Original Research Article
Year: 2023 | Month: July | Volume: 13 | Issue: 7 | Pages: 363-375
DOI: https://doi.org/10.52403/ijhsr.20230749
A Study of Clinical Profile, Prevalence of Risk Factors and Assessment of Microvascular Dysfunction by Coronary Angiography in Patients of Ischemic Heart Disease Admitted in the Department of Cardiology of a Tertiary Care Hospital in Kolkata
Dr Bappaditya Kumar1, Dr Somnath Mukhopadhay2
1Consultant Interventional Cardiologist, Hooghly, India
2Consultant Interventional Cardiologist, Howrah, India
Corresponding Author: Dr Bappaditya Kumar
ABSTRACT
BACKGROUND Substantial research and clinical evaluation has been directed towards the understanding, diagnosis and management of coronary artery disease. It is also a well-known fact that myocardial ischaemia may occur in the absence of overt atherosclerotic diseases in the epicardial coronary vessels as demonstrable by coronary angiography. Contrary to the epicardial coronary vasculature, the coronary microcirculation has remained elusive to conventional imaging techniques.
AIMS AND OBJECTIVES:
1. To assess the severity and pattern of microvascular dysfunction in patients with ischemic heart disease by corrected TIMI Frame Count (CTFC) and Myocardial Blush Grading (MBG) in vessels without any flow limiting disease.
2. To study the correlation between microvascular dysfunction and various risk factors for CAD
Methods – We measured CTFC in 400 patients. Myocardial blush in non-infarct territory was also studied. Correlation between various atherosclerotic risk factors and CTFC was studied. We also compared the CTFC between patients with different types of presentations
Results- We found that coronary flow was significantly slower in non infarct related arteries in the setting of STEMI and NSTEMI despite no obstructive epicardial coronary lesion as compared to coronary flow in the absence of acute MI (p < 0.001). CTFC in males was more than in females but was not statistically significant (p >0.10). Also, significant slow flow was present in Non infarct related arteries in STEMI as compared to NSTEMI. Similarly significant slow flow was present in the patients with unstable angina when compared with patients presenting with stable angina. Among patients with STEMI and NSTEMI, significant slow flow was present in the infarct related artery in STEMI patients. The amount of microvascular dysfunction was directly related to number of atherosclerotic risk factors which again suggests that microvascular dysfunction might precede epicardial thrombosis. Diabetes and dyslipidemia predicted higher CTFC.
Key words: microvascular dysfunction, corrected TIMI Frame Count (CTFC), Myocardial Blush Grading (MBG), coronary artery disease