Formation Of Collateral Circulation Research Articles

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

The role of atorvastatin in collateral circulation formation induced by encephaloduroarteriosynangiosis: a prospective trial

This prospective study was designed to confirm the role of atorvastatin in collateral circulation formation induced by encephaloduroarteriosynangiosis (EDAS) in patients with moyamoya disease (MMD). Patients who were diagnosed with MMD at the Department of Neurosurgery in the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China, between June 2017 and May 2018 were included. Blood samples were obtained from an antecubital vein and were analyzed using flow cytometry. Endothelial progenitor cells (EPCs) were defined as CD34brCD133+CD45dimKDR+. All patients included in the study underwent EDAS. Patients voluntarily chose whether to undergo atorvastatin treatment after EDAS. The correlation between atorvastatin and good postoperative collateral circulation was evaluated. A total of 106 patients with MMD were included in this study. Fifty-three patients (50%) received atorvastatin treatment. The baseline characteristics did not display statistically significant differences between the atorvastatin-treated and non-atorvastatin groups. Seventy-eight (42.9%) of the 182 hemispheres investigated postoperatively were classified as grade A collateral circulation, 47 (25.8%) as grade B, and 57 (31.3%) as grade C. Multivariate analysis revealed that only atorvastatin was significantly correlated with good collateral circulation after EDAS (p = 0.041). The results of this prospective clinical trial have indicated that atorvastatin administered at 20 mg daily is safe and effective for the formation of postoperative collateral induced by EDAS.

Effect of Interventional Therapy on Iliac Venous Compression Syndrome Evaluated and Diagnosed by Artificial Intelligence Algorithm-Based Ultrasound Images.

In order to explore the efficacy of using artificial intelligence (AI) algorithm-based ultrasound images to diagnose iliac vein compression syndrome (IVCS) and assist clinicians in the diagnosis of diseases, the characteristics of vein imaging in patients with IVCS were summarized. After ultrasound image acquisition, the image data were preprocessed to construct a deep learning model to realize the position detection of venous compression and the recognition of benign and malignant lesions. In addition, a dataset was built for model evaluation. The data came from patients with thrombotic chronic venous disease (CVD) and deep vein thrombosis (DVT) in hospital. The image feature group of IVCS extracted by cavity convolution was the artificial intelligence algorithm imaging group, and the ultrasound images were directly taken as the control group without processing. Digital subtraction angiography (DSA) was performed to check the patient's veins one week in advance. Then, the patients were rolled into the AI algorithm imaging group and control group, and the correlation between May–Thurner syndrome (MTS) and AI algorithm imaging was analyzed based on DSA and ultrasound results. Satisfaction of intestinal venous stenosis (or occlusion) or formation of collateral circulation was used as a diagnostic index for MTS. Ultrasound showed that the AI algorithm imaging group had a higher percentage of good treatment effects than that of the control group. The call-up rate of the DMRF-convolutional neural network (CNN), precision, and accuracy were all superior to those of the control group. In addition, the degree of venous swelling of patients in the artificial intelligence algorithm imaging group was weak, the degree of pain relief was high after treatment, and the difference between the artificial intelligence algorithm imaging group and control group was statistically considerable (p < 0.005). Through grouped experiments, it was found that the construction of the AI imaging model was effective for the detection and recognition of lower extremity vein lesions in ultrasound images. To sum up, the ultrasound image evaluation and analysis using AI algorithm during MTS treatment was accurate and efficient, which laid a good foundation for future research, diagnosis, and treatment.

Vascular endothelial growth factor-A promoter polymorphisms, circulating VEGF-A and survival in acute coronary syndromes

BackgroundDevelopment of a competent collateral circulation in established coronary artery disease is cardio-protective. The vascular endothelial growth factor (VEGF) system plays a key role in this process. We investigated the prognostic performance of circulating VEGF-A and three genetic variants in the VEGFA gene in a clinical coronary cohort.Methods and resultsThe Coronary Disease Cohort Study (CDCS) recruited 2,140 patients, with a diagnosis of acute coronary syndrome (ACS), after admission to Christchurch or Auckland City Hospitals between July 2002 and January 2009. We present data for 1927 patients from the cohort genotyped for three SNPs in the VEGF-A gene, rs699947 (C-2578A), rs2010963 (C405G) and rs3025039 (C936T). Plasma VEGF-A concentrations were assayed in a subgroup (n = 550) of CDCS patients (geometric mean 36.6 [34.7–38.5] pg/ml). VEGF-A levels correlated with patient heart rate at baseline (p = 0.034). None of rs699947, rs3025039, nor rs2010963 genotypes were significantly associated with VEGF-A levels, but rs3025039 genotype was positively associated with collateral vessels perfusion according to the Rentrop classification (p = 0.01) and baseline natriuretic peptide levels (p<0.05). Survival in the CDCS cohort was independently associated with baseline VEGF-A levels and (in males) with rs699947 genotype.ConclusionsThis study is strongly suggestive that VEGF-A levels have value as a prognostic biomarker in coronary heart disease patients and SNPs in VEGF-A deserve further investigation as prognostic markers and indicators of angiogenic potential influencing the formation of collateral circulation.

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.

N-terminal pro-brain natriuretic peptide and coronary collateral formation in patients undergoing primary percutaneous coronary intervention

There is insufficient information on the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and collateral circulation (CC) formation after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. We analyzed 857 patients who underwent primary PCI. The serum NT-proBNP levels were measured on the day of admission, and the CC was scored according to Rentrop’s classification. Log-transformed NT-proBNP levels were significantly higher in patients with good CC compared to those with poor CC (6.13 ± 2.01 pg/mL versus 5.48 ± 1.97 pg/mL, p < 0.001). The optimum cutoff value of log NT-proBNP for predicting CC was 6.04 pg/mL. Log NT-proBNP ≥ 6.04 pg/mL (odds ratio 2.23; 95% confidence interval 1.51–3.30; p < 0.001) was an independent predictor of good CC. CC development was higher in patients with a pre-TIMI flow of 0 or 1 than those with a pre-TIMI flow of 2 or 3 (22.6% versus 8.8%, p = 0.001). The incidence of left ventricular (LV) dysfunction (< 50%) was greater in patients with a pre-TIMI flow of 0 or 1 (49.8% versus 35.5%, p < 0.001). The release of NT-proBNP was greater in patients with LV dysfunction (34.3% versus 15.6%, p < 0.001). The incidence of good CC was greater in patients with log NT-proBNP levels ≥ 6.04 pg/ml (16.8% versus 26.2%, p = 0.003). The association between NT-proBNP and collateral formation was not influenced by pre-TIMI flow and LV function. NT-proBNP appears to reflect the degree of collateral formation in the early phase of STEMI and might have a new role as a useful surrogate biomarker for collateral formation in patients undergoing primary PCI.

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.

Hemobilia due to Hepatic artery pseudoaneurysm secondary to collateral circulation formation after liver trauma: a case report

BackgroundHemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma.Case presentationA 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up.ConclusionFor patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.

The Use of Artificial Hypoxia in Endurance Training in Patients after Myocardial Infarction.

The presence of a well-developed collateral circulation in the area of the artery responsible for the infarction improves the prognosis of patients and leads to a smaller area of infarction. One of the factors influencing the formation of collateral circulation is hypoxia, which induces angiogenesis and arteriogenesis, which in turn cause the formation of new vessels. The aim of this study was to assess the effect of endurance training conducted under normobaric hypoxia in patients after myocardial infarction at the level of exercise tolerance and hemodynamic parameters of the left ventricle. Thirty-five patients aged 43–74 (60.48 ± 4.36) years who underwent angioplasty with stent implantation were examined. The program included 21 training units lasting about 90 min. A statistically significant improvement in exercise tolerance assessed with the cardiopulmonary exercise test (CPET) was observed: test duration (p < 0.001), distance covered (p < 0.001), HRmax (p = 0.039), maximal systolic blood pressure (SBPmax) (p = 0.044), peak minute ventilation (VE) (p = 0.004) and breathing frequency (BF) (p = 0.044). Favorable changes in left ventricular hemodynamic parameters were found for left ventricular end-diastolic dimension LVEDD (p = 0.002), left ventricular end-systolic dimension LVESD (p = 0.015), left ventricular ejection fraction (LVEF) (p = 0.021), lateral e’ (p < 0.001), septal e’ (p = 0.001), and E/A (p = 0.047). Endurance training conducted in hypoxic conditions has a positive effect on exercise tolerance and the hemodynamic indicators of the left ventricle.

A Rare Cause of Upper Gastrointestinal Bleeding: Pacemaker Lead Induced Superior Vena Cava Stenosis

Automatic implantable cardioverter-defibrillator (AICD) lead associated superior vena cava (SVC) syndrome is rare, with an incidence of <0.1% [1]. Aetiology is thought to result from mechanical irritation and lead-related foreign body reaction, resulting in fibrosis, thrombus and vessel stenosis. Most patients are asymptomatic, in cases with rapid thrombosis and stenosis, there may be signs of SVC obstruction such as upper limb, neck and facial oedema [2]. Upper gastrointestinal bleeding due to collateral circulation formation is rare [3].

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.

Chronic mesenteric ischemia: a case report and review of the literature

Chronic mesenteric ischemia (CMI) is a rare vascular disease. Unlike acute ischemia with a sudden onset, CMI is characterized by permanent or episodic intestinal hypoperfusion, usually due to atherosclerotic vascular lesion. Despite the high prevalence of atherosclerosis of mesenteric arteries in the general population, clinical manifestations of CMI may be absent up to the end-stage disease, which is due to the formation of extensive collateral circulation and the presence of residual fetal circulation. CMI not only worsens the quality of life, but also increases the risk of acute ischemia against the background of chronic. This problem is relevant, since the incidence and related mortality do not tend to decrease. The article presents the case report of CMI in a patient with an atypical abdominal angina. The etiopathogenesis, clinical picture, diagnosis and treatment methods are described in relation not only to the presented report, but also to literature data. This improves understanding and management strategy of this rare life-threatening pathology.

The clinical value of color Doppler ultrasound combined with vascular enhancement technology in the diagnosis of iliac vein compression syndrome

Objective To evaluate the clinical value of color Doppler ultrasound(CDUS) combined with vascular enhancement technology(VET) in diagnosis of iliac vein compression syndrome(IVCS). Methods From Jan 2016 to Oct 2018, 252 patients with the lower extremities chronic venous diseases(CVD) were selected in the Second Hospital of Hebei Medical University. The ipsilateral iliac veins of the affected limbs were examined by CDUS, VET and the combined diagnosis of IVCS before X-Ray venography(XRV). Iliac vein diameter stenosis ratio(DSR)>50% in transverse section was the criterion of ultrasound diagnosis of IVCS. The stenosis site of iliac vein and indirect signs of IVCS, such as presence of collateral circulation and the retrograde flow of internal iliac vein were recorded. The cases, which had the same results in CDUS, VET and both and XRV, were divided into IVCS group and non-IVCS group. The results of XRV were taken as the gold standard, the diagnostic efficiency of the above 3 methods in diagnosis of IVCS was calculated. The cases identically diagnosed by the most effective ultrasonic method and XRV were divided into DVT group and non-DVT group according to the deep vein thrombosis in lower limbs. In the non-DVT group, there were five groups of C2-C6 on the basis of the CEAP clinical grades of CVD in lower extremity. The relationship between IVCS and different CEAP clinical grades were analyzed. The locations of common iliac vein stenosis and collateral circulation formation and internal iliac vein reverse flow were evaluated for the diagnosis of the IVCS. Results ①XRV diagnosis of IVCS was used as the gold standard. Compared with CDUS and VET alone, the sensitivity and specificity of CDUS combined with VET was the highest(all P 0.05). ④For the proportion of the iliac vein stenosis sites, the prevalence of the primary section of left common iliac vein was much higher than those of the primary section of right common iliac vein and the middle-distal sections of bilateral common iliac veins(all P 0.05). ⑤In IVCS group, which had the same results of CDUS combined with VET and XRV, there were statistical differences in the positive rate of collateral circulation and the retrograde flow of internal iliac vein(χ2=6.717, P=0.010), and the former is higher than the latter. Conclusions CDUS combined with VET has a higher diagnostic efficiency for IVCS than VET or CDUS alone. The presence of IVCS is closely related to DVT of lower extremities, but not related to clinical class of CEAP. The most common site of IVCS is the initial segment of the left common iliac vein. The presence of collateral circulation can be used as indirect indicators for the diagnosis of IVCS. Key words: Ultrasonography, Doppler, color; Vascular enhancement technology; Iliac vein compression syndrome

Ischemic diabetic foot ulcer when treated in association with photobiomodulation: Case report

Introduction: Because ischemic diabetic foot has arterial lesions with micro and macroangiopathies, it is challenging successfully treat ulcers even now. This becomes especially true if limb revascularization is impossible due to the particularities of systemic pathology and/or local arterial disease. Case Report: A 61-year-old male patient with type II Diabetes mellitus, arterial hypertension, chronic arterial insufficiency, single limb, with ischemic calcaneal ulcer and posterior tibial artery occlusion that irrigates the angiosome of the lesion, but unfavorable to revascularization. Defined by conventional treatment with platelet antiaggregant, statin and vasodilator associated with laser photobiomodulation (PBM). Red laser, 660 nm, 108 mW, 2.7 W/cm2, was used to irradiate the ulcer point by point, since the area of the laser beam was smaller than the area of the ulcer (laser beam = 0.04 cm2), in contact mode, 108 J/cm2, 4.32 J, and 10 s per point once a week for 33 weeks. Arterial Doppler ultrasound examinations were performed twice, i.e., after three and six months of treatment. Results: Gradual improvement of blood flow in the ulcer bed with postocclusive flow after three months, and after six months, triphasic flow toward the calcaneus. Conclusion: Photobiomodulation proved to be effective for the formation of collateral circulation in the occluded vascular bed studied here, despite only partial ulcer healing. Randomized controlled trials should be performed to better understand the effects of PBM.

Aortic valve endocarditis with root abscess causing superior vena cava obstruction: a case report

BackgroundTo our knowledge, we report the first case of endocarditis with root abscess causing compressive superior vena cava (SVC) obstruction.Case summaryAn 84-year-old gentleman with previous tissue aortic valve replacement presented with fevers and systemic upset. Blood cultures grew Streptococcus anginosus and transoesophageal echocardiogram identified prosthetic valve vegetations with an associated root abscess. Antibiotics were commenced and referral made for surgical consideration. Several days into treatment the patient developed clinical signs of SVC obstruction and computed tomography demonstrated an enlarging root abscess with SVC compression. The patient was discussed with local cardiothoracic centres, but surgery was not an option primarily due to abscess size and vascular involvement. Priority moved from active to palliative treatment given no improvement with antibiotics, unsuitability for surgery, and patient discomfort. Within several weeks, symptoms/signs of SVC obstruction actually improved, likely due to collateral venous circulation formation and the patient was discharged home with palliative care input.DiscussionThere are previous reports of SVC obstruction related to infected SVC thrombus, indwelling intravascular devices, and para-aortic abscess, but none related to infective endocarditis. Streptococcus anginosus endocarditis is rare but often associated with abscess formation, and male gender, increasing age, and previous surgery are recognized risk factors.

Update on the management of gastrointestinal varices.

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

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.

Logistic regression analysis on influencing factors of the collateral circulation formation in patients with acute cerebral infarction

Objective To explore the influencing factors of the collateral circulation formation in patients with acute cerebral infarction. Methods Three hundred and fifty-two patients with acute cerebral infarction were included in this study, the clinical date of their head and neck 256 slice spiral CT angiography (CTA) examination was analyzed.According to the formation of collateral circulation in the head and neck CTA imaging results, it is divided into the collateral circulation group and the non-collateral circulation group.The clinical data of the two groups were compared.The influencing factors of the formation of collateral circulation in patients with acute cerebral infarction were analyzed by single factor analysis and multivariate logistic regression analysis. Results (1) In 352 cases of acute cerebral infarction, 197 cases (56.0%) had collaterals, 155 cases (44.0%) had none collateral.(2) Single factor analysis showed that age (t=-2.860, P=0.004), hypertension combined with diabetes (χ2=10.709, P=0.001), history of TIA(χ2=4.626, P=0.034), low density lipoprotein (t=-2.176, P=0.030), high homocysteine(t=2.885, P=0.004), cerebral vascular stenosis(Z=-5.936, P=0.000), posterior circular lesions (χ2=8.548, P=0.004) were the influencing factors in the formation of collateral circulation.(3) Multivariate Logistic regression analysis showed that old age (OR=1.031; 95%CI=1.008-1.054; P=0.007), hypertension combined with diabetes (OR=2.009; 95%CI=1.159-3.482; P=0.013), high homocysteine (OR=1.023; 95%CI, 1.005-1.041; P=0.014), circular lesions(OR=1.727; 95%CI=1.063-2.804; P=0.027) were relatively independent risk factors in acute cerebral infarction patients with none circulation, the degree of cerebral vascular stenosis (OR=0.507; 95%CI=0.389-0.661; P=0.000), low density lipoprotein(OR=0.723; 95%CI=0.532-0.982; P=0.038) served as protective factor. Conclusion Old age, hypertension combined with diabetes, high homocysteine and posterior circulation lesions are risk factors for the formation of collateral circulation in patients with acute cerebral infarction, cerebral vascular stenosis degree and low density lipoprotein can promote the formation of collateral circulation. Key words: Cerebral Infarction; Collateral Circulation; Influencing Factors; Logistic Regression Analysis

Correlation between GDF-15 gene polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction.

To explore the correlation between growth differentiation factor 15 (GDF-15) -3148C/G polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction (STEMI) in Han population of Taiyuan area. The present study included 92 STEMI patients and 56 normal controls based on coronary angiography; STEMI group was divided into collateral group and non-collateral group according to Rentrop's grading method. Polymerase chain reaction (PCR) and DNA sequencing methods were used to detect and analyze the GDF-15 -3148C/G polymorphism in all participants. There was significant difference in GDF-15 -3148C/G CC and GC distribution between STEMI group and control group (p=0.009); the allele frequencies between these two groups were also significant different (p=0.016); and the risk genotype for STEMI was CC with increased OR=2.660. For STEMI group, GDF-15 -3148C/G CC and GC distribution was also significantly different between patients with and without collateral (p=0.048), and CC genotype significantly promote the formation of collateral circulation. However, there were no significant differences in allele frequencies between these two subgroups of STEMI. There was correlation between GDF-15-3148C/G polymorphism and the formation of collateral circulation in patients with acute STEMI.

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.