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      Evaluation of ghrelin levels and endothelial functions in patients with coronary slow flow phenomenon

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          Abstract

          Background

          Ghrelin has recently been reported to have beneficial effects on cardiac contractile functions and coronary blood flow. The main purpose of this study was to investigate the role of ghrelin in the pathogenesis of coronary slow flow (CSF) together with endothelial functions.

          Methods

          Twenty-five patients having normal coronary arteries with CSF and 25 controls with normal coronary flow were included into the study. The quantitative measurement of coronary blood flow was performed for each coronary artery using the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method. Ghrelin levels were measured using the enzyme-linked immunosorbent assay method from venous blood samples. Endothelial functions were evaluated from the brachial artery with the flow-mediated dilation (FMD) and nitrate-related dilation methods.

          Results

          There was a significant difference in terms of mean TFC values between the control and CSF groups ( p < 0.001 for all coronary arteries). The mean FMD percentage among patients with CSF was lower than that of the control group (5.9 ± 0.8 vs. 10.7% ± 1.1%; p < 0.001). A moderate negative correlation was observed between the FMD percentages and the TFCs. There was no relationship between the TFC and ghrelin levels.

          Conclusion

          Plasma ghrelin levels seem to be uninfluential while impaired endothelial functions play an important role in the etiopathogenesis of CSF.

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          Most cited references24

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          Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery

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            TIMI frame count: a quantitative method of assessing coronary artery flow.

            Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature. In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7 +/- 3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2 +/- 2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4 +/- 3.0) and circumflex counts (22.2 +/- 4.1, P < .001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2 +/- 20.0 frames, which improved to 31.7 +/- 12.9 frames by 18 to 36 hours (P < .001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5 +/- 9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0 +/- 3.1, P < .001) but improved to that of normal arteries by 1 day after thrombolysis (21.7 +/- 7.1, P=NS). The CTFC is a simple, reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
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              Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding.

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                Author and article information

                Journal
                imas
                IMAS
                Interventional Medicine and Applied Science
                Interventional Medicine and Applied Science
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                14 September 2017
                September 2017
                : 9
                : 3
                : 154-159
                Affiliations
                [ 1 ] Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital , Muğla, Turkey
                [ 2 ] Department of Cardiology, Kayseri Training and Research Hospital , Kayseri, Turkey
                [ 3 ] Department of Cardiology, Bülent Ecevit University Hospital of Medicine , Zonguldak, Turkey
                [ 4 ] Department of Cardiology, Hitit University Faculty of Medicine , Çorum, Turkey
                Author notes
                [* ]Corresponding author: Oğuzhan Çelik, MD; Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Orhaniye Mah. İsmet Çatak Cd. No: 22-18, Muğla 48000, Turkey; Phone: +90 538 789 7625; Fax: +90 252 214 1323; E-mail: oguzhancelik@ 123456yahoo.com
                Article
                10.1556/1646.9.2017.27
                5700701
                b0e03e53-0c61-41fb-84ed-22066cb82ad2
                © 2017 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                History
                : 9 June 2017
                : 10 July 2017
                : 11 July 2017
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 22, Pages: 6
                Funding
                Funding sources: No financial funding was received for this study.
                Categories
                ORIGINAL PAPER

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                ghrelin,coronary slow flow,coronary artery,endothelial dysfunction,TIMI frame count

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