Influence of coronary collaterals on left ventricular function in patients undergoing coronary angioplasty

doi:10.1016/0002-8703(88)90436-X

American Heart Journal

Volume 116, Issue 5, Part 1, November 1988, Pages 1174-1180

https://doi.org/10.1016/0002-8703(88)90436-X Get rights and content

Abstract

The purpose of this study was to determine the role of coronary collaterals on global left ventricular function during transient coronary occlusion. Left ventricular systolic function was evaluated noninvasively in 37 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) by means of peak aortic blood acceleration measured with a continuous-wave Doppler velocity meter placed suprasternally. Doppler measurements were made before, during, and immediately after balloon inflation. Nineteen patients underwent PTCA of the left anterior descending coronary artery, 15 of the right coronary artery, and three of the circumflex coronary artery. All patients had a subtotal coronary occlusion. Among the 37 patients 23 had no angiographic evidence of collaterals supplying the vessel undergoing PTCA and 14 had collaterals. In patients without collaterals peak acceleration was 16.0 ± 3.0 m/sec/sec before balloon occlusion and decreased to 11.8 ± 3.6 m/sec/sec within 30 to 40 seconds of coronary occlusion (p < 0.001). After 30 to 40 seconds of reperfusion (balloon deflated), peak acceleration returned to near-preocclusion levels (17.3 ± 7.5 m/sec/sec). Among patients with collaterals peak acceleration remained unchanged during balloon occlusion and reperfusion relative to preocclusion levels (NS). These data indicate that collaterals can preserve left ventricular function during transient coronary occlusion in humans.

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Acute changes in systolic and diastolic events during clinical coronary angioplasty: A comparison of regional velocity, strain rate, and strain measurement
2002, Journal of the American Society of Echocardiography
Citation Excerpt :
Our study demonstrated that it was possible to detect acute functional changes in both radial and longitudinal direction for 2 different myocardial “at-risk” territories. The impact of collateral circulation on myocardial function and global left ventricular performance has already been well recognized.29,30 It has been also shown that collaterals protect “at-risk” areas during coronary angioplasty of the related artery.35
Ultrasound-derived natural strain rate and strain are new Doppler myocardial imaging (DMI) parameters, which can measure local deformation independently of overall heart motion and thus could better characterize local contractility than DMI velocities alone. This study was undertaken to evaluate the relative benefits of regional velocity, strain rate, and strain measurements in detecting the range of acute changes in regional myocardial function in the “at-risk” zone during coronary angioplasty. Sixty-one patients (aged 63 ± 12, 18 women) with stable angina pectoris were studied before, at the end of, and during recovery from a 60-second percutaneous transluminal coronary angioplasty (PTCA) balloon occlusion. High frame rate (147 fps) color DMI regional velocity data were derived from basal posterior (parasternal view) and mid, apical septal (apical view) “at-risk” segments as well as from the corresponding segments in healthy subjects and analyzed offline for velocity (VEL), strain rate (SR), and strain (ϵ) measurements. Coronary occlusion resulted in the reduction in VEL_SYS, SR_SYS, and ϵ_SYS values for both radial (RCA/CX occlusion) and longitudinal data (LAD occlusion) in all segments analyzed. Velocity parameters alone failed to distinguish between baseline and occlusive measurements in the “at-risk” segments with visually abnormal baseline function. SR_SYS and ϵ_SYS had a higher diagnostic accuracy (sensitivity 75%, 80% and specificity 80%, 82%, respectively) than VEL_SYS velocity alone (sensitivity 68%, specificity 65%,) for identifying acute ischemia in either baseline normal and abnormal segments. DMI-derived indexes can identify and quantify the spectrum of acute systolic and diastolic ischemic changes induced during clinical PTCA. The quantitation of regional deformation rather than motion would appear to be more appropriate in detecting and quantifying acute ischemic changes in myocardial function, especially in segments with pre-existing abnormal function. (J Am Soc Echocardiogr 2002;15:1-12.)
Assessment of myocardial perfusion with contrast echocardiography at rest and with stress: An emerging technology
2000, Progress in Cardiovascular Diseases
Over the past 20 years, there has been considerable progress in the field of myocardial contrast echocardiography (MCE). What began as a modality limited to selected cardiac catherization laboratories may soon become a rapid and accurate bedside tool for assessing myocardial perfusion. Because MCE via intravenous contrast injection can be performed at the bedside and avoids the use of radiation exposure, it offers multiple potential clinical applications, including assessment of reperfusion after fibrinolytic therapy, postinfarction risk area, and myocardial viability. The addition of perfusion data to wall motion may augment the results of stress echocardiography. This report describes the technologic advances in contrast agents and related imaging technologies that enable myocardial perfusion to be assessed by echocardiography. In addition, the latest clinical studies of myocardial perfusion by MCE are presented.
Progress in Cardiovascular Diseases, Vol. 43, No. 3 (November/December), 2000: pp 245-258
Quantification of collateral flow in humans: A comparison of angiographic, electrocardiographic and hemodynamic variables
1999, Journal of the American College of Cardiology
OBJECTIVES
Evaluation of collateral vascular circulation according to hemodynamic variables and its relation to myocardial ischemia.
BACKGROUND
There is limited information regarding the hemodynamic quantification of recruitable collateral vessels.
METHODS
Angiography of the donor coronary artery was performed before and during balloon coronary occlusion in 63 patients with one vessel disease. Patients were divided into groups of those with an absence of collateral vessels (group 1, n = 10), those with recruitable collateral vessels (group 2, n = 23) and those with spontaneously visible collateral vessels (group 3, n = 30). During balloon inflation the coronary wedge/aortic pressure ratio (Pw/Pao) was determined as were collateral blood flow velocity variables, using a 0.014″ Doppler guide wire. Myocardial ischemia was defined as ≥0.1 mV ST-shift on a 12 lead electrocardiogram at 1 min coronary occlusion.
RESULTS
Myocardial ischemia was present in all patients of group 1, in 14 patients of group 2 and in 3 patients of group 3. Recruitable collateral flow without ischemia showed similar hemodynamic values as in group 3 while these values were similar to group 1 in regard to the presence of recruitable collateral vessels showing ischemia. Logistic regression analysis revealed both Pw/Pao and Vi_colas independent predictors for the function of collateral vessels.
CONCLUSIONS
Hemodynamic variables of collateral vascular circulation are better markers of the functional significance of collateral vessels than is coronary angiography. The total collateral blood flow velocity integral and coronary wedge/aortic pressure ratio are good and independent predictors of the function of collateral vessels producing complementary information.
Myocardial contrast echocardiography demonstrates that collateral flow can preserve myocardial function beyond a chronically occluded coronary artery
1996, American Journal of Cardiology
Differential characterization of human coronary collateral blood flow velocity
1996, American Heart Journal
The functional importance and protective nature of the coronary collateral circulation has been well established. There are few data, however, regarding the phasic nature and absolute velocities of collateral flow in patients. The aim of this study was to characterize and quantify ipsilateral coronary collateral blood flow velocity in patients during coronary angioplasty. Coronary collateral flow velocity was measured in 49 patients during coronary angioplasty. Angiographic collateral filling was categorized by the Rentrop grading scale (0 to 3) and by anatomic pathway (epicardial, intramyocardial, or unknown [acutely recruited]). Collateral blood flow velocity was measured with a Doppler-tipped guide wire placed distal to the balloon occlusion in the collateralized vessel. Collateral flow velocity was characterized as predominantly systolic or diastolic, and phasic flow patterns were defined as biphasic (both systolic and diastolic), monophasic (only systolic or diastolic), or bidirectional (antegrade and retrograde velocity). Twenty-three (47%) patients had biphasic flow; 17 (35%) patients had monophasic flow; and 9 (18%) patients had bidirectional flow. Thirty-six (73%) of 49 patients had predominantly systolic flow signals. Epicardial collateral pathways had the highest total flow velocity integral, at 15.0 ± 7.0 (vs intramyocardial [8.4 ± 5.7] and acutely recruitable [5.4 ± 2.1]; p < 0.05). There were no differences in flow velocity integrals among the Rentrop angiographic grades of collateral filling. These data establish three patterns of coronary collateral blood flow and demonstrate that the majority of collateral flow in the ipsilateral receiving vessel occurs during systole. The measurement of coronary collateral flow velocity provides a unique means to study the effects of pharmacologic or mechanical interventions on human collateral blood flow.
The role of the coronary collateral circulation in limiting myocardial ischemia and infarct size
1993, American Heart Journal
The role of coronary collateral circulation in limiting ischemia and infarction has been studied prospectively. Transient occlusion of a coronary artery with transluminal coronary 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.

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^☆: Supported in part by a grant from the United States Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute (R01-HL23669-08) Bethesda, Md.

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Influence of coronary collaterals on left ventricular function in patients undergoing coronary angioplasty☆

Abstract

Am J Cardiol

Am Heart J

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Chest

Am Heart J

Ultrasound Med Biol

Am Heart J

Am J Cardiol

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Am Heart J