Coronary Collateral Circulation Formation Research Articles

Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion.

Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non-ST segment elevation myocardial infarction.

Uric acid/albumin ratio (UAR) is a novel composite biomarker with superior predictive value for cardiovascular disease. To investigate the relationship between UAR and coronary collateral circulation (CCC) in patients with non-ST segment elevation myocardial infarction (NSTEMI). A total of 205 NSTEMI patients who underwent coronary arteriography with at least one major coronary stenosis, 95% were included. Patients were divided into two groups according to CCC development: poorly-developed CCC group (Rentrop 0-1) and well-developed CCC (Rentrop 2-3). Univariate analysis and logistic regression analysis were utilized to investigate the factors influencing adverse CCC formation in NSTEMI patients. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of UAR, C-reactive protein (CRP), uric acid, and albumin for patients with poorly developed CCC, and the area under the curve (AUC) was compared. The UAR values of NSTEMI patients were significantly higher in the poorly developed CCC group than those in the well-developed CCC group (10.19 [8.80-11.74] vs. 7.79 [6.28-9.55], p < .001). In the multiple logistic regression tests, UAR (odds ratio [OR]: 1.365, 95% confidence interval [CI]: 1.195-1.560, p < .001), CRP (OR: 1.149, 95% CI: 1.072-1.231, p < .001), and diabetes (OR: 2.924, 95% CI: 1.444-5.920, p = .003) were independent predictors of poorly developed CCC. The ROC curve analysis showed that the optimal cut-off value of UAR was 8.78 in predicting poorly developed CCC with a sensitivity of 76.8% and specificity of 62.4%, with the AUC of 0.737 (95% Cl: 0.668-0.805, p < .001). Elevated UAR may be an independent and effective biomarker for predicting poorly-developed CCC development in NSTEMI patients.

The Atherogenic Index of Plasma is a Predictor for Chronic Total Occlusion and Coronary Collateral Circulation Formation in CTOs Patients

The Atherogenic Index of Plasma is a Predictor for Chronic Total Occlusion and Coronary Collateral Circulation Formation in CTOs Patients

Are Thiols Useful Biomarkers for Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease?

Our aim was to investigate the relationship between thiol, which is the main component of the antioxidant system, and coronary collateral circulation (CCC). Our patients consisted of people with stable coronary artery disease (sCAD) and total occlusion in at least one vessel (n = 249). We divided the patients into two groups, good and poor, according to their CCC degree. We determined that DM, total thiol, and disulfide are independent predictors of poor CCC in multivariate logistic regression analysis (OR: 1.012, 95% CI: 1.008-1.017, p < 0.001; OR: 1.022, 95% CI: 1.000-1.044, p = 0.044; OR: 2.671, 95% CI: 1.238-5.761, p = 0.012, respectively). The ROC analysis showed a cut-off value of 328.7 for native thiol regarding the prediction of poor CCC, with 67.4% specificity and 78% sensitivity. For disulfide, it revealed a cut-off value of 15.1 regarding the prediction of poor CCC, with 57.9% specificity and 69.5% sensitivity. In this study, we detected that the patients with sCAD who developed poor CCC had lower levels of native thiol, total thiol, and disulfide compared to those with good CCC. The most interesting finding of our study is that CCC formation is an effective predictor of the antioxidant cascade rather than the inflammation cascade in sCAD patients.

The relationship between mean platelet volume lymphocyte ratio and collateral circulation in patients with chronic total coronary occlusion.

To correlate mean platelet volume lymphocyte ratio (MPVLR) and coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO). A total of 643 patients who were hospitalized at a single large academic medical center from January 2020 to October 2021 and had CTO lesions in at least one major coronary artery confirmed by coronary angiography were retrospectively analyzed. Patients were divided according to the Rentrop criteria into poorly formed CCC (Rentrop grade 0-1, n = 235) and well-formed CCC (Rentrop grade 2-3, n = 408) groups. Mean platelet volume lymphocyte ratio (MPVLR) was calculated from routine laboratory data (MPV divided by lymphocyte count). The clinical data of the two groups were compared, and relationships between MPVLR and CCC formation were analyzed. The MPVLR of patients with poorly formed CCC was significantly higher than that of patients with well-formed CCC (7.82 ± 3.80 vs. 4.84 ± 1.42, P < 0.01). The prevalence of diabetes mellitus and C-reactive protein levels were significantly higher in the poor CCC group than in the good CCC group (P < 0.01), while the proportions of patients with CTO or multivessel lesions in the right coronary artery were significantly lower in the poor CCC group than in the good CCC group (P < 0.01). Multivariate logistic regression analysis identified MPVLR (OR: 2.101, 95% CI: 1.840-2.399, P < 0.01), C-reactive protein level (OR: 1.036, 95% CI: 1.008-1.064, P < 0.05), a history of diabetes mellitus (OR: 2.355, 95% CI: 1.532-3.621, P < 0.01), and right coronary CTO ratio (OR: 0.313, 95% CI: 0.202-0.485, P < 0.01) as independent risk factors for CCC formation. The area under the ROC curve of MPVLR for predicting poorly formed CCC was 0.82 (95% CI: 0.784-0.855, P < 0.01), the best cut-off point was 6.02 and the sensitivity and specificity of MPVLR for predicting poorly formed CCC were 72.3 and 82.4%, respectively. In patients with coronary CTO, MPVLR was negatively correlated with CCC and a high MPVLR level was an independent predictor of poorly formed CCC.

Correlation between serum uric acid and coronary collateral circulation in patients with coronary chronic total occlusion

Background and purpose: Previous studies showed urate crystals in atherosclerotic plaques, suggesting that uric acid is involved in plaque formation, but whether it affects the formation of coronary collateral circulation (CCC) is unknown. This single-center retrospective study was conducted to investigate whether serum uric acid (SUA) level has an association with the CCC in patients with coronary chronic total occlusion (CTO). Methods: The final analysis included a total of 94 patients with CTO (defined as 100% stenosis in at least one of the left anterior descending artery, circumflex artery and right coronary artery with thrombolysis in myocardial infarction [TIMI] grade 0 of forward flow) for more than 3 months (66.03 ± 10.10 years of age; 54 men and 40 women). In the analysis, patients were divided into four groups of equal size based on the SUA level on admission (n = 32, 31, 31 for low, mid, and high SUA groups). Multivariate logistic regression was conducted to identify risk factors that were associated with poor CCC (as defined by Rentrop level ≤ 1). Results: The rate of poor CCC was 44.5% in the low SUA group, 54.8% in the mid-SUA group, and 77.4% in the high SUA group, respectively (P &lt; 0.05 for all three pairwise comparisons). In multivariate regression analysis that treated SUA as a continuous variable, poorer CCC was associated with higher SUA (adjusted odds ratio [OR] = 1.011, 95% confidence interval [CI]: 1.005–1.017, P &lt; 0.05). In comparison to the patients with lowest SUA in the regression analysis that treated SUA as a categorical variable, there was a statistically non-significant trend for increased risk of poor CCC (OR 2.277, 95% CI: 0.753–6.884) in the patient with mid-level SUA. The risk of poor CCC was significantly elevated in the patients with high SUA (OR 6.243, 95% CI: 1.872–20.828). Conclusions: Elevated SUA level was associated with poor CCC in patients with CTO.

Serum CTRP9 Reflects Coronary Collateralization in Nondiabetic Patients with Obstructive Coronary Artery Disease

Aim To explore the association between the serum C1q/tumor necrosis factor-related protein 9 (CTRP9) and the formation of coronary collateral circulation in obstructive coronary artery disease (CAD). Methods A total of 206 patients who underwent coronary angiography at Beijing Anzhen Hospital and had epicardial arteries with at least 95% stenotic lesion were enrolled. Blood samples were taken after an overnight fasting before the coronary angiography. Serum CTRP9 level was measured using commercial enzyme linked immunosorbent assay (ELISA) kit. The development of coronary collateralization was determined according to the Rentrop classification system. Rentrop score 0-1 was graded as impaired or less-developed coronary collateralization (n = 54) while the Rentrop score 2-3 was defined as well-developed collateralization (n = 152). Results Serum CTRP9 level was significantly higher in well-developed collateralization and diabetes groups (P < 0.001). To further explore the association between the CTRP9 level and coronary collateralization, the enrolled participants were divided into 3 tertiles according to the serum CTRP9 level. The prevalence of impaired coronary collateralization decreased stepwise with the increasing CTRP9 tertiles (P for trend <0.001). Multivariate regression analysis showed that the serum CTRP9 is independently associated with well-developed collateralization, with an OR (95% CI) of 4.49 (1.75-11.55) and 8.98 (2.75-29.35) in the tertiles 2 and 3, respectively. The following subgroup and receiver-operating characteristic (ROC) analysis also indicated that the diagnostic value of serum CTRP9 level for detecting the formation of collateralization persisted only in nondiabetic participants. Lastly, adding the serum CTRP9 into the baseline model could increase the diagnostic value of established model consisting of relevant factor for the discrimination of well-developed collateralization only in the nondiabetic group (P = 0.046). Conclusions Serum CTRP9 reflects well-developed coronary collateralization in nondiabetic patients with obstructive CAD, and CTRP9 level ≥ 1.217 indicated a greater chance to forming well-developed coronary collaterals.

Correlation between Increased Serum Vascular Endothelial Growth Factor Levels and 30-Day-Outcome After Acute Myocardial Infarction

Vascular Endothelial Growth Factor (VEGF) plays an important role in the process of regeneration and vascular repair. Atherogenesis and angiogenesis contribute to the formation of coronary collateral circulation as an alternative source of blood supply during the repairing process of Acute Myocardial Infarction (AMI). This study aimed to investigate the elevation of VEGF and its correlation to Peripheral Blood Mononuclear Cells (PBMC) and Major Adverse Cardiovascular st nd th Events (MACE). Serum VEGF measurements were carried out on 1 , 2 , and the 5 -day onset of angina on 20 patients using st th Chemwell Analyzer based on ELISA method. PBMC was counted on days 1 and 5 according to CBC results from Automatic Cell Counter Sysmex XN-1000i. The major adverse cardiovascular event was recorded 30 days after AMI onset. It was found nd that serum VEGF level in this study was 169.3±34.5 pg/mL on the 1st day, 217.0±49.7 pg/mL on the 2 day, and th th 249.2±48.5 pg/mL on the 5 day. Serum VEGF levels increased gradually and the highest value was found on the 5 day st (p=0.000). There was no correlation between elevated serum VEGF levels with PBMC on the 1 day (p=0.429, r=-0.035) and th the 5 day of AMI (p=0.225, r=+0.081). There was no correlation between elevated serum VEGF levels with incidence of MACE on 30 days after onset of AMI (OR=0.959, 95% CI, p=0.302). Serum VEGF concentrations are increased in Acute Myocardial Infarction and can be used as a marker of myocardial injury. However, this study was unable to prove its role in the outcome of AMI

Non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio serve as a predictor for coronary collateral circulation in chronic total occlusive patients

ObjectiveThe present study investigated the potential correlation between non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (non-HDL-C/HDL) and the formation of coronary collateral circulation (CCC) in coronary artery disease cases with chronic total occlusive (CTO) lesions.MethodsTwo experienced cardiologists identified and selected patients with CTO lesions for retrospective analysis. The 353 patients were divided into a CCC poor formation group (Rentrop 0–1 grade, n = 209) and a CCC good formation group (Rentrop 2–3 grade, n = 144) based on the Cohen-Rentrop standard. A comparison of non-HDL-C/HDL ratios between the two groups was performed. The Spearman test was used to obtain the correlation between the cholesterol ratio and Rentrop grade. Independent predictors of CCC were analyzed using logistic regression. Receiver operating characteristic (ROC) curve analysis was also performed to quantify the predictive value of research indicator.ResultsThe non-HDL-C/HDL ratio in the CCC poor formation group was elevated markedly compared to the CCC good formation group [( 3.86 ± 1.40) vs ( 3.31 ± 1.22), P = 0.000]. The Spearman test results indicated that non-HDL-C/HDL negatively correlated with Rentrop grade (r = − 0.115, P = 0.030). Multivariate logistic regression analysis showed that non-HDL-C/HDL ratio was an independent predictor of CCC formation (OR = 1.195, 95%CI = 1.020–1.400, P = 0.027). The area under the curve of ROC for detecting CCC poor formation was 0.611 (95% CI: 0.551–0.671, P = 0.000) with an optimal cut-off value of 2.77.ConclusionNon-HDL-C/HDL negatively correlated with the formation of CCC and served as an independent predictor of CCC formation, which may be used as a biomarker for the evaluation of CCC.

Correlation between ischemia-modified albumin level and coronary collateral circulation

ObjectiveTo investigate the correlation between ischemia-modified albumin (IMA) levels and coronary collateral circulation (CCC) in patients with chronic total occlusive (CTO).MethodsCoronary angiography was performed in the Department of Cardiology, Zhongnan Hospital of Wuhan University from 2017 to 08 to 2019–02 to identify 128 patients with CTO lesions in at least one major coronary artery. According to the Rentrop evaluation criteria, the degree of CCC formation was divided into the poor CCC formation group (Rentrop0–1 grade,n = 69) and the good CCC formation group (Rentrop2–3 grade,n = 59). The IMA level of the patients was measured using an albumin-cobalt binding assay. The general data, routine blood panel, total bilirubin (TBIL), blood lipids, uric acid (UA), left ventricular ejection fraction (LVEF) and other indicators of the patients were recorded and analyzed while assessing the patients’ blood vessel occlusion.ResultsThe proportion of platelet count and diabetes in the poor CCC group was higher than that in the good CCC group (P < 0.05). The ratio of ischemia-modified albumin and total bilirubin in the poor CCC group was lower than that in the good CCC group (P < 0.05). Multivariate logistic regression analysis showed that ischemia-modified albumin was positively correlated with CCC formation [OR = 1.190,95% CI (1.092–1.297),P < 0.001], while diabetes was negatively correlated with CCC formation [OR = 0.285,95% CI (0.094–0.864), P < 0.05]. Ischemic modified albumin predicted good formation of CCC according to the ROC curve, and the area under the ROC curve was 0.769(95% CI,0.686–0.851, P<0.001); the optimal cut-off value was 63.35 KU/L, and the sensitivity was 71.2%,specificity is 71%.ConclusionThe IMA level is closely related to good formation of CCC. Higher IMA levels can be used as an effective predictor of good CCC formation in patients with CTO.

The preservation effect of coronary collateral circulation on left ventricular function in chronic total occlusion and its association with the expression of vascular endothelial growth factor A.

Patients with coronary chronic total occlusion (CTO) typically have collateralization of the distal vessel, and these collaterals can contribute to the relief of ischemia and anginal symptoms and to the preservation of ventricular function. To investigate the preservation effect of coronary collateral circulation on left ventricular (LV) function in coronary CTO, and to explore the potential mechanism behind the development of coronary collateral circulation. A total of 102 consecutive patients with coronary CTO were divided into 2 groups: the left ventricular ejection fraction (LVEF)-preserved group (LVEF ≥ 50%; n = 46) and the LVEF-decreased group (LVEF < 50%; n = 56). Clinical, angiographic and laboratory data was collected for all patients. The association between LVEF and coronary collateral circulation in coronary CTO patients was analyzed with multivariate logistic regression analysis, and the serum levels of VEGF-A and the mRNA expression levels of the VEGF-A gene were compared between different grades of coronary collateral circulation. Multivariate analysis revealed that Rentrop grades 2-3 and coexisting collateral pathways were independent predictors of LVEF preservation in coronary CTO patients. Patients with Rentrop grades 2-3 had smaller left ventricular end diastolic diameters (LVDd) and left ventricular end systolic diameters (LVSd), and they had larger LVEFs than the patients with Rentrop grades 0-1. Patients with Rentrop grades 2-3 also had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in their peripheral blood mononuclear cells (PBMCs) than patients with Rentrop grades 0-1. Patients with coexisting collateral pathways had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in PBMCs than patients without coexisting collateral pathways. Coronary collateral circulation is significantly associated with LVEF preservation, and VEGF-A might promote the formation of coronary collateral circulation.

The relationship of plasma miR-503 and coronary collateral circulation in patients with coronary artery disease

ObjectiveAlthough angiogenesis plays an important role in coronary collateral circulation (CCC) formation and there are many determinants of coronary angiogenesis, they cannot fully explain the mechanism of CCC formation or as potent biomarker for CCC status. Therefore, there is of great clinical significance to identify the novel molecules associated with CCC. Previously, miR-503 exerts anti-angiogenesis effect via inhibition of VEGF-A and its expression is associated with many angiogenesis-related factors. Thus, we aimed to investigate the relationship of plasma miR-503 with CCC formation as well as its predictive power for CCC status in patients with coronary artery disease. MethodsAmong patients who underwent coronary angiography with coronary artery disease and a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrop Cohen classification. The patients were divided to good CCC group (grade 2 or 3) and poor CCC group (grade 0 or 1) according to Rentrop grade. We investigated the plasma levels of miR-503 and VEGF-A by ELISA or q RT-PCR, respectively. In addition, we assayed the correlations of plasma miR-503 with VEGF-A or Rentrop grade using the spearman correlation test and its predictive power by receiver operating characteristic (ROC) and binary logistical regression analysis. ResultsOur data showed that plasma VEGF-A was significantly higher in good CCC group than that in poor group. Plasma miR-503 was lower in CAD patients with good CCC or poor CCC compared with control subjects and lowest in good CCC group. In addition, miR-503 negatively correlated with VEGF-A and Rentrop grade, respectively. Moreover, miR-503 displayed more potent predictive power for CCC status than VEGF-A, but its sensitivity and specificity for CCC status were only 72.4 or 60.9%, respectively. ConclusionsLower plasma miR-503 level was related to better CCC formation, accompanied by up-regulation of VEGF-A. In addition, miR-503 displayed potent predictive power for CCC status, but its sensitivity and specificity were not high enough, indicating that miR-503 might be as an additional prognosis biomarker for CCC.

The relationship of plasma decoy receptor 3 and coronary collateral circulation in patients with coronary artery disease

ObjectivePreviously, decoy receptor 3 (DcR3) was found to be a potential angiogenetic factor, while the relationship of DcR3 with coronary collateral circulation formation has not been investigated. In this study, we aimed to investigate whether plasma decoy receptor 3 levels was associated with CCC formation and evaluate its predictive power for CCC status in patients with coronary artery disease. MethodsAmong patients who underwent coronary angiography with coronary artery disease and had a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrope Cohen classification. Patients with grade 2 or 3 collateral degree were enrolled in good CCC group and patients with grade 0 or 1 collateral degree were enrolled in poor CCC group. ResultsPlasma DcR3 level was significantly higher in good CCC group (328.00±230.82 vs 194.84±130.63ng/l, p<0.01) and positively correlated with Rentrope grade (p<0.01). In addition, plasma DcR3 was also positively correlated with VEGF-A. Both ROC (receiver operating characteristic curve) and multinomial logistical regression analysis showed that plasma DcR3 displayed potent predictive power for CCC status. ConclusionsHigher plasma DcR3 level was related to better CCC formation and displayed potent predictive power for CCC status.

Dendritic cells and coronary collateral circulation in coronary heart disease

To determine the relationship between the number,phenotype and functional status of dendritic cells (DCs) and coronary collateral circulation (CCC) in coronary heart disease (CHD). Forty patients with severe coronary stenosis were recruited and divided into a CCC formation group (Group A, n=22) and a non-CCC formation group (Group B, n=18). Density gradient centrifugation was applied to separate the mononuclear cells (MNCs) from coronary artery blood samples, and MNCs were cultured and proliferated in vitro. The morphology of DCs was observed under converted microscope. The number of harvested cells and DCs was counted by hematocytometer. Flow cytometry was applied to investigate the phenotype and the mean fluorescence intensity (MFI). Mixed lymphocyte reaction was used to test the function of DCs to stimulate the proliferation of T lymphocytes. Stimulation index (SI) was calculated and compared. (1) After in vitro proliferation, DCs were cultured successfully from the mononuclear cells from coronary artery blood samples and the morphology of DCs was not different in the 2 groups. (2) The number of mononuclear cells (MNC no) was (3.95+/-1.41)*10(6), in the CCC group and (2.76+/-0.92)*10(6) in the non-CCC group. The MNC number was significantly increased in the CCC group (P=0.003). (3) The number of DCs was (1.54+/-0.96)*10(6) in the CCC group, and (0.99+/-0.46)*10(6) in the non-CCC group (P=0.033). (4)There was no statistical significance in the percent of CD1a+, CD1a+CD80+, CD1a+CD83+, CD1a+CD86+ cells, and MFI in the 2 groups (P>0.05). (5) SI was 4.96+/-2.30 in the CCC group, whereas 2.66+/-1.04 in the non-CCC group. The SI in the CCC group increased significantly(P=0.0003). In CHD patients with severe coronary stenosis, patients with CCC formation have higher number of DCs and stronger potential of T lymphocyte stimulation.

Prognostic relevance of coronary collateral circulation: Clinical and epidemiological implications

Coronary collateral circulation provides an important response to ischemic heart disease and partially determines the severity of ischemic myocardial damage. Practical significance of coronary collateral circulation has long been a matter of uncertainty due to concerns about the means for gauging coronary collateral circulation and the modest populations to be representative for all patients with ischemic heart disease. It is possible that prognosis may be defined by the balance between the harm of atherosclerotic burden, and the benefit from coronary collateral circulation. Atherosclerosis acts as a potent trigger for the formation of coronary collateral circulation, but at the same time it has deleterious effects on cardiovascular morbidity and mortality. Coronary collateral circulation has a complex role in modifying the risk of cardiovascular morbidity and mortality in ischemic heart disease. A more comprehensive insight into the exact determinants of coronary collateral circulation would help establish its potential implications in clinical and epidemiological realm.

Restrictive effect of puerarin on myocardial infarct area in dogs and its possible mechanism.

To evaluate the protective effect of puerarin on ischemic myocardium in dogs with acute myocardial infarction (AMI) and to reveal its possible mechanism, 10 dogs were randomly divided into puerarin group (group G) and control group (group C). AMI model was established in all dogs. Puerarin or saline was administered over a period of 21 days. Coronary angiography was performed before and after ligation of coronary artery. Eight hemorheological parameters were examined before and 22 days after the operation. The infarct area and vessel density of myocardium were assessed. The infarct area in group G was smaller than that in group C. Angiography 2 h and 22 d after ligation of coronary artery revealed significant augmentation of collateral vessels in group G as compared with control group. The platelet aggregation and the blood viscosity were increased during AMI when compared with control phase, and the increased indexes during AMI would be inhibited when puerarin were given. Capillaries and distribution vessel density in ischemic zone on day 22 showed statistically significant augmentation in group G as compared with control group. Puerarin might improve the opening and formation of coronary collateral circulation, and might inhibit the increase of platelet aggregation and the blood viscosity during AMI, and thereby improve microcirculation and restrict myocardial infarct area.

Effect of Salvia Miltiorrhiza on coronary collateral circulation in dogs with experimental acute myocardial infarction.

To evaluate the effect of Salvia Miltiorrhiza on coronary collateral circulation in dogs with experimental acute myocardial infarction, 12 dogs were randomly divided into Salvia Miltiorrhiza group (group D) and control group (group C). Acute myocardial infarction model was established in all dogs, Salvia Miltiorrhiza or saline was administered to the 2 groups respectively for 21 days. Coronary angiography was performed before and after ligation of coronary artery. The capillaries and distribution vessel density in tissue sections of myocardia were assessed. Angiography 2 h and 22 days after ligation of coronary artery revealed significant augmentation of collateral vessels, and capillaries and distribution vessel density in ischemic zone on day 22 showed statistically significant augmentation in group D as compared with that of controls (P < 0.05 and P < 0.01). It is concluded that Salvia Miltiorrhiza might improve the opening and formation of coronary collateral circulation of ischemic myocardia in dogs and thereby protecting myocardia from ischemia.

CLINICAL STUDY OF VARIANT FORM OF ANGINA PECTORIS

Twenty eight cases of variant form of angina pectoris, included 27 males and 1 female were studied during a 10 years period. The age of onset of symptoms were 44 to 73 years old with average of 58. 1. Onset of angina usually occurred during rest at night, 25 out of 28 patients were attacked between 1 : 00 AM to 8 : 00 AM. Usually, the attack was in cyclic fashion, 4 to 15 episodes and each episode lasts for 2 to 10 minutes in duration. 2. As the anginal pain is over, the patient remain well and free of pain in rest at night and day time. 3. There was no significant variation of blood pressure between attack and after anginal episodes. Eight out of 15 patients showed slightly decreased in the blood pressure during anginal pain. 4. ECG study showed that 6 patients had involvement of the left coronary; 21, the right coronary artery and 1, both arteries. 5. In 11 cases ST segment elevation could occur by two step exercise test, this is different to the preliminary report of Prinzmetal et al. 6. Arrhythmias and conductive disturbance occurred in 10 out of 28 patients (35.7%) complete A-V block with VPCs in 2, VPCs only in 5, atrial fibrillation in 2, Wenckebach type A-V block in one and RBBB in one. 7. Twenty two out of 28 patients were placed on physical training program, and thus the frequency of anginal attacks were decreased and its physical capacity reached to significantly more than before in one to two months from admission. 8. One patient had left and right coronary cineangiograms, which showed slight narrowing of anterior descending branch, poor distal run-off on left circumflex branch and stagnation of dye on apex. The right coronary artery was almost normal. 9. In the follow-up study, out of 23 patients observed from 4 months to 10 years, only 3 patients died, one due to Hodgkin's disease, one expired suddenly on 10 years later from another anginal attack. Only one patient developed into myocardial infarction on the third hospital day, and expired, autopsy was performed. In histopathological findings of the autopsy case, the left coronary artery showed intimal thickening and narrowing of the vessel lumen by about 75 % with calcification. The right coronary artery showed severe calcification and stenosis of the entire lumen. 10. Nitroglycerin or isosobide dinitrate during acute attack is much more effective, although β-blockade may play an some role to prevent and reduce the frequency of attack. 11. The effect of anticoagulant therapy can not be predicted. 12. Good exercise capacity was preserved in variant form of angina. Exercise may improve the formation of coronary collateral circulation, and normalization of unbalanced autonomic nervous system. 13. The most important coronary risk factor seems to be hypertension, however, the incidence of hypertension at admission is low. The mechanism which decreased spontaneously the blood pressure in patients with variant angina is not clear, but it is speculated that this mechanism might be responsible to play a role to produce the attack of variant angina.