TIMI Frame Count and Adverse Events in Women with No Obstructive Coronary Disease: A Pilot Study from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE)

Abstract

BackgroundTIMI frame count (TFC) predicts outcomes in patients with obstructive coronary artery disease (CAD); it remains unclear whether TFC predicts outcomes in patients without obstructive CAD.MethodsTFC was determined in a sample of women with no obstructive CAD enrolled in the Women's Ischemia Syndrome Evaluation (WISE) study. Because TFC is known to be higher in the left anterior descending artery (LAD), TFC determined in the LAD was divided by 1.7 to provide a corrected TFC (cTFC).ResultsA total of 298 women, with angiograms suitable for TFC analysis and long-term (6–10 year) follow up data, were included in this sub-study. Their age was 55±11 years, most were white (86%), half had a history of smoking, and half had a history of hypertension. Higher resting cTFC was associated with a higher rate of hospitalization for angina (34% in women with a cTFC >35, 15% in women with a cTFC ≤35, P<0.001). cTFC provided independent prediction of hospitalization for angina after adjusting for many baseline characteristics. In this cohort, resting cTFC was not predictive of major events (myocardial infarction, heart failure, stroke, or all-cause death), cardiovascular events, all-cause mortality, or cardiovascular mortality.ConclusionsIn women with signs and symptoms of ischemia but no obstructive CAD, resting cTFC provides independent prediction of hospitalization for angina. Larger studies are required to determine if resting TFC is predictive of major events in patients without obstructive coronary artery disease.

Myocardial perfusion reserve and global longitudinal strain as potential markers of coronary allograft vasculopathy in late-stage orthotopic heart transplantation

“…Using the ISHLT grading criteria, patients with no or mild CAV had a higher MPRi compared to those with more significant CAV. Additionally, we confirmed the results of other smaller studies that showed that elevated TIMI frame counts correlated with microvascular disease in both native and transplanted hearts [3, 43–45]. We also found that worsening in MPRi and GLS was associated with worsening in TIMI frame counts.…”

Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials

“…Future studies should also address whether and to what extent sex differences in response to volume overload and biological and/or hormonal differences between the sexes might have contributed to the differential outcomes, including pulmonary vascular function, plaque characteristics, microvascular dysfunction, inflammation, and left atrial function. [37][38][39] Of note, the less frequent restoration of TIMI 3 flow in women compared to men in our study is consistent with a potential role for microvascular dysfunction contributing to the poor prognosis in women. 39 …”

“…[37][38][39] Of note, the less frequent restoration of TIMI 3 flow in women compared to men in our study is consistent with a potential role for microvascular dysfunction contributing to the poor prognosis in women. 39 …”

Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy

“…87 Although not visualized using angiography, the speed of contrast movement during angiography as the resting corrected Thrombolysis In Myocardial Infarction (cTIMI) frame count can be considered, and has been shown to correlate with aspects of CMD in WISE and other study participants. [92][93][94] For example, cTIMI scores in women with no obstructive CAD are predictive of hospitalizations for angina. 94 cTIMI has been used to show that the presence of flow delays immediately after thrombolysis is correlated with CMD.…”

“…[92][93][94] For example, cTIMI scores in women with no obstructive CAD are predictive of hospitalizations for angina. 94 cTIMI has been used to show that the presence of flow delays immediately after thrombolysis is correlated with CMD. 92 This measure is objective, reproducible, and highly correlated with Doppler blood-flow measurements.…”