Coronary Collateral Circulation In Patients Research Articles

Coronary Collateral Circulation in Patients of Coronary Ectasia with Significant Coronary Artery Disease

ObjectivesPatients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development.MethodsWe evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group.Results73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027) and poorer coronary collateral (58.2% vs 71.2%, p = 0.040). Patients with poor collateral (n = 331) had a higher incidence of CE (15.7% vs 9.5%, p = 0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p = 0.026), CE (OR = 0.544, p = 0.048), and number of diseased vessels (OR = 2.488, p<0.001) were significant predictors of coronary collaterals development.ConclusionThe presence of CE was associated with poorer coronary collateral development in patients with SCAD.

Predictors of Well Developed Coronary Collateral Circulation in Patients with Stable Angina Pectoris

Objective: We aimed to demonstrate the predictors of Coronary Collateral Development (CCD) in patients with Stable Angina Pectoris (SAP). Methods: We prospectively enrolled 52 patients with at least 90% coronary stenosis. Their demographic, anthropometric and clinical data as well as hematological and biochemical parameters, medications, Ejection Fraction (EF) and perfusion index values and angiographic findings were used for determining the predictors for CCD. The Rentrop score (between 0 and 3) was used for the angiographic categorization and patients in Rentrop grades 0 and 1 were classified as poor CCD, and patients in Rentrop grades 2 and 3 were classified as well CCD. Results: We found moderate negative correlation between the Rentrop score and ejection fraction (r=-0,469, p<0.001). There was also positive correlation between the Gensini score (GS) and the Rentrop score (r=0.627, p<0.001). We made Classification and Regression Tree Model (C&RT) to define best predictors of CCD and found that EF (cut off 55%) and GS (cut off 41%) together constitute a useful prediction algorithm. Furthermore an advanced research was conducted to develop another algorithm to forecast coronary collateral development prior to angiography. The analysis was repeated after the extraction of angiographic data from the first C&RT model. It was concluded that EF (cut off 55%) and mean platelet volume (MPV) (cut off 9 fl) can be used in the second algorithm. Conclusions: CCD is negatively related to EF and positively related to GS. EF and MPV together constitute a simple and cost effective algorithm to predict the CCD before the angiography. However, GS and EF seem to be the best predictors of CCD among the whole variables.

Relation of coronary collateral circulation with epicardial fat volume in patients with stable coronary artery disease.

ObjectiveTo investigated the relationship between epicardial fat volume (EFV) and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD).MethodsThe study population consisted of 152 consecutive patients with CAD who underwent coronary angiography and were found to have at least 95% significiant lesion in at least one major coronary artery. EFV was assessed utilizing 64-multislice computed tomography. The patients were classifield into impaired CCC group (Group 1, Rentrop grades 0−1, n = 58), or adequate CCC (Group 2, Rentrop grades 2−3, n = 94).ResultsThe EFV values were significantly higher in paitients with adequate CCC than in those with impaired CCC. In multivariate logistic regression analysis, EFV (OR = 1.059; 95% CI: 1.035−1.085; P = 0.001); and presence of angina were independent predictors of adequate CCC. In receiver-operating characteristic curve analysis, the EFV value > 106.5 mL yielded an area under the curve value of 0.84, with the test sensitivity of 49.3%, and with 98.3% specifity.ConclusionsHigh EFV, and the presence of angina independently predict adequate CCC in patients with stable coronary artery disease. This association offers new diagnostic opportinities to assess collateral flow by conventional ultrasound techniques.

The J-curve relationship between diastolic pressure and coronary collateral circulation in patients with single chronic total occlusion

BackgroundIn our previous study, we had shown that high diastolic blood pressure (DBP) was positively related to well-developed coronary collateral circulation (CCC). This study sought to find out the more precise relationship between DBP and CCC. Methods and resultsTo investigate this, we conducted a study of 671 patients with single chronic total occlusion of coronary artery. The DBP of the patients was divided into six groups: ≤65 mmHg, >65–≤75 mmHg, >75–≤85 mmHg, >85–≤95 mmHg, >95–≤105 mmHg, >105 mmHg). The extent of CCC was graded as poorly-developed or well-developed collaterals according to Rentrop classification. There was a J-curve relationship between the level of DBP and the incidence of poorly-developed collaterals. ConclusionThe relationship between DBP and CCC is similar to the J-curve relationship between DBP and cardiovascular risk. The influence of DBP on the development of CCC may be one of the pathophysiologic mechanisms of the J-curve phenomenon relating DBP to cardiovascular risk.

The Relation of Platelet–Lymphocyte Ratio and Coronary Collateral Circulation in Patients With Stable Angina Pectoris and Chronic Total Occlusion

We aimed to investigate the relationship between the platelet-lymphocyte ratio (PLR) and coronary collateral circulation (CCC) in patients with stable angina pectoris (SAP) and chronic total occlusion (CTO). A total of 294 patients with both SAP and CTO were classified according to their Rentrop collateral grades as either poor (Rentrop grades/0-1) or good (Rentrop grades/2-3). The PLR values were significantly higher in patients with poor CCC than in those with good CCC (156.8 + 30.7 vs 132.1 + 24.4, P < 0.001). In regression analysis, PLR (unit = 10) [odds ratio 1.48, 95% confidence interval (CI) 1.33 -1.65; P < 0.001] and high-sensitivity C-reactive protein were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, optimal cut-off value of PLR to predict poor CCC was found as 138.1, with 76% sensitivity and 65% specificity. PLR may be an important, simple, and cost effective tool predicting the degree of collateralization in patients with SAP and CTO.

The relationship between gamma-glutamyltransferase and coronary collateral circulation in patients with chronic total occlusion

The aim of this study was to evaluate the relation between blood gamma-glutamyltransferase (GGT) levels and coronary collateral circulation in patients with chronic total occlusion (CTO). Two hundred twenty-two patients with chronic stable coronary artery disease (CAD) and CTO were included in this cross-sectional, observational study. Coronary collaterals were graded from 0 to 3 according to the Rentrop method. Patients with grade 0-1 collateral development were regarded as poor collateral group (n=66) while patients with grade 2-3 collateral development were regarded as good collateral group (n=156). Statistical analysis was performed using independent samples t, Mann-Whitney U and Chi-square tests, logistic regression and receiver operator curve analysis. The poor coronary collateral group had significantly higher levels of serum GGT compared to the good collateral group (p<0.001). Multiple logistic regression analysis showed that GGT levels were independent predictors of poor collateral circulation (OR-0.946, 95% CI=0.918-0.9719, p<0.001). The result of ROC curve analysis for GGT was as following: area under the ROC curve (AUC)=0.732, 95% CI: 0.622-0.841, p<0.001. Higher GGT levels are associated with poor coronary collateral circulation in patients with CTO. GGT may be used to predict the grade of coronary collateral circulation in CTO patients with chronic stable CAD.

Association Between Neutrophil/Lymphocyte Ratio and the Development of Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease

PP-262 Several studies have established the important role of CRP in the development of coronary collateral circulation. The correlation between neutrophil/lymphocyte (N/L) ratio and collateral formation in patients with stable coronary artery disease (CAD) has not been reported. We investigated

The Relationship Between Neutrophil-to-Lymphocyte Ratio and Coronary Collateral Circulation

Neutrophil/lymphocyte ratio (NLR) has been proposed as a prognostic marker to determine systemic inflammatory response and atherosclerosis. Our aim was to determine the relationship between NLR and development of coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). A total of 521 consecutive patients with stable CAD who underwent coronary angiography and documented total occlusion in one of those major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell, and NLR were significantly higher in patients with poor collateral than in those with good collateral. After multivariate analysis, high level of NLR was an independent predictor of CCC together with levels of fasting blood glucose. The receiver-operating characteristic analysis provided a cutoff value of 2.75 for NLR to predict poor CCC with 65% sensitivity and 68% specificity. We demonstrated an independent association between levels of NLR and development of CCC in patients with stable CAD.

Association Between Uric Acid and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

Serum uric acid (SUA) levels have been proposed as a biomarker of coronary artery disease (CAD) and coronary collateral circulation (CCC). We investigated the association between SUA levels and development of CCC in patients with stable CAD. Consecutive patients (n = 480) with stable CAD who underwent coronary angiography and documented total occlusion in 1 of the major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell (WBC), creatinine, platelet count, and SUA were significantly higher in patients with poor CCC than in those with good CCC. After multivariate analysis, high levels of SUA were an independent predictor of CCC together with levels of fasting blood glucose and WBC. The receiver-operating characteristic analysis provided a cutoff value of 5.65 mg/dL for SUA to predict poor CCC with 60% sensitivity and 66% specificity. High levels of SUA may be associated with poor CCC in patients with stable CAD.

GW24-e3188 The association between insulin resistance and coronary collateral circulation in patients with impaired glucose tolerance

ObjectivesTo study the relationship between insulin resistance and coronary collateral vessel formation in patients with impaired glucose tolerance.MethodsThis study enrolled 122 patients with impaired glucose tolerance, who underwent coronary angiography....

The relation of serum γ-glutamyl transferase levels and coronary collateral circulation in patients with chronic coronary total occlusion

Sufficient coronary collateral circulation (CCC) protects myocardial tissue against ischemia in patients with coronary chronic total occlusion (CTO). In this study, we aimed to investigate whether there is an association between serum γ-glutamyl transferase (GGT) levels and development of CCC in patients with coronary CTO. A total of 203 patients with CTO at coronary angiography were included in this study. On the day of admission to the hospital, blood samples were taken and GGT levels were analyzed for all patients. Development of collateral circulation was graded according to the Rentrop classification after coronary angiography. Then, patients were divided into two groups on the basis of CCC grades: group 1 included 99 patients (49%) with poorly developed CCC, and group 2 included 104 patients (51%) with well-developed CCC. Patients with poorly developed CCC had significantly higher serum GGT levels compared with those with well-developed CCC, (66.5±16 vs. 51.8±10 U/l, P<0.0001). Correlation analysis showed an inverse correlation between GGT levels and the Rentrope score (r=-0.579, P<0.001). Logistic regression analysis showed that GGT level was an independent predictor of poorly developed CCC (odds ratio 0.92, 95% confidence interval 0.90-0.94; P<0.001). Increased serum GGT levels independently predict poorly developed CCC in patients with coronary CTO. Our results show that GGT is a simple and readily available marker for sufficiency of CCC in patients with CTO.

The Relationship Between Diastolic Pressure and Coronary Collateral Circulation in Patients With Stable Angina Pectoris and Chronic Total Occlusion

The most important biomechanical source of activation of the coronary collateral circulation (CCC) is increased tangential fluid shear stress at the arterial endothelial surface. The coronary circulation is unique in that most coronary blood flow occurs in diastole. Consequently, the diastolic blood pressure (DBP) may influence the tangential fluid shear stress on the arterial endothelial surface in diastole, therebyaffecting development of the CCC. To investigate this, we conducted a study of 222 patients with stable angina pectoris and chronic total occlusion of coronary arteries. All of the patients had no history of coronary artery interventional therapy, coronary artery bypass surgery, cardiomyopathy, or congenital heart disease. The extent of the collateral vasculature of the area perfused by the artery affected by chronic total occlusion was graded as poor or well-developed according to Rentrop's classification. Univariate analysis showed a significant difference between the study subgroup with poorly developed collaterals and that with well-developed collaterals in terms of high diastolic blood pressure (DBP) and mean DBP. Multivariate analysis revealed high DBP as the only independent positive predictor of a well-developed collateral circulation. High DBP is positively related to a well-developed CCC. Differences in development of the CCC may be one of the pathophysiologic mechanisms responsible for the J-curve phenomenon in the relationship between DBP and cardiovascular risk.

Abstract 18332: Clinical Parameters Associated with the Development of the Coronary Collateral Circulation in Patients with a Chronic Total Occlusion

A well-developed collateral circulation provides a survival benefit in patients with obstructive coronary artery disease. Studies aiming to detect clinical parameters associated with collateral circulation show controversial results and have only been assessed in studies using angiographic assessment of the collateral circulation and mainly in patients with non-occlusive lesions. Here we assess the correlation of clinical parameters with intracoronary derived collateral flow index (CFI) a unique group of patients with a chronic total occlusion (CTO) in which was measured directly upon opening of the CTO. Data from 295 patients (Bern, Switzerland, Amsterdam, the Netherlands and Jena, Germany) were pooled. Clinical parameters and lab values were collected before the procedure. CFI was calculated from the occlusive pressure distal from the coronary lesion (Pd), the aortic pressure (Pao) and central venous pressure (CVP). Multivariate analysis was performed to assess the correlation between collateral formation and clinical parameters. The mean CFI was 0.39 ± 0.14. After multivariate analysis, β-blockers, hypertension and duration of AP were positively associated with a well-developed collateral circulation (respectively B=0.07, SE=0.03, p=0.02, B=0.040, SE=0.02, p=0.042 and B=0.001, SE=0.000, p=0.02). Furthermore, high serum leukocytes, prior MI and high diastolic blood pressure were negatively associated with a well-developed collateral circulation (respectively B=-0.01, SE=0.005, p=0.03, B=-0.04, SE=0.02, p=0.03 and B=-0.002, SE=0.001, p=0.011). In a unique cohort of CTO patients we show that high serum leukocytes and high diastolic blood pressure are associated with a poorly developed collateral circulation. Interestingly, the use of β-blockers is positively associated with a well developed collateral circulation, shedding new light on the potential mode of action of this drug in patients with angina pectoris.

Effects of serum uric acid levels on coronary collateral circulation in patients with non-ST elevation acute coronary syndrome

The strong relationship between high level of serum uric acid (UA) and cardiovascular disease has been shown in many studies. In this study, we investigated whether serum UA levels affect coronary collateral circulation (CCC) in patients with non-ST elevation acute coronary syndrome. The study population included 175 patients with non-ST elevation acute coronary syndrome. On the first day of admission to the hospital, blood samples were taken and UA levels were analyzed for all patients. Coronary angiography was performed on patients within 24-72 h. Rentrop collateral classification was performed. Patients were divided into two groups on the basis of UA levels: group I consisted of 102 patients (90 male, 12 female) with normal UA levels and group II consisted of 73 patients (59 male, 14 female) with elevated UA levels. Group 2 had a significantly higher rate of poorly developed CCC and a lower rate of well-developed CCC compared with group 1 (P=0.003 and 0.001, respectively). Patients with poor CCC had significantly higher serum UA levels compared with patients with well-developed CCC (6.5±1.1 vs. 5.5±1.7 mg/dl, P=0.028). Linear regression analyses showed that poor CCC development was significantly associated with serum UA levels (coefficient=0.22, P=0.005). Serum UA level on admission is associated with poor CCC development and may be a useful biomarker for stratification of risk in patients with non-ST elevation acute coronary syndrome.

Determinants of coronary collateral circulation in patients with coronary artery disease

This study aims to identify possible determinants of coronary collaterals in patients with severe coronary artery disease. The current study has a retrospective cohort design. Seventy four patients with ≥90% stenosis or total occlusion of the left anterior descending artery (LAD) were enrolled; coronary collateral grades, high-sensitive C-reactive protein (hs-CRP), fibrinogen, protein C and S, lipids, uric acid levels and medications applied before coronary angiography were noted and compared. Multiple logistic regression analysis was used for the multivariate analyses of independent variables associated with the development of adequate coronary collateral vessels. The presence of coronary collaterals was significantly higher in males (p=0.018), with higher hs-CRP (p=0.023), prior statin use (p=0.022), and higher Gensini scores (p<0.001). In multiple logistic regression analysis, hs-CRP levels (OR=0.94, 95.0% CI=0.883-1.000, p=0.048), male gender (OR=4.73, 95.0% CI=1.441-15.539, p=0.010) and prior statin usage (OR=4.70, 95.0% CI=1.264-17.452, p=0.021) were identified as independent predictors of coronary collateral development. Male gender, prior statin usage, and higher hs-CRP levels are determinants of coronary collaterals in patients with coronary artery disease.

The Relationship Between High-Density Lipoprotein Cholesterol and Coronary Collateral Circulation in Patients With Coronary Artery Disease

IntroductionHigh-density lipoprotein cholesterol (HDL-C) promotes cholesterol efflux from macrophage foam cells in atheroma plaques. In addition, HDL-C has anti-inflammatory and endothelium-protective properties. Despite that the only prerequisite for collateral development...

Response to Mildly Decreased Glomerular Filtration Rate Is Associated With Poor Coronary Collateral Circulation in Patients With Coronary Artery Disease

Response to Mildly Decreased Glomerular Filtration Rate Is Associated With Poor Coronary Collateral Circulation in Patients With Coronary Artery Disease

Angiotensin-Converting Enzyme DD Polymorphism Is Associated With Poor Coronary Collateral Circulation in Patients With Coronary Artery Disease

ObjectivesAlthough association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported by many studies, the relation between ACE I/D polymorphism and coronary collateral circulation (CCC) has not...

Assessment of Coronary Collateral Circulation in Patients with Chronic Total Occlusion: The Functional Relevance and Estimate the Quality of the Distal Run-offs

Background: The purpose of this article is to investigate the functional relevance of coronary collateral circulation and estimate the quality of the distal run-offs in patients with coronary chronic total occlusion (CTO). Methods: We analyzed the 267 consecutive patients who underwent PCI for CTO. In 119 patients, the distal portion of total occlusion was filled with ipsilateral collateral connections (ipsilateral group), and in 103 patients, it was filled with contralateral collateral connections (contralateral group). The target vessel diameter and dilatation rates of the groups were evaluated and compared for the echocardiographic parameters. Results: The principal finding in this study is that mean value of the target vessel diameter beyond occlusion was significant higher in the contralateral group than in the ipsilateral group (p<0.05). The LVEF values before PCI in the contralateral group were significantly higher than in the ipsilateral group. However, Increase in LVEF after PCI were significantly higher in the ipsilateral group than contralateral group (p<0.05). Conclusion: Our study results concerning contralateral circulation in patients with CTO have shown less negative vessel remodelling after CTO. We also showed that the increases of LVEF after PCI, the ipsilateral group had significant increases compared with the contralateral group.

Mildly Decreased Glomerular Filtration Rate Is Associated With Poor Coronary Collateral Circulation in Patients With Coronary Artery Disease

The aim of this study was to evaluate the association between mildly decreased glomerular filtration rate (GFR) and coronary collateral circulation (CCC). There would be an association between mildly decreased GFR and CCC. Patients who had an occlusion in at least 1 major coronary artery were included in this study. Patients with severely and moderately decreased GFR were excluded. Patient data were obtained from their files. To classify CCC, we used the Rentrop classification. Patients were classified as having poor CCC (Rentrop grades 0 to 1) or good CCC (Rentrop grades 2 to 3). We used the Modification of Diet in Renal Disease (MDRD) equation to calculate GFR. Mildly decreased GFR was defined as 60 mL/min per 1.73 m(2) ≥ eGFR ≤89 mL/min per 1.73 m(2) according to the MDRD definition. Multivariate logistic regression analysis was performed to determine independent variables. The study group consisted of 299 patients. Ninety-three patients had poor CCC and 206 patients had good CCC. The frequency of mildly decreased GFR was higher in the poor CCC group than in the good CCC group (P<0.001). Also, the frequency of diabetes and dyslipidemia, and the plasma high sensitive C-reactive protein levels, were higher in the poor CCC group (P = 0.003, P = 0.018, P<0.001, respectively). Logistic regression analysis revealed that eGFR is an independent predictor of CCC (B = 1.68; odds ratio = 5.4; P<0.001; 95% confidence interval, 3.1-9.4). We found that CCC was worse in patients with mildly decreased GFR compared to patients with normal GFR in patients with coronary artery disease.