Coronary Collaterals Research Articles

Is There Any Correlation Between The Grade of Coronary Collaterals and Vitamin D Levels In Patients with Coronary Chronic Total Occlusion?

Objective: There have been studies which revealed a possible relation with the grade of coronary collateral circulation (CCC) and the level of Vitamin D in the literature. The objective of this study was to assess whether there is a correlation between the grade of CCC and the level of Vitamin D according to both Rentrop and Werner classifications in patients with coronary chronic total occlusion (CTO) who underwent percutaneous coronary intervention. Material-Method: The present study is a single-centre, retrospective cohort study. A total of 101 consecutive patients, who were hospitalized to undergo coronary CTO procedure, were enrolled in the study. The patients were classified into 3 groups with regard to the grade of CCC according to both Rentrop and Werner classifications. These groups were compared with each other according to the 25(OH)VitD3 levels. Results: There was no significant difference among 3 groups with regard to 25(OH)VitD3 levels when the patients were classified according to the Rentrop classification [Rentrop 1: 15.7 ng/ml (7.0-77.0 ng/ml), Rentrop 2: 16.9 ng/ml (7.0-71.3), Rentrop 3: 16.6 ng/ml (7.0-28.7), p=0.925]. Moreover, there was no significant difference among 3 groups with regard to 25(OH)VitD3 levels when the patients were classified according to the Werner classification. [Werner 0: 19.6 ng/ml (7.0-77.0 ng/ml), Werner 1: 16.6 ng/ml (7.0-71.3), Werner 2: 17.0 ng/ml (7.0-28.3), p=0.411]. Conclusion: We deem that there may not be a direct correlation (one-to-one relationship) between the level of 25(OH)VitD3 and the grade of CCC in clinical practice.

Association between Vascular Endothelial Growth Factor Plasma Levels and rs699947 Polymorphism and Coronary Collateral Vessel Formation

Background: The vascular endothelial growth factor (VEGF), as an angiogenic cytokine, binds endothelial cell receptors and stimulates angiogenesis and collateral formation. We evaluated the association between VEGF plasma levels and the gene polymorphism rs699947 and the formation of coronary collaterals in patients with coronary artery disease. Methods: A total of 195 patients with ≥70% narrowing in at least 1 coronary vessel (according to coronary angiography) were included in the study. The presence of the rs699947 polymorphism within the promoter of the VEGF gene was investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The plasma VEGF concentration was quantified via the ELISA method. The Rentrop method was used to grade the extent of collateral development. Results: There was no significant difference in VEGF levels between the groups with good and poor collaterals. The frequency of the A allele of rs699947 was found to be higher in the patients with good collaterals than in those with poor collaterals (P=0.014). The odds ratio of good collaterals for AA was 2.67 (P=0.025) when compared with the CC genotype. Further, our additive model revealed an association between the rs699947 polymorphism and collateral formation (OR: 1.96, 95% CI: 1.05-3.65, P=0.033). Conclusion: The rs699947 polymorphism might be a novel genetic factor affecting collateral development in Iranian patients with coronary artery disease.

Spontaneous coronary collateral recruitment in patients with recurrent ST elevation myocardial infarction (STEMI).

The spontaneous recruitment of acute coronary collaterals in the setting of an ST elevation myocardial infarction (STEMI) is seen frequently in those patients undergoing primary percutaneous coronary intervention (pPCI) and is associated with improved clinical outcomes. However, it is unknown whether in patients who present with a recurrent STEMI, the degree of collateral recruitment remains the same as in the index procedure. We reviewed all patients presenting to our tertiary centre with a STEMI undergoing primary or rescue percutaneous coronary intervention (PCI) from July 2010 until December 2018. We identified patients who presented with a recurrent STEMI following their index procedure. We defined patients with poor collateral recruitment as Rentrop grade 0 or 1, whilst patients with robust collateral recruitment as Rentrop grade 2 or 3. Of the 1795 patients who were identified, there were 27 cases in 25 patients who presented with a repeat STEMI following their index procedure. The median time between cases was 12.8days (IQR 2.3-589.5days). Compared to the index case, there was no statistically significant difference in the degree of collateral recruitment in recurrent presentations (Z = -0.378, p = 0.70). In those patients presenting more than 6months following the index procedure, the median time between cases was 654.5days (IQR 479.5-1151.9). There was no difference in the degree of collateral recruitment in recurrent presentations (Z = 0.000, p = 1.0). Cases which had poorer collateral recruitment in recurrent presentations were less likely to be current smokers (0% vs 50%, p < 0.001) and less likely to have diabetes (0% vs 27.3%, p < 0.05) The recruitment of spontaneous coronary collaterals remains constant in recurrent STEMI presentations suggesting an innate biological process rather than merely a manifestation of alteration of haemodynamic blood flow. Further investigations to identify these processes is required.

Abstract 592: Cardioprotection During Ischemia by Induced Coronary Collateral Growth

Patients with poorly developed coronary collateral networks have a poorer prognosis after a cardiovascular event than those with well-developed collaterals. The outcome of patients with metabolic syndrome (MetS) was worse than the patient without MetS. Interestingly, coronary collateral growth is impaired in MetS. We hypothesize that coronary collaterals are critical for the cardiac protection in ischemic heart diseases (IHD) and induction of coronary collateral growth (CCG) might ameliorate the outcome of patients with MetS. We study the cardiac protection by coronary collaterals in IHD and the underlying mechanism of impaired CCG in the MetSin a mouse model of CCG. A pneumatic snare was implanted and situated around the LAD. After the mice recovery from the surgery, periodic inflation of the snare occludes the LAD; thus, producing repetitive ischemia (RI). Cardiac function was measure with echocardiography. CCG was measured by myocardial blood flow with contrast echocardiography and by collateral numbers with micro-CT or by vascular density with fluorescence scope. Our preliminary results showed that with occlusion of the LAD, there was no blood flow in the ischemic area. However, after stimulation of CCG by RI, the blood flow the ischemic area was compensated by the grown coronary collaterals and cardiac function was reserved during ischemia. Diabetic mice failed to grow coronary collaterals after RI stimulation and there was no cardiac protection from coronary collaterals during ischemia. Moreover, we studied the roles of growth differentiation factor 11 (GDF11) and miR21 in the regulation of CCG and cardiac protection in IHD. GDF11 was downregulated and miR21 was upregulated in the hearts of Zucker Obese Fatty (ZOF) rats during CCG. We used the Gdf 11 knockout mice and miR 21 knockout mice to study the underlying mechanism. GDF11 is highly expressed in myocardial blood vessels, which suggested the role of GDF11 in vascular growth. Impaired CCG of mice on high fat and high sugar was restored by miR-21 knockout. These data suggest that miR-21 is involved in the impairment of CCG in MetS.

Obstructive sleep apnoea in acute coronary syndrome.

Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7-9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk.

Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion

BackgroundWe investigated whether or to what extent the interaction of lipoprotein (a) [Lp(a)] with cholesterol-containing lipids was associated with angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion.MethodsSerum levels of Lp(a), total cholesterol, low-density lipoprotein–cholesterol (LDL-C), high-density lipoprotein–cholesterol (HDL-C), and triglyceride were determined and non-HDL-C was calculated in 706 type 2 diabetic and 578 non-diabetic patients with stable coronary artery disease and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3).ResultsFor diabetic and non-diabetic patients, Lp(a), total cholesterol, LDL-C, and non-HDL-C levels were higher in patients with poor coronary collateralization than in those with good collateralization, whereas HDL-C and triglyceride levels were similar. After adjustment for potential confounding factors, tertiles of Lp(a), total cholesterol, LDL-C and non-HDL-C remained independent determinants for poor collateralization. A significant interaction between Lp(a) and total cholesterol, LDL-C or non-HDL-C was observed in diabetic patients (all P interaction < 0.001) but not in non-diabetics. At high tertile of total cholesterol (≥ 5.35 mmol/L), LDL-C (≥ 3.36 mmol/L) and non-HDL-C (≥ 4.38 mmol/L), diabetic patients with high tertile of Lp(a) (≥ 30.23 mg/dL) had an increased risk of poor collateralization compared with those with low tertile of Lp(a) (< 12.66 mg/dL) (adjusted OR = 4.300, 3.970 and 4.386, respectively, all P < 0.001).ConclusionsIncreased Lp(a) confers greater risk for poor coronary collateralization when total cholesterol, LDL-C or non-HDL-C are elevated especially for patients with type 2 diabetes.

Surgical Revascularization of Chronically Occluded Coronary Arteries-What You See Is What You Get?

Revascularization strategy in coronary artery bypass grafting (CABG) surgery usually depends on coronary dimension and stenosis severity. Little is known about the relation of preoperative evaluation of scarcely or invisibly chronic occluded coronary arteries (chronic total occlusion [CTO]) and revascularization rate or anastomosis quality. We aimed to evaluate the success rates of CTO revascularization in CABG surgery and determine the influence of coronary lumen visibility and collateralization in preoperative angiograms on revascularization rates, bypass blood flow, and target vessel diameter. Preoperative coronary angiograms were evaluated for 938 consecutive patients who underwent isolated CABG surgery between 2014 and 2016 and screened for occluded coronary arteries. The occluded vessels were scored for visibility using the Rentrop grading of collateral filling. Intraoperatively, dimensions of the occluded arteries were measured using conventional vessel probes, and anastomosis quality was assessed by transit time flow measurement. A total of 404 (43.1%) patients were identified with at least one CTO. Revascularization rates differed from 96.2% in the left anterior descending artery, to 85.0% in left circumflex artery-dependent vessels, and 78.8% in right coronary artery territory. Coronary visibility and grade of collateralization in the preoperative angiogram had no influence on intraoperatively measured coronary diameter. Bypass blood flow in grafts revascularizing CTOs lacking collateralization were not significantly lower than those grafts leading to CTOs with higher Rentrop scores. Preoperative coronary assessment often differs from intraoperative findings. Our study confirms that even patients with scarcely collateralized CTOs and impaired visibility in the coronary angiogram have a high chance of complete revascularization during CABG surgery.

Predictors of poorly developed coronary collateral circulation in patients with subclinical hypothyroidism suffered from chronic stable angina.

Background. The development of coronary collaterals is variable among patients with coronary artery disease and remains incompletely understood. We aimed to demonstrate the predictors of poorly developed coronary collateral circulation (CCC) in patients with subclinical hypothyroidism suffered from chronic stable angina.Methods. The study was conducted on 226 patients with subclinical hypothyroidism suffered from chronic stable angina, coronary angiography documented total occlusion at any major coronary artery or coronary artery lumen diameter stenosis >90%. Patients were divided into two groups according to grade of CCC, group A: 138 patients with (good collaterals) and group B: 88 patients with (poor collaterals). To classify CCC, we used Rentrop’s classification.Results. Multivariate regression analysis was performed and identified the independent predictors of poor coronary collaterals: N/L ratio (OR 0.413, CI 95% [0.172–0.993], p = 0.048), and TSH (OR 2.511, CI 95% [1.784–3.534], p = 0.001). The ROC analysis provided a cut-off value of >4.6 for N/L ratio, and >9 µIU/mL for TSH to predict poor coronary collaterals.Conclusion. An elevated level of N/L ratio >4.6 and TSH level >9 µIU/mL were the independent predictors of poorly developed CCC in patients with subclinical hypothyroidism suffered from chronic stable angina.

A Correlative, Three‐dimensional Approach to Studying Coronary Collateral Growth Using Lineage Tracing, Micro‐computed Tomography and Multiphoton Imaging in a Mouse Model of Repetitive Ischemia

Coronary heart diseases (CHD) are the leading cause of mortality and morbidity in the United States. Inherent coronary collateral network in the heart represents a native circulation that is capable of undergoing tremendous abluminal expansion to provide flow to an ischemic area of the myocardium. A well‐developed coronary collateral circulation ameliorates the consequences of CHD, reducing the incidence of sudden death and infarct size following coronary occlusion. Stimulation of coronary collateral growth (CCG) is an alternative therapeutic approach for patients with intractable angina pectoris who are not indicated for percutaneous coronary intervention and/or coronary artery bypass grafting. Even though the importance of CCG is undisputable, the mechanism underlying the CCG is not clear, such as its time course and sequence of process, critical cell type(s) and genes/factors. We developed a mouse model of CCG by repetitive ischemia (RI) and validated the CCG with contrast echo to measure the coronary blood flow and 3D imaging using micro‐CT (μCT) to quantitate the CCG. Figure 1B shows the micro‐CT images of grown coronary collaterals after RI while Figure 1A shows no native coronary collaterals in mouse heart. Moreover, we adopted lineage tracing to dissect the process of CCG. We crossed lineage tracing (ROSA mT/mG floxed) mice with tissue specific cre expressing lines (endothelial cells, smooth muscle cells, inflammatory cells, etc.) and these mice were subjected to RI surgery and protocol. Mice were echoed for blood flow measurement and sacrificed at various time‐points. Mouse hearts were harvested for micro‐CT or multi‐photon fluorescent imaging. Tiled and stitched z‐stacks of heart slices containing the growing collaterals were acquired for fluorescent target cells as well as vasculature. Figure 2 shows vasculature of a ROSA‐tie2‐GFP mouse heart by multiphoton without RI. Also, datasets from μCT and multiphoton modalities could be merged in Amira™ so that the final 3D reconstruction included precise locations of lineage cells within the growing collaterals. Post‐imaging, the heart slices could also be embedded and sectioned for fluorescent IHC for proliferation and other proteins critical for arteriogenesis. In conclusion, we have developed a method for exploring the process of CCG in greater detail at the molecular and cellular level in a mouse CCG model. Understanding this process at such level could provide a therapeutic strategy to induce CCG in ischemic heart diseases.Support or Funding InformationThe research is funded by National Institutes of Health grant 2R01HL103227‐05 (YZ, LY), 1R01HL135110‐01 (WMC, LY), 1R01 HL137008‐01A1 (LY), 1R15HL115540‐01 (LY) and 14BGIA18770028 from American Heart Association (LY).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Myeloid Derived miR‐21 Influences Coronary Collateral Growth in Metabolic Syndrome

Well‐developed coronary collaterals prove to be highly beneficial in salvaging ischemic myocardium, preserving cardiac function, and improving patient outcome post‐occlusion. However, this process is impaired in patients with metabolic syndrome. A more complete understanding of the underlying mechanism, cell types, and genes causing the impaired coronary collateral growth (CCG) response have yet to be elucidated. Better understanding of the process of CCG will lead to potential therapeutics to induce CCG and circumvent ischemic injury. MicroRNA‐21 (miR‐21) has been studied in cancer, with its central role in the down‐regulation of pro‐apoptotic genes leading to sustained cellular proliferation. However, miR‐21 has recently been reported to modulate inflammation after myocardial infarction (MI) and to play a role in the development of atherosclerosis. Furthermore, miR‐21 has been shown to be involved in macrophage polarization, where it generally serves to reduce inflammatory markers and promote anti‐inflammatory markers. In addition, miR‐21 dysregulation has been rooted in the diabetic population wherein lies a systemic inflammatory state. In this study, we investigated the role of miR‐21 during CCG in diabetes mellitus, which is a major risk factor for the development of cardiovascular disease. Our preliminary data suggested that down‐regulating miR‐21 rescues the impaired CCG in diet‐induced diabetic animals. Given that miR‐21 is highly abundant in immune cells, we sought to further study if miR‐21 regulates CCG by modulating the inflammatory response. While macrophages have been extensively studied during MI events or in atherosclerosis conditions, their roles during CCG are not well‐defined. Thus, we utilize a myeloid specific (Lyz2) miR‐21 knockout to investigate the impact of miR‐21 in macrophages on CCG within the context of diabetes. First, colony stimulating factor‐1 directed bone marrow derived macrophages from miR‐21 Lyz2‐knockout mice were subjected to high glucose (4.5 g/L) and / or hypoxia (3% oxygen) to mimic diabetic conditions. Interestingly, the knockout macrophages have differences in their spindle like projections even before beginning treatment. This possibly suggests greater baseline activation compared to the control. We also observe morphological differences after treatment. The expression profile will give more accurate results. In vivo, CCG is blunted in the miR‐21 Lyz2‐knockout animals subjected to the repetitive ischemia protocol. This suggests that miR‐21 in the myeloid lineage is critical for CCG in healthy non‐diabetic mice. Further studies of CCG in the miR‐21 Lyz2‐knockout mice fed high fat and high sugar diet will give us more insight into the mechanisms underlying impaired CCG in diabetes.Support or Funding InformationThe research is funded by National Institutes of Health grant 2R01HL103227‐05 (Zhang, Yin), 1R01HL135110‐01 (WMC, LY), 1 R01 HL137008‐01A1 (LY), 1R15HL115540‐01 (LY) and 14BGIA18770028 from American Heart Association.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Could platelet distribution width predict coronary collateral development in stable coronary artery disease?

OBJECTIVE:We hypothesized that hemogram parameters should be related to the development of coronary collateral vessels. For this purpose, we aimed to compare platelet distribution width (PDW) and PDW to platelet ratio (PPR) in subjects with stable coronary artery disease having adequate or inadequate coronary collateral development.METHODS:A total of 398 patients with stable angina pectoris undergoing coronary angiography were enrolled and divided on the basis of the development of coronary collateral (CCD) (inadequate CCD (n=267) and adequate CCD (n=131). Routine complete blood count and biochemical parameters were measured before coronary arteriography.RESULTS:Mean PDW and PPR values of inadequate and adequate CCD groups were 17.5% (10–23) and 12.4% (9.8–22) %, p<0.001, respectively. In multivariate analysis, age (p=0.012, 95% CI for OR: 0.958 (0.933–0.983) and PDW (p<0.001, 95% CI for OR: 1.432 (1.252–1.618) were found to be statistically significantly different inadequate CCD group compared to adequate CCD group. Receiver operating curve (ROC) analyses revealed that a PPR value greater than 0.057 had 76% sensitivity and 51% specificity and a PDW higher than 16.2% had 80% sensitivity and 66% specificity in predicting inadequate CCD.CONCLUSION:The present study suggests that PDW and PPR may be associated with the degree of collateral development in chronic stable coronary artery disease (CAD).

Association between uric acid and coron ary collateral circulation in stable coronary artery disease patients

Objective The aim of this study was to investigate the association between serum uric acid levels and the development of coronary collateral circulation (CCC) in patients with stable coronary artery disease. Background Serum uric acid can cause atherosclerosis. High serum uric acid levels may be associated with poor CCC in patients with stable coronary artery disease. Patients and methods A cross-sectional study was carried out on 100 patients with stable CAD who underwent coronary angiography and documented total occlusion in one or more of the major coronary arteries in Cardiovascular Department Menoufia University Hospital during the period from 1 February 2016 to 30 January 2017. Development of CCC will be graded according to the Cohen–Rentrop method: grades 2–3 will be classified as good CCC (group A) and grades 0–1 as poor CCC (group B). Results A significant relationship between high level of serum uric acid and poor coronary collaterals was observed. Mean value of uric acid in group A was 4.72 ± 1.69 mg/dl and mean value of uric acid in group B was 6.68 ± 2.36 mg/dl (P Conclusion The measurement of uric acid level provides a good predictor of poor CCC in stable coronary artery disease patients.

Determinants of coronary collateral formation in patients with acute ST-elevation myocardial infarction and total occlusion of infarct-related artery

Background: The presence or absence of collateral circulation to the infarct-related artery territory significantly impacts the infarct size and resulting left ventricular function and hence the prognosis. However, the determinants of collateral formation have been poorly understood. Materials and Methods: The present single-center observational study examined 200 patients with acute ST-elevation myocardial infarction (STEMI), irrespective of the status of thrombolysis, undergoing coronary angiogram within 48 h showing complete occlusion of infarct-related coronary artery. Results: High-grade collaterals (Rentrop Grade 2 and 3) were seen in 17% of patients (n = 34). High-grade coronary collaterals were more often seen in patients belonging to the age group of 46–70 years compared to elderly individuals >70 years of age (38.2% vs. 2.9%,P Conclusions: The finding of high-grade coronary collaterals was seen more in patients who had angina prior to STEMI. High-grade collaterals were significantly more in middle-aged individuals compared to the elderly. Diabetes mellitus and smoking status were negative predictors of high-grade collaterals.

Correlation Between Coronary Collaterals and Systemic Endothelial Biomarkers: MCP-1 and ICAM-1 are Associated with the Coronary Collateral Circulation

Correlation Between Coronary Collaterals and Systemic Endothelial Biomarkers: MCP-1 and ICAM-1 are Associated with the Coronary Collateral Circulation

Functional Mediastinal Paraganglioma Irrigated by Coronary Artery Collaterals Associated With Bilateral Renal Artery Fibro-Dysplasia in a Hypertensive Patient

We present a symptomatic functional anterior mediastinal paraganglioma (PGL) in a 56-year-old woman. The patient was known to have renovascular resistant hypertension caused by fibromuscular dysplasia diagnosed several years ago. The diagnosis of PGL was confirmed by 123I-metaiodobenzylguanidine scintigraphy, 18F-FDOPA positron emission tomography/computed tomography and a thoracic tomographic scan which revealed an anterior mediastinal tumor. Complete tumor resection was done through a sternotomy and extracorporeal circulation with cardiac arrest. The histological examination of the operative specimen was characteristic of PGL.

The evaluation of the effect of coronary collateral formation on left ventricular function by using strain echocardiography

The aim of this study is to compare the strain echocardiography method, that we think, evaluate ventricular functions more accurately, and the other echocardiographic methods in patients with or without angiographically developed collaterals. Non acute coronary syndrome 45 patients with determined occlusion of the left anterior descending artery (LAD) over 90% were included in this study. Collateral vessel devellopping according to Rentrop classification, grade 0-1 patients were determined as Group I (n=24) , grade 2-3 patients determined as Group II (n=21). PW doppler, tissue doppler and strain echocardiography was applied. The peak strain levels in basal anteroseptal, midseptal and apical septal segments were significantly lower in Group I (p=0.04, p=0.01 and p=0.02 respectively). Also €peak I value was significantly lower in Group I (p=0.02). In Group I, postsystolic shortening index (PSSI) was found to be positively correlated with left ventricle end diastolic volume (LVEDV) (r=0.4, p=0.05), left ventricle end systolic volume (LVESV) (r=0.47, p=0.01) and wall motion score index(WMSI) (r=0.64, p=0.001) and negatively correlated with ejection fraction(EF) (r= -0.57, p=0.03) and mitral septal annulus systolic velocity (MSA S) (r= -0.49, p=0.01). In Group II, PSSI was positively correlated with left ventricle end diastolic diamater (LVESD) (r=0.5, p=0.01) and LVESV (r=0.5, p=0.01) and negatively correlated with MSA S (r= 0.45, p=0.03). In patients who have better developed collaterals have better left ventricle functions that were observed both by strain echocardiography and conventional echocardiographic methods.

Anatomical Assessment of Coronary Collaterals Predicts Procedural Success in Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention (CTO-PCI)

Anatomical Assessment of Coronary Collaterals Predicts Procedural Success in Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention (CTO-PCI)

Acute Coronary Collaterals Reduce Mortality and Improve Left Ventricular Function in Patients Presenting with ST Elevation Myocardial Infarction (STEMI)

Acute Coronary Collaterals Reduce Mortality and Improve Left Ventricular Function in Patients Presenting with ST Elevation Myocardial Infarction (STEMI)

Features of left ventricular myocardial remodeling associated with state of coronary сollateral arteries in patients with intermediate function of left ventricle and background of acute decompensation of heart failure

Features of left ventricular myocardial remodelling depending on the state of collateral coronary flow are presented. Disorders of the left ventricle`s myocardium local contractility in patients with the intermediate function of left ventricle under acute decompensation of heart failure were studied. It was established that in such patients with postinfarction cardiosclerosis the main disorders were more often obtained in the basal and middle parts of lower and posterior walls of left ventricle vascularized by a circumflex branch of the left coronary artery or right coronary artery. It was shown that as blood flow increased in coronary collaterals; increase in left ventricular ejection fraction was 7%. In this case, an improvement in collateral blood flow by 1 point according to the Rentrop’s modified classification was accompanied by an increase in the left ventricular ejection fraction by 2 relative percents. In addition, in patients with intermediate left ventricular function, types of left ventricular myocardial remodelling were determined. Thus, in the pathogenesis of acute decompensation of heart failure, an important link is remodelling of the left ventricular myocardium, that is a complex of changes in structure and geometry that occurred under the action of trigger factor. Determination of qualitative type of remodelling, as well as its relationship with changes in extracellular matrix, is important for assessing the risk of cardiovascular complications and selecting adequate therapeutic tactics. and a volume fraction of interstitial collagen was calculated in patients with intermediate left ventricular function and background of acute decompensation of heart failure.

An angiographic study of impact of percutaneous coronary intervention on coronary collaterals

An angiographic study of impact of percutaneous coronary intervention on coronary collaterals