyperemic microvascular resistance (2.35 ± 1.09 vs 1.94 ± 0.93, P = .049), despite a similar hyperemic CFR (2.25 ± 0.84 vs 2.26 ± 0.58, P = .971) compared to those without CSFP. Furthermore, the cTFC as a continuous measure, correlated with resting coronary blood flow, resting/hyperemic resistance but not CFR.

Conclusion

The conventional marker of CMD (i.e. CFR <2) was similar in patients with/without the CSFP. However alternative hemodynamic markers of impaired coronary microvascular function were abnormal in patients with the CSFP, including resting/hyperemic coronary microvascular resistance. Moreover, cTFC is a simple semi-quantitative marker correlated with coronary microvascular resistance and thus has clinical utility in the diagnosis of the CSFP.

查看原文本刊更多论文

ANOCA患者冠状动脉慢血流的功能性冠状动脉造影表现。

背景：冠状动脉慢血流现象（CSFP）被认为是冠状动脉微血管疾病，并被定义为心肌梗死帧数(cTFC)≥25帧时的纠正溶栓。最近的侵入性生理学研究报道，cTFC不是冠状动脉微血管功能障碍（CMD）的替代标志物，CMD是由冠状动脉血流储备异常（CFR）定义的，这对ccsf的完整性提出了质疑。本研究评估有和无ccsf患者的功能性冠状动脉造影（FCA）结果，以及cTFC与有创冠状动脉功能测量的关系。方法：对103例心绞痛合并非阻塞性冠状动脉疾病患者，在腺苷输注和乙酰胆碱激发下，采用压力多普勒血流线进行FCA检查（结果：FCA检查显示CMD（即CFR））

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.