Relationship between carotid artery stiffness and total serum homocysteine in coronary slow flow phenomenon: a high-resolution echo-tracking study

Association Between Orthostatic Hypotension With Coronary Slow Flow in Patients With Chest Pain: A Single Center Experience

BACKGROUND

Orthostatic hypotension (OH) is associated with different cardiovascular diseases, however, the association between OH and coronary slow flow (CSF) has never been evaluated before.

MATERIALS AND METHODS

Chest pain patients who underwent coronary angiography (CAG) and with normal coronary arteries in our department from January 1st, 2022 to August 31st, 2023 were retrospectively enrolled. Patients were divided into the CSF group and the normal blood flow (NBF) group. Relative clinical information, laboratory test results as well as the results of CAG were collected and analyzed. Both uni-variable and multi-variable logistic regression analyses were used to evaluate the association between OH and CSF in these patients.

RESULTS

Four thousand six hundred and twenty-seven patients underwent CAG and 655 patients had normal coronary arteries. In which, sixty-nine patients were diagnosed with CSF while 586 patients were diagnosed with NBF. Uni-variable analysis revealed that higher body weight index, faster heart rate in sitting position, accompanied with chronic kidney disease, did not take Antidiabetic therapy, higher level of aspartate transaminase, uric acid, triglyceride, total cholesterol, ApoB1, low-density lipoprotein cholesterol, homocysteine, B-type natriuretic peptide as well as OH are the risk factors for CSF in these patients. Multi-variable logistic regressing analysis further demonstrated that OH was the independent risk factor for predicting CSF in these patients.

CONCLUSIONS

Our finding suggests OH might be a useful predictor for CSF in patients with chest pain but normal coronary arteries.

Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow

This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.

Homocysteine levels in patients with coronary slow flow phenomenon: A meta-analysis

BACKGROUND

With the development of coronary angiography, more and more attention has been paid to coronary slow flow phenomenon (CSFP). Recent studies have found that the correlation between homocysteine (Hcy) levels and CSFP was contradictory, so we conducted this meta-analysis to investigate the correlation.

METHODS

By March 2022, studies that meet the research requirements were identified by searching multiple databases including Embase, Web of Science, and PubMed. We included studies evaluating the correlation between Hcy levels and CSFP. Random or fixed effect meta-analyses were performed according to heterogeneity among included studies. A leave-out method and subgroup analyses were conducted to determine the source of heterogeneity.

RESULTS

Thirteen studies involving 625 CSFP and 550 subjects were included. After pooling data from each study, Hcy levels were higher in the CSFP groups (standard mean difference [SMD], 1.45; 95% CI, 0.94 to 1.96, P < .00001) than in the control group. In the meta-analysis, there was significant heterogeneity (I2 = 93%), which was further explored through leave-out method and and subgroup analyses. Specifically, pooling data from studies with a mean thrombolysis in myocardial infarction (TIMI) frame count ≥ 46 (SMD, 1.31; 95% CI, 1.00 to 1.63, P < .00001) resulted in no heterogeneity (0%), indicating that the TIMI frame count ≥ 46 was the source of heterogeneity.

CONCLUSIONS

Our study found that elevated Hcy levels are strongly associated with CSFP. More importantly, the association was stronger in CSFP patients with mean TIMI frame count ≥ 46.