Presence Of Coronary Collateral Circulation Research Articles

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.

Serum Sphingosine 1 Phosphate Levels in Patients with and without Coronary Collateral Circulation.

Sphingosine 1 phosphate, an active sphingolipid metabolite, functions in both healthy and diseased cardiovascular systems. It has been reported to play a role in angiogenesis and arteriogenesis in various tissues, which are the proposed mechanisms for the development of coronary collateral circulation. To the best of our knowledge, no data exist regarding serum sphingosine 1 phosphate levels and the presence of coronary collateral circulation in the literature. Thus this study aimed to investigate serum sphingosine 1 phosphate levels in patients with and without coronary collateral circulation. A total of 140 patients were included (70 with coronary collateral circulation and 70 with normal coronary arteries and stable coronary artery disease without collaterals). Rentrop collateral grade and the number of coronary arteries with collateral circulation were recorded. Serum sphingosine 1 phosphate levels were higher in the collateral group than in the control group [186.6 (142.3-243.5) μg/l vs. 128.5 (105.0-161.6) μg/l, p < 0.001]. Multivariate logistic regression analysis revealed that the presence of multivessel disease, high serum sphingosine 1 phosphate levels and previous history of P2Y12 use were independent predictors of coronary collateral circulation. Median sphingosine 1 phosphate levels in different Rentrop grades in the collateral group were similar, and there was no significant difference in median serum sphingosine 1 phosphate level with a higher number of coronary arteries with collateral circulation. Our findings demonstrated higher levels of sphingosine 1 phosphate in the patients with coronary collateral circulation.

Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction?

BackgroundAccording to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC).MethodsWe retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system.ResultsOut of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively).ConclusionMore than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels.

Prognostic Impact of Coronary Collaterals in Acute Coronary Syndrome: A Meta-Analysis (PICC-ACS)

Background: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). A recent meta-analysis found that among patients with stable CAD, the presence of CCC has a relevant protective effect in terms of mortality. Among patients with acute coronary syndrome (ACS), surrogate end-points such as infarct size, systolic function, ventricular dilatation and post-infarct aneurysm formation have positive results in relation to the presence of CCC. The prognostic value of the presence of CCC at the time of ACS is still undefined with regard to hard outcomes, specifically, reduction of mortality. Objective: To determine whether the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality Methodology: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials databases in all languages and examined the reference lists of the studies. The inclusion criteria for studies were (1) observational or randomized controlled trials; (2) population included adults ≥19 years old with ACS; (3) reported data on mortality in association with the presence or absence of CCC on angiography; and (4) if observational study, should have controlled for confounders by using logistic regression analysis. Studies identified were assessed for quality using either the Newcastle-Ottawa Quality Assessment Scale for observational studies or the Cochrane Tool for Assessing Risk of Bias for randomized trials. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenszel analysis of random effects to compute for relative risk, carried out using Review Manager (RevMan) 5.3. Results: Pooled analysis from 12 identified trials showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality but no statistical difference from no CCC (RR 0.69, 95% CI 0.44–1.08, p&lt;0.0001, I2=73%). In the secondary analysis, patients with ACS and CCC treated with PCI had a significant reduction in mortality compared to those without CCC (RR 0.48, 95% CI 0.35–0.65, p&lt;0.00001, I2=0%). Conclusion: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incremental significant reduction in mortality compared to those without CCC. Keyword: coronary collaterals, acute coronary syndrome.

The association between prolongation in QRS duration and presence of coronary collateral circulation in patients with acute myocardial infarction.

BackgroundIt is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction.MethodsThe present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0–1) and Group 2 with good coronary collateral circulation (Rentrop 2–3).ResultsOf all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p < 0.005). Additionally, we found that Rentrop grading had negative correlation with both QRS duration and white blood cell count (r: −0.28; p < 0.005 and r: −0.35; p < 0.001).ConclusionOur study showed that there was an inverse relationship between QRS duration on admission and presence of coronary collateral circulation in patients with acute myocardial infarction.

Aneurysm of the Left Coronary Artery in Postoperative Bland-White-Garland Syndrome.

We report a case of anomalous left coronary artery from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome, present the challenges of performing a differential diagnosis, and discuss the treatment of the syndrome. Although ALCAPA is a rare congenital heart disease, it is one of the most common causes of myocardial ischemia in childhood and presents a diagnostic challenge. A four-year-old girl was referred to a pediatric cardiologist for evaluation of mitral valve regurgitation murmur and heart failure. The transthoracic echocardiogram demonstrated the left coronary artery (LCA) not arising from the aorta, presence of coronary collateral circulation, and moderate mitral valve regurgitation. ALCAPA was confirmed using angiotomography. The LCA was surgically reimplanted into the aorta. After 3 years of postoperative follow-up, the patient developed an LCA aneurysm. Diagnosis of cardiac ischemia in childhood remains a challenge, and careful evaluation of coronary arteries on the echocardiogram is an important tool. In this report, we present a case of ALCAPA with an uncommon postoperative outcome.

Coronary Collateral Circulation: Any Effect on P-Wave Dispersion?

Coronary collateral circulation determines the severity of ischemic myocardial damage. Increased P-wave dispersion is an independent predictor for atrial fibrillation. Consistent evidence is little about the relation between coronary collateral circulation and arrhythmia risk. In this article, the effect of coronary collateral circulation on P-wave dispersion was evaluated. Collateral grade and P-wave dispersion were ascertained in 100 patients with >or=85% diameter stenoses in left anterior descending or right coronary arteries. Left ventricular function score was also determined in all patients. Coronary collateral circulation was absent in 32 patients, whereas 68 patients had coronary collateral circulation. Patients with collateral grade >or=1 had greater left ventricular function score than did patients with collateral grade 0 (P = .048). However, there was no significant difference between P-wave dispersion of patients with and without coronary collateral circulation (P = .45). The presence of coronary collateral circulation failed to exert a beneficial decreasing effect on P-wave dispersion.

The effect of collateral circulation on left ventricular systolic function

Conflicting reports exist on the influence of coronary collateral circulation on preservation of left ventricular systolic function. The aim of this study was to assess the effect of coronary collateral circulation on left ventricular systolic function in coronary artery disease. Seventy-one consecutive patients having left anterior descending arteries with proximal or near-proximal stenosis of at least 95% (excluding 100%) were included in the study. The coronary collateral circulation to left anterior descending artery was evaluated with regard to its effects on left ventricular systolic function. Among the 71 patients, 46 patients were found to have a coronary collateral circulation grade of >or=1 (group 1), whereas the remaining 25 patients had coronary collateral circulation grade of 0 (group 2). The mean value of left ventricular function score in group 1 was higher than that of group 2 (3.69+/-2.34 vs. 2.00+/-1.55, P=0.002), whereas the mean value of left ventricular ejection fraction in group 1 was lower than that of group 2 (44.67+/-12.05 vs. 54.32+/-10.22, P=0.001). The value of coronary collateral circulation grade was found to be positively correlated with the value of left ventricular function score (P=0.01, r=0.3), and negatively correlated with the value of left ventricular ejection fraction (P=0.01, r=-0.3). Coronary collateral circulation to the severely stenotic left anterior descending artery was not found to have an improving effect on left ventricular systolic function. In contrast with the previous studies demonstrating the coronary collateral circulation-associated preservation of left ventricular systolic function, presence of coronary collateral circulation was found to accompany or be associated with impairment of left ventricular systolic function. The grade of coronary collateral circulation was also found to be positively correlated with the severity of left ventricular systolic dysfunction. Further research on larger patient populations based on a long-term follow-up is warranted to investigate this issue.

Coronary collateral circulation: The effects of smoking and alcohol

Objective The presence or absence of coronary collaterals is of vital importance during acute ischemia. Smoking and alcohol have been suggested to play a role, but data are scarce. We examined the extent to which smoking and alcohol use affect the presence of coronary collateral circulation. Methods Cross-sectional study in 242 patients, admitted for elective PTCA. Smoking was defined as past or current. Packyears were calculated and categorized into never-smokers (reference-category): <10, 10–19, 20–29, and ≥30 packyears. Alcohol consumption was defined as past or current, and categorized into never-users (reference-category): <1, 1–10, 11–20, and ≥21 units per week (UPW). Collaterals were graded with Rentrop's classification. Coronary collateral presence was defined as Rentrop-grade ≥1. Results Current smoking (odds ratio (OR) 4.17; 95% confidence interval (CI) 1.79–9.71) was positively associated, while packyears of smoking was not related. Current alcohol intake showed a J-shaped tendency with coronary collateral presence, while past moderate alcohol consumption was inversely associated (OR 0.19; 95% CI 0.04–0.98). Conclusions Smoking and (to some extent) alcohol use are associated with collateral presence. The results support the view that life-style factors may affect the formation of coronary collaterals in patients with ischemic cardiac disease.

Reduced pericardial levels of endostatin correlate with collateral development in patients with ischemic heart disease

ObjectivesWe investigated whether pericardial levels of a pro-angiogenic factor (vascular endothelial growth factor, VEGF) or an anti-angiogenic factor (endostatin) related to the presence of coronary collateral circulation in patients with significant coronary artery disease (CAD). BackgroundCoronary collateralization favorably alters the prognosis of patients with occlusive CAD. The specific factors that mediate and maintain collateral formation in coronary vessel occlusion are yet to be identified. MethodsCoronary angiograms from 39 patients undergoing coronary artery bypass surgery were evaluated for the absence of collaterals (n = 20) or the presence of Rentrop classification grade 3 collaterals (n = 19). Pericardial fluid samples were obtained at the time of surgery and were assayed for the VEGF and endostatin by enzyme-linked immunosorbent assay comparing the two groups of patients. ResultsVascular endothelial growth factor levels were not significantly different between the groups (28.86 ± 4.67 pg/ml vs. 24.39 ± 3.08 pg/ml, p = 0.43). However, pericardial fluid endostatin levels were nearly 40% lower in patients with grade 3 collateralization compared with those lacking angiographic evidence of collaterals (15.17 ± 1.87 ng/ml vs. 24.25 ± 2.08 ng/ml, p < 0.0025). ConclusionsPericardial fluid levels of endostatin, but not VEGF, are associated with the presence or absence of collaterals in patients with CAD. These data suggest that the angiogenesis inhibitor endostatin levels may locally modulate coronary collateral formation.

Influence of residual blood flow in the infarct-related artery on ventricular tachycardia after myocardial infarction

Ventricular tachycardia (VT) late after myocardial infarction is generally attributed to reentry due to slowed conduction and heterogeneous refractoriness in surviving myocytes bordering and traversing the infarcted area. 1 Thrombolytic trials and angiographic studies indicate that a patent infarct-related artery (IRA) is associated with lower sudden death mortality and that this benefit may be independent of measurable preservation of global left ventricular function. 2–5 Similarly, the presence of coronary collateral circulation to nonreperfused IRAs is associated with a reduction in infarct size, and a decrease in early ventricular arrhythmias. 6–8 Predictors of VT development after myocardial infarction including inducible arrhythmias at programmed electrical stimulation, 9–11 development of a left ventricular aneurysm and late potentials detected by signal-averaged electrocardiography 12,13 are also favorably influenced by IRA perfusion. To determine if absence of residual IRA flow distinguishes post-myocardial infarction patients with VT, we reviewed coronary angiograms of 14 patients with recurrent VT late after myocardial infarction and 14 matched control patients.

QRS alterations immediately following production of left ventricular free-wall ischemia in dogs.

QRS alterations immediately following production of left ventricular free-wall ischemia in dogs.