Abstract
The role of collaterals in influencing postischemic recovery after exercise testing has not been investigated previously. We studied 54 patients (mean age 59 ± 6 years) with effort-induced angina and documented coronary disease who underwent exercise testing and thallium-201 myocardial scintigraphy. On angiography, 30 patients (group A) exhibited visible collaterals (grade 2 to 3, Cohen and Rentrop classification) perfusing the ischemic zone, whereas the other 24 (group B) did not. Patients with collaterals had more severe coronary artery disease (Gensini score 46.9 ± 16 vs 28.6 ± 18; p < 0.001) and more severe impairment of coronary flow reserve (time and rate-pressure product to 1 mm ST segment depression 3.5 ± 0.8 vs 4.8 ± 0.6 minutes, p < 0.01; 14189 ± 2451 vs 16081 ± 2215 beats/min × mm Hg, p < 0.04, respectively). However, in these patients the ECG returned to baseline more rapidly after exercise (5.5 ± 1.6 vs 11.7 ± 3.3 minutes; p < 0.001). Therefore, although collaterals do not apparently prevent or delay the development of exercise-induced ischemia, they can limit its duration by allowing a faster recovery.
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