A Comparison of Dynamic SPECT Coronary Flow Reserve with TIMI Frame Count in the Treatment of Non-Obstructive Epicardial Coronary Patients

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Abstract

Background

Microvascular dysfunction in patients with non-obstructive epicardial coronary may aggravate patient’s symptoms or lead to various clinical events.

Objective

To investigate the correlation between dynamic single photon emission computed tomography (D-SPECT) derived coronary flow reserve (CFR) and TIMI frame count (TFC) in patients with non-obstructive epicardial coronary patients.

Methods

Patients with suspected or known stable CAD who were recommended to undergo invasive coronary angiography were prospectively enrolled in this study. Those who had non-obstructive coronary received TIMI frame count (TFC) and D-SPECT. A cut-off value of >40 was defined as slow flow referred to TFC.

Results

A total of 47 patients diagnosed with non-obstructive coronary were enrolled. The mean age of patients was 66.09 ± 8.36 years, and 46.8% were male. Dynamic SPECT derived coronary flow reserve (CFR) was significantly correlated with TIMI frame count in 3 epicardial coronary (LAD: r=−0.506, P = 0.0003; LCX: r= −0.532, P = 0.0001; RCA: r= −0.657, P < 0.0001). The sensitivity and specificity of CFR in identifying abnormal TIMI frame count < 40 was 100.0% and 57.6% in LAD, 62.5% and 87.0% in LCX, 83.9% and 75.0% in RCA, respectively. The optimal CFR cut-off values were 2.02, 2.47, and 1.96 among the three vessels.

Conclusion

In patients with non-obstructive coronary, CFR derived from D-SPECT was strongly correlated with TFC. This study demonstrates that that CFR may be an alternative non-invasive method for identifying slow flow in non-obstructive coronary.

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Most cited references 32

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2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

Juhani Knuuti, William Wijns, Antti Saraste … (2019)

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Fourth universal definition of myocardial infarction (2018)

Fred S Apple, James Januzzi, Raffaele De Caterina … (2018)

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European Society of Cardiology: Cardiovascular Disease Statistics 2019

Adam Timmis, Nick Townsend, Chris P Gale … (2020)

The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Interv Aging

Journal ID (iso-abbrev): Clin Interv Aging

Journal ID (publisher-id): cia

Title: Clinical Interventions in Aging

Publisher: Dove

ISSN (Print): 1176-9092

ISSN (Electronic): 1178-1998

Publication date (Electronic): 02 November 2023

Publication date Collection: 2023

Volume: 18

Pages: 1831-1839

Affiliations

[1 ]Department of Cardiology, Huadong Hospital Affiliated to Fudan University , Shanghai, People’s Republic of China

[2 ]Department of Nuclear Medicine, Huadong Hospital Affiliated to Fudan University , Shanghai, People’s Republic of China

[3 ]Clinical Research Center for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University , Shanghai, People’s Republic of China

Author notes

Correspondence: Wenzheng Han; Xinkai Qu, Department of Cardiology, Huadong Hospital Affiliated to Fudan University , No. 221, Yan’an Road (W), Shanghai, People’s Republic of China, Email wzhan_cardiology@foxmail.com; qxkchest@126.com

[*]

These authors contributed equally to this work

Article

Publisher ID: 429450

DOI: 10.2147/CIA.S429450

PMC ID: 10627069

SO-VID: d5ea3a41-a5c2-43b7-a6a3-972a7a660d85

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 07 July 2023

Date accepted : 24 October 2023

Page count

Figures: 3, Tables: 2, References: 32, Pages: 9

Funding

Funded by: This work was supported by grant from Clinical medical research of Geriatric Coronary Disease Center (No. LCXZ2205), Project of Huadong Hospital clinical research (HDLC2022014), Clinical Research Plan of Shanghai Health and Family Planning Commission (No. 202040298) and Shanghai Municipal Key Clinical Specialty (No. shslczdzk02801);

This work was supported by grant from Clinical medical research of Geriatric Coronary Disease Center (No. LCXZ2205), Project of Huadong Hospital clinical research (HDLC2022014), Clinical Research Plan of Shanghai Health and Family Planning Commission (No. 202040298) and Shanghai Municipal Key Clinical Specialty (No. shslczdzk02801).

A Comparison of Dynamic SPECT Coronary Flow Reserve with TIMI Frame Count in the Treatment of Non-Obstructive Epicardial Coronary Patients

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Abstract

Background

Objective

Methods

Results

Conclusion

Related collections

Tobacco Prevention & Cessation

Most cited references 32

2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

Fourth universal definition of myocardial infarction (2018)

European Society of Cardiology: Cardiovascular Disease Statistics 2019

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