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Influence of diabetes mellitus on coronary collateral flow: an answer to an old controversy

Department of Cardiology, University Hospital Bern, Bern, Switzerland

Correspondence to:
Correspondence to:
Professor Christian Seiler
University Hospital Bern, CH-3010 Bern, Switzerland; christian.seiler{at}insel.ch

Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accurate means of collateral flow measurement in a large population with variable degrees of coronary artery disease.

Methods: 200 patients (mean (SD) age 64 (9) years; 100 diabetic and 100 non-diabetic) were enrolled in the study. Coronary collateral flow was assessed in 174 stenotic and in 26 angiographically normal vessels with a pressure guidewire (n = 131), Doppler guidewire (n = 36), or both (n = 33) to calculate pressure or flow velocity derived collateral flow index (CFI). Diabetic patients were perfectly matched with a non-diabetic control group for clinical, haemodynamic, and angiographic parameters.

Results: CFI did not differ between the diabetic and the non-diabetic patients (0.21 (0.12) v 0.19 (0.13), not significant). Likewise, CFI did not differ when only angiographically normal vessels (0.20 (0.09) v 0.15 (0.08), not significant) or chronic total coronary occlusions (0.30 (0.14) v 0.30 (0.17), not significant) were compared. Fewer patients in the diabetic group tended to have angina pectoris during the one minute vessel occlusion (60 diabetic v 69 non-diabetic patients, p = 0.15).

Conclusion: Quantitatively measured coronary CFI did not differ between diabetic and non-diabetic patients with stable coronary artery disease.

Abbreviations: CAD, coronary artery disease; CFI, collateral flow index; CFI_p, pressure derived collateral flow index; CFI_v, velocity derived collateral flow index; CVP, central venous pressure; DM, diabetes mellitus; P_ao, mean aortic pressure; P_occl, distal coronary pressure at the end of a one minute balloon occlusion

Keywords: collateral circulation; diabetes mellitus; angiogenesis; collateral flow index

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