{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:12:13Z","timestamp":1792617133262,"version":"4.5.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC)\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                <mml:semantics>\n                  <mml:mrow>\n                    <mml:mo>&gt;<\/mml:mo>\n                  <\/mml:mrow>\n                  <mml:annotation encoding=\"application\/x-tex\">$$ &gt; $$<\/mml:annotation>\n                <\/mml:semantics>\n              <\/mml:math>\n              27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor\u2010tipped guidewire during rest, adenosine\u2010mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve &lt;2.5) and CED in response to acetylcholine (acetylcholine flow reserve \u22641.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty\u2010six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                <mml:semantics>\n                  <mml:mrow>\n                    <mml:mo>\u00b1<\/mml:mo>\n                  <\/mml:mrow>\n                  <mml:annotation encoding=\"application\/x-tex\">$$ \\pm $$<\/mml:annotation>\n                <\/mml:semantics>\n              <\/mml:math>\n              6.9 versus 20.2\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                <mml:semantics>\n                  <mml:mrow>\n                    <mml:mo>\u00b1<\/mml:mo>\n                  <\/mml:mrow>\n                  <mml:annotation encoding=\"application\/x-tex\">$$ \\pm $$<\/mml:annotation>\n                <\/mml:semantics>\n              <\/mml:math>\n              6.9 cm\/s;\n              <jats:italic>P<\/jats:italic>\n              =0.001 and 6.26\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                <mml:semantics>\n                  <mml:mrow>\n                    <mml:mo>\u00b1<\/mml:mo>\n                  <\/mml:mrow>\n                  <mml:annotation encoding=\"application\/x-tex\">$$ \\pm $$<\/mml:annotation>\n                <\/mml:semantics>\n              <\/mml:math>\n              1.83 versus 5.36\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                <mml:semantics>\n                  <mml:mrow>\n                    <mml:mo>\u00b1<\/mml:mo>\n                  <\/mml:mrow>\n                  <mml:annotation encoding=\"application\/x-tex\">$$ \\pm $$<\/mml:annotation>\n                <\/mml:semantics>\n              <\/mml:math>\n              1.83\u2009mm\u2009Hg\/cm\/s;\n              <jats:italic>P<\/jats:italic>\n              =0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%\u20130.50%] and 0.36 [95% CI, 0.23%\u20130.49%], respectively).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.027664","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T10:36:31Z","timestamp":1671878191000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5733-3250","authenticated-orcid":false,"given":"Utkarsh","family":"Dutta","sequence":"first","affiliation":[{"name":"School of Cardiovascular Medicine and Sciences British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King\u2019s College London London 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