Development Of Coronary Collateral Circulation 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.

Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease

Abstract: Background: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease. Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC. Results: Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI &gt; 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%. Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease.

The impact of the apelinergic system in coronary collateral formation.

This study aims to examine the relationship between the development of coronary collateral circulation and serum elabela levels. Between January 2020 and December 2021, a total of 50 control individuals (29 males, 21 females; mean age: 63.2±10.0 years; range, 52 to 73 years) with no significant coronary artery disease as confirmed by angiography (Group 1) and 100 patients (55 males, 45 females; mean age: 66.6±9.6 years; range, 56 to 75 years) with coronary artery disease were included. The patients were further divided into two equal groups according to the Rentrop classification as poor (Group 2) and good coronary collateral circulation (Group 3). All groups were compared in terms of several parameters, particularly serum elabela levels. Serum elabela levels were found to be statistically higher in the group with good collateral than the other groups (p<0.05). Low serum elabela levels increased the risk of developing weak collaterals by 2.43 times. The elabela protein is directly related to good collateral development and can be considered a potential agent for treatment.

The association of serum uric acid/albumin ratio with the development of coronary collateral circulation in patients with chronic total occluded coronary arteries.

Introduction: Coronary collateral circulation (CCC) develops in chronic total occluded (CTO) vessels and protects the myocardium against ischemia in addition to the improvement of cardiac functions. Poor CCC is related to adverse cardiac events as well as poor prognosis. Serum uric acid/albumin ratio (UAR) has emerged as a novel marker associated with poor cardiovascular outcomes. We aimed to investigate whether there was an association between UAR and poor CCC in CTO patients. Methods: This study was comprised of 212 patients with CTO (92 with poor CCC and 120 with good CCC). All patients were graded based on Rentrop scores to poor CCC (Rentrop scores 0 and 1) and good CCC (Rentrop scores 2 and 3). Results: Poor CCC patients had higher frequencies of diabetes mellitus, triglyceride levels, Syntax and Gensini scores, uric acid, and UAR and lower lymphocyte, high-density lipoprotein cholesterol, and ejection fraction when compared to good CCC patients. UAR was an independent predictor of poor CCC in CTO patients. Furthermore, UAR had a better discriminative ability for patients with poor CCC from good CCC compared to serum uric acid and albumin. Conclusion: Based on the results of the study, the UAR could be used to detect poor CCC in CTO patients.

The Relationship Between Coronary Collateral Circulation and Serum Adropin Levels.

Objective Coronary collateral circulation (CCC) are vascular structures that limit the infarct area, protect left ventricular function, and reduce the frequency of arrhythmia and mortality during myocardial ischemia and infarction. In this study, we examined the relationship between the development of CCC and serum adropin levels, which has been shown in previous studies to regulate endothelial functions and increase endothelial nitric oxide synthesis,in patients with acute myocardial infarction. Methods This study included 41 patients with insufficient CCC and 43 patients with well-developed CCC who were hospitalized for acute myocardial infarction and underwent coronary angiography. The Cohen-Rentrop classification was used to grade the CCC. The patients were divided into two groups according toRentrop grades: those with a 0-1 stage were considered as insufficientand those withgrades of 2-3 were considered as well-developed CCC. We took blood samples to measure the adropin levels within the first 24 hours of hospitalization. Results The mean age was 59.1±11.9 yearsand62 (73.8%)were male. The right coronary artery was the most frequently target vessel (n: 51, 60.7%), and the majority of the patients presented with ST-segment elevation myocardial infarction (STEMI) (n:58, 69%). The median interval between the severe chest pain and the intervention was significantly higher in patients with well-developed CCC (p=0.042). The serum adropin levels in patients with insufficient CCC were significantly lower than in those with well-developed CCC(196.3 [131.5 - 837.0] pg/mL vs. 235.5 [171.9 - 1124.2] pg/mL, p<0.001). Logistic regression analysis revealed that the circumflex artery as the target vessel, NSTEMI (non-STEMI) as the type of myocardial infarction, and serum adropin level were the independent risk factors for the prediction of poor coronary collateral vessel formation (p<0.05). Conclusions In this study, we found that in patients with acute myocardial infarction, those with well-developed CCC had higheradropin levels.

Cytokine storm: behind the scenes of the collateral circulation after acute myocardial infarction.

At least 17 million people die from acute myocardial infarction (AMI) every year, ranking it first among causes of death of human beings, and its incidence is gradually increasing. Typical characteristics of AMI include acute onset and poor prognosis. At present, there is no satisfactory treatment, but development of coronary collateral circulation (CCC) can be key to improving prognosis. Recent research indicates that the levels of cytokines, including those related to promoting inflammatory responses and angiogenesis, increase after the onset of AMI. In the early phase of AMI, cytokines play a vital role in inducing development of collateral circulation. However, when myocardial infarction is decompensated, cytokine secretion increases greatly, which may induce a cytokine storm and worsen prognosis. Cytokines can regulate the activation of a variety of signal pathways and form a complex network, which may promote or inhibit the establishment of collateral circulation. We searched for published articles in PubMed and Google Scholar, employing the keyword “acute myocardial infarction”, “coronary collateral circulation” and “cytokine storm”, to clarify the relationship between AMI and a cytokine storm, and how a cytokine storm affects the growth of collateral circulation after AMI, so as to explore treatment methods based on cytokine agents or inhibitors used to improve prognosis of AMI.

Assessment of the Relationship Between the Adropin Levels and the Coronary Collateral Circulation in Patients wıth Chronic Coronary Syndrome.

ResumoFundamento A circulação colateral coronária (CCC) proporciona um fluxo sanguíneo alternativo a tecido miocárdico exposto a isquemia e ajuda a preservar as funções miocárdicas. A produção endotelial de óxido nítrico (NO) e o fator de crescimento endotelial vascular (VEGF) foram apontados como os fatores mais importantes no desenvolvimento da CCC. A adropina é um hormônio peptídeo responsável pela hemostasia energética, e é conhecida por seus efeitos positivos no endotélio por NO e VEGF.Objetivo O objetivo deste estudo é investigar a associação entre adropina e a presença de CCC em pacientes com síndrome coronariana crônica (SCC)Métodos Um total de 102 pacientes com SCC, que tinham oclusão total de pelo menos 1 artéria coronária epicárdica importante, foram incluídos no estudo e foram divididos em dois grupos: o grupo de pacientes (n: 50) com CCC ruim (Rentrop 0-1) e o grupo de pacientes (n: 52) com CCC boa (Rentrop 2-3). O nível de significância adotado para a análise estatística foi 5%.Resultados Os níveis médios de adropina identificados foram 210,83±17,76 pg/mL e 268,25±28,94 pg/mL nos grupos com CCC ruim e boa, respectivamente (p<0,001). Detectou-se que os níveis de adropina têm correlação com as razões neutrófilo-linfócito (r: 0,17, p: 0,04) e com os escores de Rentrop (r: 0,76, p<0,001), e correlação negativa com idade (r: -0,23, p: 0,01) e com os escores Gensini (r: -0,19, p: 0,02). O nível de adropina é um preditor independente da boa evolução da CCC (RC: 1.12, IC 95%: (1,06–1,18), p<0,001).Conclusão Este estudo sugere que os níveis de adropina podem ser um fator associado à de CCC em pacientes com SCC.

Frequency of Poor &amp; Good Coronary Collateral Circulation in patients of Non-ST Segment Elevation Myocardial Infarction &amp; to compare mean Platelet –Lymphocyte ratio with good &amp; poor coronary collateral circulation

Background: Coronary collateral circulation (CCC) is a secondary source of blood supply to an ischemic myocardial area in coronary artery disease. One of the most important protective responses of the cardiac against ischemia is the development of CCC. Recently, platelet to lymphocyte ratio has emerged as a major inflammatory marker &amp; a new predictor of serious unfavorable cardiovascular outcomes. Aim: To find the frequency of poor &amp; good coronary collateral circulation in patients of Non-ST Segment Elevation Myocardial Infarction &amp; to compare mean platelet–lymphocyte ratio in patients with poor &amp; good coronary collateral circulation of Non-ST Segment Elevation Myocardial Infarction. Methodology: This cross Sectional study was conducted in Cardiology Department, Mayo Hospital Lahore After taking informed consent 150 patients meeting inclusion criteria was taken in this study. The patients were enrolled from Department Cardiology, Mayo Hospital Lahore. Their basic demographical information like age, gender and contact detail was obtained. Patients were labeled as according to CCC, one with Poor CCC and second with good CCC [as per operational definition]. All procedure was done by consultant cardiologist having more than 5 years of experience after post-graduation. Venous blood was collected from patients in sterilized manners by experienced staff nurse and was sent to hospital laboratory for analysis of PLR. PLR was compared in cases with good and poor CCC. Results:1The average age of cases was 52.41 ± 18.12 years with minimum and maximum age of 20 and 80 years. There were 96(64%) male and 54(36%) female cases in this study. A total of 33 (22%) cases had poor and 117(78%) cases had good CCC. The mean Platelet-to-lymphocyte ratio (PLR) was 122.16 ± 30.10 with minimum and maximum PLR was 80.64 and 201.60. The mean PLR in cases with poor and good CCC was 165.95±21.93 and 109.81 ± 18.21 respectively, the mean PLR was highly significant in cases with Poor CCC when compared with good CCC, p-value &lt; 0.0001. Conclusion: This study concludes that cases with poor CCC have higher PLR when compared to good CCC, so in future cases with higher PLR at admission can be predict for high risk patients for poor CCC. Using PLR (inexpensive and readily available) test we can hence, patients with NSTEMI can be prevented from morbidity &amp; mortality by early and appropriate medications or interventions. Keywords Cardiology, Angiography, coronary artery disease, Low ejection fraction, coronary collateral circulation.

Monocyte High-Density Lipoprotein cholesterol Ratio and coronary collateral circulation development in patients with stable coronary artery disease and no history of revascularization

Monocyte High-Density Lipoprotein cholesterol Ratio and coronary collateral circulation development in patients with stable coronary artery disease and no history of revascularization

Visfatin and 25-Hydroxyvitamin D3 Levels Affect Coronary Collateral Circulation Development in Patients with Chronic Coronary Total Occlusion

Background: Coronary collateral circulation (CCC) plays a vital role in the myocardial blood supply, especially for ischemic myocardium. Evidence suggests that the visfatin and 25-hydroxyvitamin D3 [25(OH)D3] levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease; however, few studies have evaluated the effect of visfatin and 25(OH)D3 on CCC development in patients with chronic total occlusion (CTO). This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D3 levels and CCC in patients with CTO. Methods: A total of 189 patients with CTO confirmed by coronary angiography were included. CCC was graded from 0 to 3 according to the Rentrop-Cohen classification. Patients with grade 0 or grade 1 collateral development were included in the poor CCC group (n=82), whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group (n=107). The serum visfatin and 25(OH)D3 levels were measured by ELISA. Results: The visfatin level was significantly higher in the poor CCC group than in the good CCC group, and the 25(OH)D3 level was significantly lower in the poor CCC group than in the good CCC group (P=0.000). Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level (r=−0.692, P=0.000) but positively correlated with the 25(OH)D3 level (r=0.635, P=0.000). Logistic regression analysis showed that the visfatin and 25(OH)D3 levels were independent risk factors for CCC (odds ratio 1.597, 95% confidence interval 1.300–1.961, P=0.000 and odds ratio 0.566, 95% confidence interval 0.444–0.722, P=0.000, respectively). The visfatin and 25(OH)D3 levels can effectively predict the CCC status. Conclusion: Serum visfatin and 25(OH)D3 levels are related to CCC development and are independent predictors of poor CCC.

Systemic immune inflammation index: a novel predictor for coronary collateral circulation.

Recently, a new inflammatory and prognostic marker has emerged called as Systemic Immune Inflammation Index (SII). In the current study, we searched the relation between SII and Coronary Collateral Circulation (CCC) formation in stable Coronary Artery Disease (CAD). 449 patients with stable CAD who underwent coronary angiography and documented coronary stenosis of 95% or more in at least one major coronary vessel were included in the study. The study patients were divided into two groups according to the Rentrop score as well CCC (Rentrop 2-3) and bad CCC (Rentrop 0-1). Blood samples for SII and other laboratory parameters were gathered from all the patients on admission. The SII score was formulized as platelet × neutrophil/lymphocyte counts. Patients, who had developed bad CCC had a higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR) and SII levels compared to those who had developed well CCC (p < 0.001, for all). Multivariate logistic regression analysis showed that high levels of SII was an independent predictor of bad CCC (OR: 1.005, 95% confidence interval (CI): 1.003-1.006, p < 0.001) together with dyslipidemia, high levels of CRP and NLR. In Receiver Operator Characteristic curve (ROC) analysis, the optimal cutoff value of SII to predict poor CCC was found to be 729.8, with 78.4% sensitivity and 74.6% specificity (area under ROC curve = 0.833 (95% CI: 0.777-0.889, p < 0.001). We have demonstrated that SII, a novel cardiovascular risk marker, might be used as one of the independent predictors of CCC development.

Assessment of selected angiogenesis markers in the serum of middle-aged male patients with plaque psoriasis.

Local angiogenesis accompanies inflammation in psoriasis-affected skin. To determine the serum concentrations of selected pro- and anti-angiogenic factors and their interrelationships in patients with plaque psoriasis. The study included 41 men diagnosed with psoriasis, aged 43.5 ± 11.7 years. The Psoriasis Area and Severity Index score was 23.4 ± 5.2 points. The control group consisted of 38 healthy, age-matched men. The levels of pro-angiogenic cytokines and angiogenesis inhibitors, including fibroblast growth factor 1 (FGF-1), vascular endothelial growth factor A (VEGF-A), endostatin, and angiostatin, were determined from the serum of patients and controls using enzyme-linked immunosorbent assays. Compared with controls, patients with psoriasis had a significantly lower concentration of FGF-1 (P = .01) but higher concentrations of endostatin (P = .04) and angiostatin (P = .02). The concentration of VEGF-A was also higher in patients with psoriasis but not significantly (P = .25). The concentration of C-reactive protein (CRP) was significantly higher among patients with psoriasis than controls (P < .0001). Among controls, CRP concentrations did not correlate significantly with the concentrations of FGF-1, VEGF-A, endostatin, or angiostatin. Among patients with psoriasis, CRP concentrations correlated moderately with the concentrations of VEGF-A (r = .35; P = .02) and angiostatin (r = .31; P = .04). The concentration of VEGF-A correlated positively with PASI (r = .05; P = .0009) and BSA values (r = .39; P = .01). Psoriasis is associated with an altered systemic balance between pro-angiogenic and anti-angiogenic factors. The increase in serum angiogenesis inhibitors may be associated with unfavorable changes in the development of coronary collateral circulation. However, the clinical significance of this has not yet been established.

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 between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome

Aim: Homocysteine is an amino acid that plays a role in folate metabolism and inhibits endothelial cell proliferation which is important for angiogenesis. In this study, we aimed to investigate the relationship between serum homocysteine levels and coronary collateral development. Material and Method: 176 consecutive patients, with acute coronary syndrome and chronic total occlusion, were divided into two groups according to coronary collateral development. Rentrop 0 and 1 were regarded as group I and Rentrop 2 and 3 as group II. Results: Plasma homocysteine levels were 18,2 ± 7,0 μmol/L in the group I and 15,7 ± 5,1 μmol/L in the group II. Univariate logistic regression analysis showed that mean platelet volume and homocysteine were associated with poor coronary collateral. Multivariate logistic regression analysis showed that homocysteine level was independently associated with poor coronary collateral circulation (OR 1,069 [95% CI 1,012-1,130]; P=0,018). Conclusion: In this study clearly demonstrates that high serum homocysteine level is associated with poor collateral development in patients with acute coronary syndrome.

Neutrophil-To-Lymphocyte Ratio Predicts Coronary Collateral Circulation in Multivessel Coronary Artery Disease

Background: Coronary collateral circulation (CCC) is an adaptive response to chronic myocardial ischemia. Patients with coronary stenosis develop varying degrees of collateral. Levels of inflammatory cells were suggested as potential determinants of collateral development. Neutrophil to lymphocyte (N/L) ratio has been proposed as a prognostic marker to determine systemic inflammatory response and the development of CCC. Our aim was to determine the relationship between N/L ratio and development of CCC in patients with coronary artery disease (CAD) with multivessel disease.Method:A total of 151 patients with multivessel disease were included in this study. Coronary collateral grades were classified according to Rentrop collateral grades as either poorly developed CCC (Rentrop grade 0-1) or well developed CCC (Rentrop grades 2-3). Factors significant at the p≤0.25 in the bivariate models were put into multiple logistic regressions. The receiver–operating characteristic (ROC) analysis were performed to determine the cutoff value of NLR in predicting poor CCC.Result: Of the 151 CAD patients in this study, 76 patients had poorly developed CCC and 75 patients had well developed CCC. Poorly developed CCC had significantly higher N/L ratio than well developed CCC (2.25±1.189 vs. 3.03±1.527, p &lt;0.001). Logistic regression analysis showed that N/L ratio (OR0.756; CI 95% 0.587 – 0.974, p 0.031) was independent predictor of poorly developed CCC. The ROC analysis provided a cut-off value of 1.99 (AUC 0.72, sensitivity 78.9%, specificity 52%) for N/L ratio to predict poorly developed CCC.Conclusion: Higher neutrophil to lymphocyte ratio was useful in predicting poor coronary collateral circulation in stable coronary heart disease with multivessel disease. Neutrophil to lymphocyte ratio &gt;1.99 was independently associated with impairment in coronary collateralization. This value had a sensitivity of 78.9% and specificity of 52%.

Blood Group Types O and Non-O Are Associated With Coronary Collateral Circulation Development

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

Koroner Kronik Total Oklüzyonu Olan Hastalarda Serum Endokan Düzeyi ile Koroner Kollateral Dolaşım Arasındaki İlişki

Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level and development of coronary collateral circulation (CCC) in patients with stable angina pectoris. Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO) (n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was evaluated according to the Rentrop and Cohen's classification. Patients who had grade 0 or 1 collateral filling were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling were included in the well-developed collateral group (n= 23). Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002, 95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC) curve: 0.749, 95% CI: 0.654-0.849, p< 0.001). Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play an important role in the development of CCC.

COA-Cl (2-Cl-C.OXT-A) can promote coronary collateral development following acute myocardial infarction in mice

2-Cl-C.OXT-A (COA-Cl) is a novel nucleic acid analogue that promotes tube-forming activity of human umbilical vein endothelial cells (HUVEC) through vascular endothelial growth factor (VEGF). The development of coronary collateral circulation is critical to rescue the ischemic myocardium and to prevent subsequent irreversible ischemic injury. We evaluated whether COA-Cl can promote angiogenesis in ischemic tissue, reduce infarct size and preserve cardiac contractility in vivo. Mice received COA-Cl or placebo daily for three days after myocardial infarction (MI) by coronary ligation. The degree of angiogenesis in ischemic myocardium was assessed by staining endothelial cells and vascular smooth muscle cells, and measuring infarct size/area-at-risk. In mice treated with COA-Cl, enhanced angiogenesis and smaller infarct size were recognized, even given a similar area at risk. We observed increases in the protein expression levels of VEGF and in the protein phosphorylation level of eNOS. In addition, the heart weight to body weight ratio and myocardial fibrosis in COA-Cl mice were decreased on Day 7. Administration of COA-Cl after MI promotes angiogenesis, which is associated with reduced infarct size and attenuated cardiac remodeling. This may help to prevent heart failure due to cardiac dysfunction after MI.

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.