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PubMed2006

Angiotensin II type 1 receptor blockers do not promote coronary collateral circulation in patients with coronary artery disease.

We previously reported that angiotensin-converting enzyme inhibitors (ACE-Is) promote collateral circulation in patients with coronary artery disease (CAD). There have been many reports on the beneficial effects of angiotensin II type 1 receptor blockers (ARBs) on the cardiac microvasculature. Therefore, the following studies were performed to evaluate the association between treatment with an ARB and the enhancement of coronary collateral circulation as assessed by the Rentrop Score (RS) (Study 1) and to compare these results to those obtained with an ACE-I (Study 2). The subjects were 456 patients with angina who underwent coronary angiography. Study 1: Those who had one (1-V), two (2-V) or three significantly stenosed vessels (3-V) and who received only an ARB without any other anti-hypertensive medication were defined as the ARB group (n=81), and age-, sex- and body mass index-matched subjects (n=146) were selected as a comparative group. There were no significant differences in the percentage of patients with RS>or=1 between the two groups. Study 2: Those who received an ACE-I as the only anti-hypertensive treatment were defined as the ACE-I group (n=67), which was matched to the ARB group in Study 1. The percentage of patients with RS>or=1 in the ACE-I group was significantly higher than that in the ARB group as assessed by a Cochran-Mantel-Haenszel analysis. In addition, patients with 3-V disease who were treated with an ACE-I, but not an ARB, were most likely (odds ratio [confidence Interval]): 27.7 [4.8-161.0]) to show enhanced collateral circulation, as assessed by a multiple logistic regression analysis. These results suggest that treatment with an ACE-I, but not treatment with an ARB, was associated with the enhancement of collateral circulation in patients with CAD.

Aged↗
PubMed2002

Collateral coronary circulation in the absence of obstructive coronary artery disease.

The presence of collateral coronary circulation almost always accounts for significant obstructive coronary artery disease and its development remains unclear. We present two cases wherein there was a large collateral artery in a patient with angiographically normal coronary arteries. In both cases, the vessel ran in the atrioventricular groove, between the distal right coronary artery and the circumflex artery. We believe that this vessel is of congenital origin and after reviewing the literature we describe the angiographic features that distinguish such a vessel from collaterals that are secondary to coronary stenosis or hypoxia.

Aged↗
PubMed1991

Coronary collateral circulation.

The occurrence and influence of coronary collateral circulation and obstruction of the supplying coronary arteries on left ventricular contractility, prevalence of myocardial infarction, and bicycle exercise ergometer test were studied in a random sample of 286 patients with angiographically documented coronary artery disease. Collaterals appeared increasingly in all three main coronary arteries with grade of obstruction. The highest prevalence of collaterals occurred in stenosis of the right coronary artery (60%), followed by the left descending artery (45%); they occurred least in the left circumflex artery (21%) (p less than 0.001). The frequency of intra-arterial collateral circulation was 42%, 11%, and 12%, respectively (p less than 0.001). With total occlusion of the left anterior descending coronary artery, 22% of the patients had normokinetic anterior and apical left ventricular wall when collaterals were present. More often, the inferior wall showed normal contraction with total occlusion of the right coronary artery and collaterals [52%, p less than 0.001 compared with left anterior descending artery (LAD)]. The prevalence of inferior myocardial infarction was 39%, with collateral circulation to the totally occluded right coronary artery. The respective prevalence of anterior infarction and total occlusion in the left coronary artery was 58% (p less than 0.02). The presence or absence of collaterals had no obvious influence on ST-segment response during bicycle ergometer test. In triple-vessel disease, peak work capacity was better when collaterals to LAD were not jeopardized (427 kpm) than when jeopardized (321 kpm) (p less than 0.02).

Analysis of Variance↗
PubMed1987

Ischaemia induced development of functional coronary collateral circulation in ponies.

The response of coronary collaterals in nine ponies subjected to repeated reversible occlusions (2 min duration, 30 min interval) of the left anterior descending coronary artery was studied at rest. Each pony was instrumented with a Doppler flowmeter and hydraulic cuff occluder around the left anterior descending coronary artery, left ventricular subendocardial sonomicrometers, and a left ventricular micromanometer. Initial occlusions increased end diastolic myocardial segment length by 3% and decreased segment systolic shortening, stroke work, and velocity of shortening by 103%, 95%, and 79% respectively in the left ventricular apex. Left ventricular systolic and end diastolic pressure, peak positive dP/dt, and heart rate were not significantly changed by occlusion. After 421(70) (mean(SEM)) occlusions no sustained alterations in myocardial segment function occurred in response to occlusion. Thus the presence of a subendocardial plexus did not protect against a severe loss of myocardial segment function when the ponies were initially subjected to occlusions of the left anterior descending coronary artery. However, repeated reversible occlusions enhanced coronary collateral blood flow such that it was adequate to maintain left ventricular function in the absence of left anterior descending coronary artery flow. It is concluded that the pony is highly suitable for use in studies of coronary collateral circulation because of its coronary anatomical similarity to man and its capacity to develop functional collateralisation.

Animals↗
PubMed2002

[Are there effects due to the existence of coronary collateral circulation on left ventricular function in patients with coronary artery disease?].

OBJECTIVE: The role of coronary collateral circulation (CCC) on the improvement of left ventricular function in coronary artery disease is controversial. The aim of this study is to investigate the effect of CCC on left ventricular function in patients with ischaemic heart disease. METHODS: Accordingly, 76 patients (39 female, 37 male, mean age--61 +/- 17 years) who had single vessel disease with > 85% narrowing in left anterior descending coronary artery were enrolled in this study. Coronary collateral circulation was determined according to the Rentrop classification (Class 0 = no collateral circulation; class 1 = small branches of occluded vessel fill with CCC; class 2 = epicardial segment of the occluded vessel partially fills with CCC; class 3 = epicardial segment of the occluded vessel totally fills with CCC). Left ventricular function was assessed with echocardiography and left ventricular regional wall motion score (0 = normokinetic; 1 = hypokinetic; 2 = akinetic; 3 = dyskinetic; 4 = aneurysmatic). Rentrop classification of the patients were compared with left ventricular regional wall motion scores and ejection fractions. RESULTS: Twenty one of 76 patients had no collateral circulation. The regional wall motion score of class 0 patients was similar with that of patients with CCC (class 1,2,3) (2.28 +/- 2.1 vs 3.39 +/- 2.1, p > 0.05). Particularly, the regional wall motion score was positively correlated with Rentrop classes (p < 0.05). Class 3 patients had the highest wall motion score (4.24 +/- 2.5, p < 0.05). Patients with and without CCC had similar left ventricular ejection fractions (49 +/- 11 vs 46 +/- 17, p > 0.05). CONCLUSION: This study showed that development of CCC has no preventive effect on left ventricular functions in patients with coronary artery disease. Interestingly as the stage of CCC increases left ventricular function worsens. It may be the result of the fact that patients with well developed CCC have more severe coronary artery disease.

Collateral Circulation↗
PubMed2005

Cardiac ischemic score determines the presence of coronary collateral circulation.

PURPOSE: The presence of coronary collaterals is of vital importance during acute ischemia, however, marked interindividual variability exists. We examined the extent to which the burden of cardiac ischemia, expressed as a cardiac ischemic score, affects coronary collateral presence. METHODS: Cross-sectional study in 244 patients, admitted for elective coronary angioplasty. Collaterals were graded with Rentrop's classification. Coronary collateral presence was defined as Rentrop-grade > or =1. The cardiac ischemic score (range 0-4) was calculated by adding 1 point for each of the following four clinical factors present: angina pectoris on exertion, angina pectoris during emotions, previous myocardial infarction, and previous coronary intervention. These four clinical factors were chosen because they can be easily assessed in every patient. We used logistic regression with adjustment for gender, age, hypertension, diabetes mellitus, and hyperlipidemia. RESULTS: The extent of the cardiac ischemic score (odds ratio 1.8 per score-point; 95% confidence interval 1.3-2.5) was strongly associated with coronary collateral presence. Additional adjustment for multivessel coronary disease left the relation essentially unchanged. Also, if the definition of collateral presence was limited to Rentrop-grade 2 and 3, results were effectively the same. CONCLUSION: The extent of the cardiac ischemic score determines the presence of coronary collaterals, and may provide a new index for simple assessment of collateral vascular development.

Angioplasty, Balloon, Coronary↗
PubMed1987

Vasomotor properties of immature canine coronary collateral circulation.

This study examined the ability of the immature coronary collateral circulation to undergo vasodilation in response to nitroglycerin and vasoconstriction in response to alpha-adrenoceptor stimulation. Studies were performed in 12 anesthetized dogs. Collateral flow was estimated from measurements of retrograde flow from the acutely ligated and cannulated anterior descending branch of the left coronary artery. Antegrade flow into the collateral-dependent myocardium was minimized by embolizing the anterior descending artery with 25-microns microspheres. Drugs to be tested were introduced into the left main coronary artery to reach collateral vessels arising from the left circumflex and septal arteries. Intracoronary administration of nitroglycerin (6 micrograms X kg-1 X min-1) resulted in a 33 +/- 7.7% increase in retrograde blood flow (P less than 0.01) and a 23 +/- 3.8% decrease in calculated collateral resistance (P less than 0.01). No significant change occurred in retrograde blood flow or calculated collateral resistance during cardiac sympathetic nerve stimulation after beta-adrenergic blockade with propranolol, selective alpha-adrenergic stimulation with phenylephrine (1 microgram X kg-1 X min-1), or selective alpha 2-stimulation with BHT 933 (2 micrograms X kg-1 X min-1). Thus, the immature coronary collateral circulation was capable of active vasomotion, as demonstrated by vasodilation in response to nitroglycerin, but did not undergo vasoconstriction in response to alpha-adrenoceptor stimulation.

Animals↗
PubMed1998

Long-term physical exercise and quantitatively assessed human coronary collateral circulation.

OBJECTIVES: This prospective, cross-sectional study sought to determine an association between the level of long-term physical activity as well as other clinical and angiographic variables and an index of collateral flow to the vascular region undergoing percutaneous transluminal coronary angioplasty (PTCA). BACKGROUND: There is limited and conflicting information about the effect of physical exercise on the coronary collateral circulation in humans, partly because previous studies lacked a quantitative means of assessing collateral channels. METHODS: In 79 patients (mean [+/-SD] age 58 +/- 10 years) with coronary artery disease undergoing PTCA (no transmural myocardial infarction), a coronary collateral flow index was determined as the ratio between the intracoronary (IC) distal flow velocity time integral during (Vi(occl)[cm]) and after (Vi(occl) [cm]) PTCA of the stenosis. Vi(occl)/Vi(occl) was measured by a 0.014-in. Doppler guide wire, from which an IC electrocardiogram (ECG) was also recorded. Patients without ECG ST-T wave changes during PTCA were considered to have sufficient collateral channels (n = 29); those with ST-T wave changes were considered to have insufficient collateral channels (n = 50). The level of long-term physical activity was determined by a structured interview (score from 1 to 4). Univariate and multivariate analyses were used to find associations between physical activity as well as 30 other clinical and angiographic variables and the collateral flow index. RESULTS: Long-term physical activity during leisure time, but not during work hours, and the severity of the stenosis undergoing PTCA were found to be independently and directly associated with sufficient versus insufficient collateral channels and with Vi(occl) Vi(occl) (leisure time physical activity [LTPA] score 3.3 +/- 0.9 vs. 2.4 +/- 1.0, p = 0.0002; percent diameter stenosis 88 +/- 12% vs. 80 +/- 14%, p = 0.001; Vi(occl)/Vi(occl) = 0.1 +/- 0.1 LTPA score, p = 0.0002 for trend). CONCLUSIONS: In patients with coronary artery disease, the level of long-term physical activity during leisure time and the severity of the stenosis undergoing PTCA are directly associated with the quantitative degree of collateral flow.

Adult↗
PubMed1981

[Effect of isoptin and its combination with strophanthin on collateral coronary circulation and systemic hemodynamics in acute myocardial ischemia].

It was established in acute experiments on dogs with the anterior interventricular branch of the left coronary artery ligated in the middle third that isoptin increases essentially the blood flow and oxygen tension in the focus of acute myocardial ischemia, increases the cardiac stroke and minute volumes, and reduces the total peripheral vascular resistance. Strophanthin removes the favourable effect of isoptin on collateral coronary circulation and contractile myocardial activity and increases the total peripheral vascular resistance.

Acute Disease↗
PubMedDate not supplied

[Effect of neuroleptanalgesia agents on the collateral coronary circulation and systemic hemodynamics in acute myocardial ischemia].

The effects of neuroleptoanalgetics on the local heart blood supply and general hemodynamics were studied in acute coronary occlusion. It was noted that droperidol, phentanyl and their combination are capable of raising the collateral coronary circulation and of maximal acceleration of the blood flow in the aorta under moderate hypotension. Administration of the increased doses of droperidol and phentanyl had an adverse effect on the blood supply of an acutely ischemized myocardium, general hemodynamics and heart contractility.

Acute Disease↗
PubMed1994

[Effects of furyl-dihydropyridine I on coronary collateral circulation in myocardial infarction of dogs].

Effects of furyl-dihydropyridine I (FDP-1) on collateral circulation were observed in ischemic myocardium of dogs. FDP-1 (200 micrograms.kg-1) of intracoronary injection increased collateral flow, reduced systemic artery resistance, and coronary systolic pressure in infarcted region and the area of infarction decreased from 28.9 +/- 1.3% to 15.3 +/- 1.2% (P < 0.01, n = 6). The results indicated that FDP-1 could improve coronary collateral circulation, increase collateral flow in ischemic region, decrease collateral flow in ischemic region, decrease myocardial oxygen demand, and protect myocardial ischemia.

Animals↗
PubMed1993

The role of the coronary collateral circulation in limiting myocardial ischemia and infarct size.

The role of coronary collateral circulation in limiting ischemia and infarction has been studied prospectively. Transient occlusion of a coronary artery angioplasty has provided evidence that collateral circulation decreases wall motion abnormalities, ST segment changes, and lactate production. Patients who have collateral flow also have a better outcome after coronary artery dissection and acute closure than patients without collateral flow. Collateral circulation also limits infarct size during acute myocardial infarction with and without thrombolysis. Although collateral flow may decrease coronary artery bypass graft patency in certain subgroups of patients, the perioperative infarct rate and mortality is decreased. Growth factors have been identified that increase the development collateral circulation and may improve ventricular function in the setting of myocardial infarction.

Acute Disease↗
PubMed2006

Impact of coronary collateral circulation on QT dispersion in patients with coronary artery disease.

OBJECTIVE: The aim of this study was to assess the effect of coronary collateral circulation (CCC) on QT dispersion (QTD) in coronary artery disease. BACKGROUND: A prolonged QTD has been linked to increased heterogeneity of ventricular repolarization implicated in the genesis of ventricular arrhythmias and has been associated with an adverse prognosis in patients with coronary artery disease. METHOD: CCC and corrected QTD (QTcD) were established in patients who had at least 85% stenosis in the left anterior descending coronary artery or in proximal part or in the body of the right coronary artery. Furthermore, left ventricular function score was determined for all the patients. RESULTS: While CCC was not present (CCC grade 0) in 32 patients, 68 patients were observed with CCC (CCC grade > or =1). Mean QTcD was higher in patients who had CCC grade > or =1 than in patients with grade 0 (64.3+/-3.5 and 46.8+/-2.7, respectively, P=0.002). We detected a significant correlation between the collateral score and QTcD (r=0.354, P=0.001). CCC grade > or =1 patients had higher mean left ventricular function scores than grade 0 patients (P=0.048). Left ventricular function score and QTcD were observed to be correlated (r=0.200, P=0.046). CONCLUSION: CCC in chronic coronary artery disease was not established to have a positive decreasing effect on QTcD. On the contrary, QTcD values were observed to be even higher in patients with well developed CCC. Further research including larger series and long-term follow-up is required to investigate this issue.

Arrhythmias, Cardiac↗
PubMed1998

Effect of coronary collateral circulation on exercise stress test.

In this study, patients who have recovery-only ST segment depression in exercise stress test were chosen. It is proposed that coronary collateral circulation could improve with stress-increased coronary perfusion, and accordingly, patients with recovery-only ST segment depression were evaluated by coronary angiography for grading the coronary collateral circulation. Twenty-one men and five women were assigned to the study group. Sixteen men and two women who had exercise-induced ST segment depression were assigned to the control group. Age and gender of both groups were not statistically different (p>0.05). The reason for terminating the exercise stress test was chest pain in two of 26 patients in the study group versus 15 of 18 in the control group (p<0.001). In both groups coronary collateral frequency and grade were directly correlated with the severity of the coronary artery disease (p<0.001 in the study group, and p<0.05 in the control group). When both groups were compared for the frequency of significant coronary collateral circulation, 14 of 26 patients in the study group versus 4 of 18 patients in the control group had significant coronary collateral circulation (p=0.035). The authors conclude that recovery-only ST segment depression correlates well with the frequency of significant coronary collateral circulation, and coronary collaterals may prevent myocardial ischemia during exercise.

Case-Control Studies↗
PubMed1998

[Pathophysiology of coronary collateral circulation in the human].

The functional relevance of coronary collaterals in humans has yet to be fully explored. Several studies demonstrated a protective role of collaterals in patients with coronary artery disease. On the other hand, negative aspects of well-developed coronary collaterals have been reported, e.g. a higher rate of restenosis following coronary angioplasty, or a redistribution of blood via collaterals away from the myocardial area in need towards normally perfused areas (coronary steal). In the past, the coronary collateral circulation has been assessed only qualitatively, using visual angiographic or nuclear imaging methods. With the recent advent of intracoronary Doppler and pressure-transducers, quantitative assessment of functional parameters of the coronary circulation has become feasible. This article reviews ongoing research in the field of coronary collaterals in humans, concerning their exact determination, the positive and negative aspects of their structure as well as their functional aspects.

Angioplasty, Balloon, Coronary↗
PubMed2003

Coronary collateral circulation is less developed when ischaemic heart disease coexists with diabetes.

BACKGROUND: The extent of myocardial ischaemia and the magnitude of systolic function impairment following myocardial infarction (MI) depend to a large degree on the performance of coronary collateral circulation. Endothelial function is altered in several disorders, including diabetes. An impaired development of coronary collateral circulation may be a factor responsible for post-MI complications in patients with diabetes. AIM: To compare the degree of coronary collateral circulation development between patients with advanced ischaemic heart disease (IHD), with or without diabetes. METHODS: The study group consisted of 70 consecutive patients with diabetes who underwent coronary angiography between September 1998 and December 1999 and had total occlusion of at least one of the main coronary vessels. The control group consisted of 70 age-, gender, and MI history-matched non-diabetic patients. Coronary collateral circulation was assessed using the collateral score (CS). RESULTS: Patients with diabetes had less developed coronary collateral circulation than the patients without diabetes which was reflected by a significantly lower CS value - 1.47+/-1.56 vs 2.03+/-1.81; p < 0.05. No significant relationship was found between CS and age, gender, body mass index, history of MI or the presence of IHD risk factors. There was a significant association between the number of vessels with lesions and CS: r=0.40, p=0.0006 in the control group and r=0.42, p=0.0003 in patients with diabetes. The CS values in patients with single-, two- or three-vessel disease were 1.27+/-1.34, 2.38+/-1.85 and 2.98+/-2.07 in the control group, and 0.70+/-0.90, 1.10+/-1.30 and 2.23+/-1.76 in patients with diabetes, respectively. A multivariate analysis revealed that the presence of diabetes (t=-3.04, p=0.003) and the number of affected vessels (t=5.23, p=0.0001) were independently related to the CS values. CONCLUSIONS: Patients with IHD and diabetes have less developed coronary collateral circulation than IHD patients without diabetes, regardless of the extent of coronary lesions. Patients with diabetes who undergo coronary angiography, have more advanced coronary atherosclerotic lesions than patients without diabetes.

Aged↗
PubMed1996

Relation between preexistent coronary collateral circulation and the incidence of restenosis after successful primary coronary angioplasty for acute myocardial infarction.

OBJECTIVES: The purpose of this study was to test the hypothesis that the incidence of restenosis after primary percutaneous transluminal coronary angioplasty for acute myocardial infarction is largely influenced by the preexistent coronary collateral circulation to the infarct-related coronary artery. BACKGROUND: The occurrence of restenosis after coronary angioplasty is the most serious limitation of this procedure. However, prediction of restenosis is difficult. Severe preexistent stenosis of the infarct-related coronary artery causing the development of collateral circulation may result in a high frequency of restenosis. METHODS: The study group consisted of 152 consecutive patients undergoing primary coronary angioplasty within 12 h after the onset of a first acute myocardial infarction. Of this group, 124 patients were angiographically followed up during the convalescent period of infarction and were classified into two groups according to the extent of preexistent collateral circulation to the infarct-related coronary artery. RESULTS: Restenosis occurred in 26 (38%) of 69 patients with poor or no collateral circulation (group A) in contrast to 35 (64%) of 55 patients with good angiographic collateral circulation (group B, p < 0.005). The frequency of preinfarction angina was significantly lower (p < 0.05) in group A (26% [18 of 69]) than in group B (44% [24 of 55]). CONCLUSIONS: These findings indicate that the presence of well developed collateral circulation to the infarct-related coronary artery predicts a higher frequency of restenosis after primary coronary angioplasty. The difference in restenosis rates observed between the patients with and without good collateral circulation probably reflects the impact of underlying severity of stenosis on the long-term outcome after coronary angioplasty.

Aged↗