The vast majority of cardiovascular research emphasizes the high burden of heart diseases and the preponderance of these diseases in mortality.^, Efforts to learn how major cardiovascular diseases are managed have been led by the countries with the greatest economic power. However, a large part of the world’s population has been forgotten, because the realities of life in developing countries make it impossible to apply all the recommendations. As a result, adverse cardiovascular outcomes remain common, reducing quality of life and life expectancy. In the following paragraphs, I will comment on chronic coronary syndromes, specifically on the efforts made by physicians in India to adapt the management of this disease to their resources and situation.

The underlying pathophysiology of chronic coronary syndromes is myocardial ischemia caused by alterations in coronary flow, mostly due to atherosclerosis, and they are part of a continuum in which atheromatous plaques can become complicated and unstable, causing acute coronary syndromes. To speak of chronic coronary syndromes is not only to refer to a phenomenon at the coronary level but also to consider the associated risk factors. The most common risk factors are hypertension, diabetes, dyslipidemia, smoking, and physical inactivity. However, other non-conventional factors such as exposure to pollutants, social deprivation, occupational stress, hormonal changes, environmental noise, and the area of the world in which we live must also be emphasized. All these phenomena can cause alterations in coronary flow, either by atheroma plaque or by alteration of the microcirculation. For the diagnosis of these diseases, many studies are required, such as electrocardiograms, echocardiograms, cardiac scintigraphy, magnetic resonance imaging, coronary artery tomography, or invasive coronary angiography. Initial treatment is medical, but in many cases, a revascularization strategy will be necessary, either by surgery or percutaneous coronary intervention.

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Abstract

Background

TIMI flow grade and corrected TIMI frame count (CTFC) are widely used methods to evaluate angiographic coronary blood flow. Measurement of coronary blood flow (CBF) on standard coronary angiography (CAG) has aroused great interest recently, trying to combine the CTFC concept with new methods for post-angioplasty and for cardiac syndrome X assessment. Additionally, coronary slow flow it is now considered a major criterion for microvascular angina.

Objective

Explore a new approach of quantitative angiographic measurement of CBF based on densitometric contrast detection in CAG off-line, using an accessible software to obtain a more precise and reliable CBF assessment.

Methods

Thirty patients were studied and divided in 2 groups, normal coronary blood flow (NF) and slow coronary blood flow (SF), according to CTFC definition. The DM was applied to the study sample to differentiate between NF and SF. Non-parametric statistics was used to assess differences between groups at p<0.05.

Results

The DM normal reference value obtained for coronary blood flow was 9 [5–10] frames. NF vs SF group were compared and expressed as median [interquartile range], for the left anterior descending: 10 [7-11] vs 21 [8-33];p= 0.016; circumflex: 9 [4-13] vs 14 [11-30]; p= 0.012 and right coronary artery: 5 [3-11] vs 13 [8-26]; p=0.009.

Conclusion

The DM showed the feasibility of measuring coronary blood flow with precision, consistency and reproducible in a standard coronary angiogram, showing the additional capability to differentiate between NF and SF in chest pain patients with normal coronary arteries. (Arq Bras Cardiol. 2020; 115(3):503-512)

OBJECTIVE: To evaluate the length of time required for atherosclerotic plaque stabilization in acute coronary syndromes (ACS), using inflammatory markers. METHODS: In this prospective study, C-reactive protein (CRP), fibrinogen, factor VIIIc, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels were measured on admission, at discharge, and three and six months post-discharge in 40 patients with non-ST-segment elevation ACS (NSTE-ACS) and 40 healthy subjects. RESULTS: C-reactive protein levels were significantly higher on admission and at discharge, but not at three and six months post-discharge, compared with the control group. Fibrinogen levels remained unchanged, except at six months, when they were significantly lower than in the control group. Factor VIII-c did not differ from that of the control group on admission, but it was significantly higher at discharge, with no differences at three and six months. Interleukin-6 levels were significantly higher than in the control group in all time points. However, they declined significantly between discharge and three months. In no time point was TNF-alpha significantly different from that of the control group. Only IL-6 correlated significantly and independently with future cardiovascular events. CONCLUSION: With respect to CRP and factor VIIIc, plaque stabilization is suggested in up to three months; IL-6 analysis suggests stabilization as from the third month, although it remained higher than that of the control group for up to six months. Only IL-6 showed prognostic value for further events within a year.