Rainer Zbinden | Bern University (original) (raw)

Papers by Rainer Zbinden

Research paper thumbnail of Wohin sind die Elektroden verschwunden?

Research paper thumbnail of Is myocardial contrast echocardiography ready to assume 'gold standard' status for quantification of collateral flow in humans? Authors' reply

European Heart Journal, 2006

Research paper thumbnail of Abstract 2806: Percutaneous Intervention Leads to a Reduction in "Minimum" Microvascular Resistance

Circulation, Oct 31, 2006

Research paper thumbnail of Collateral vessel physiology and functional impact??? experimental evidence of collateral behaviour

Coronary Artery Disease, Dec 1, 2004

The existence and recruitment of collateral vessels within the coronary circulation may account f... more The existence and recruitment of collateral vessels within the coronary circulation may account for the tremendous variability in presentation, symptoms and outcome in patients with coronary atherosclerosis. Multiple episodes of ischemia have been found to produce the stimuli necessary for the growth of new vessels which result in collateral blood flow. Furthermore, there is also a subset of patients with readily recruitable collateral vessels that function to limit myocardial necrosis during an acute ischemic event. Promising early studies have utilized angiogenic growth factors as a means to stimulate collateral growth, bringing a renewal interest in their assessment and significance. We review, in brief, the significance and understanding of the development of coronary collaterals as well as the available means to assess them.

Research paper thumbnail of Cardiac magnetic resonance imaging in the diagnosis of anterolateral left ventricular ballooning, a variant of classic takotsubo cardiomyopathy

Case reports in cardiology, 2012

Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of t... more Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks.

Research paper thumbnail of Perimyocarditis and myocardial infarction: A rare manifestation of Churg-Strauss syndrome

Experimental and clinical cardiology, 2012

The present article reports a case involving a 58-year-old man without cardiovascular risk factor... more The present article reports a case involving a 58-year-old man without cardiovascular risk factors who was admitted to hospital with acute coronary syndrome. Coronary angiography revealed high-grade arteriosclerotic stenosis of the mid-left anterior descending coronary artery and 80% proximal intermediate branch stenosis, which were treated using three drug-eluting stents. Churg-Strauss syndrome was diagnosed based on the patient's history of asthma, sinusitis, eosinophilia, nasal polyps, transient radiological pulmonary infiltrations and transient paresthesia over the left tibia, and eosinophilic pericardial effusion and eosinophilic infiltrations revealed in a myocardial biopsy. Treatment with prednisone was initiated, followed by treatment with cyclophosphamide. Eosinophil levels returned to normal after nine days of treatment. There is evidence that Churg-Strauss syndrome may promote arteriosclerosis.

Research paper thumbnail of Coronary aneurysm formation in a patient early after everolimus-eluting stent implantation

The Journal of invasive cardiology, 2008

Coronary aneurysm formation after drug-eluting stent (DES) implantation is a rare complication wi... more Coronary aneurysm formation after drug-eluting stent (DES) implantation is a rare complication with late stent thrombosis as a potentially fatal sequela. One possible mechanism involved in aneurysm formation is thought to be late-acquired stent malapposition due to a local inflammatory response to the polymer and/or the drug. Coronary aneurysm formation has been documented with sirolimus- and paclitaxel-eluting stents. We report a case of coronary aneurysm formation in a patient with an everolimus-eluting stent (EES; Xience(R) Abbott Vascular, Redwood City, California) relatively early (3 months) after stent implantation. This case illustrates that even with second-generation DES like the EES, which is thought to be highly biocompatible, there can be adverse reactions to the polymer and/or to the drug.

Research paper thumbnail of Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable polymer everolimus-eluting stent for percutaneous coronary revascularisation (BIOSCIENCE): a randomised, single-blind, non-inferiority trial

The Lancet, 2014

Background Refi nements in stent design aff ecting strut thickness, surface polymer, and drug rel... more Background Refi nements in stent design aff ecting strut thickness, surface polymer, and drug release have improved clinical outcomes of drug-eluting stents. We aimed to compare the safety and effi cacy of a novel, ultrathin strut cobalt-chromium stent releasing sirolimus from a biodegradable polymer with a thin strut durable polymer everolimus-eluting stent.

Research paper thumbnail of Safety and Efficacy of Subcutaneous-Only Granulocyte-Macrophage Colony-Stimulating Factor for Collateral Growth Promotion in Patients With Coronary Artery Disease

Journal of the American College of Cardiology, 2005

This study was designed to investigate the safety and efficacy of a short-term subcutaneousonly g... more This study was designed to investigate the safety and efficacy of a short-term subcutaneousonly granulocyte-macrophage colony-stimulating factor (GM-CSF) protocol for coronary collateral growth promotion. BACKGROUND The safety and efficacy of an exclusively systemic application of GM-CSF in patients with coronary artery disease (CAD) and collateral artery promotion has not been studied so far.

Research paper thumbnail of Coronary Collateral Function Long After Drug-Eluting Stent Implantation

Journal of the American College of Cardiology, 2007

This study was designed to compare coronary collateral function in patients after bare-metal sten... more This study was designed to compare coronary collateral function in patients after bare-metal stent (BMS) or drug-eluting stent (DES) implantation.

Research paper thumbnail of 1045-198 Influence of diabetes mellitus on coronary collateral flow: A definite answer to a rather elderly controversy

Journal of the American College of Cardiology, 2004

lytic myofibers (IIb + IIx), and an overall decrease in capillary density was observed in CSQ/CHF... more lytic myofibers (IIb + IIx), and an overall decrease in capillary density was observed in CSQ/CHF mice compared to WT littermates. Analysis of fiber type-specific capillary density revealed an increase in type IIa myofiber capillary density and a concomitant decrease in type IIb + IIx myofiber capillary density in the CSQ/CHF mice. Conclusion. These results suggest that chronic heart failure causes skeletal muscle fiber type switching and dysregulation of angiogenesis in a fiber type-specific manner. Furthermore, these results support the use of the CSQ/CHF mouse model to further study the role of skeletal muscle maladaptation in chronic heart failure and to explore potential therapeutic targets.

Research paper thumbnail of 1045-190 Documentation of exercise-induced coronary collateral growth in humans

Journal of the American College of Cardiology, 2004

ABSTRACTS -Vascular Disease, Hypertension, and Prevention 457A Vascular Disease, Hypertension, an... more ABSTRACTS -Vascular Disease, Hypertension, and Prevention 457A Vascular Disease, Hypertension, and Prevention and IGF-1. RV mRNA levels were linearly related (p<0.01) with those of the LV, both for ACE (r=+0.88) and . The present study showed that LV dysfunction in a model of selective RV overload is accompanied by biventricular activation of regulatory (ACE and ET-1) systems, while counter-regulatory BNP is selectively activated in the RV. These findings might add to the understanding of the relative importance of load and autocrine/paracrine activation in the progression to heart failure.

Research paper thumbnail of Silent ischemia normalized for coronary collateral function in patients with and without diabetes mellitus

International Journal of Cardiology, 2011

Research paper thumbnail of Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up

Heart, 2011

Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in dive... more Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in divers. Design Prospective, non-randomised, longitudinal threearm study. Setting Tertiary referral centre. Population 104 scuba divers with a history of major decompression illness (DCI). Intervention Transcutaneous PFO closure. Main outcome measures Baseline and three follow-up examinations with a questionnaire about health status and diving habits/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations.

Research paper thumbnail of Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner

Research paper thumbnail of Stem cells to repair the broken heart: much ado about nothing?

Research paper thumbnail of Coronary collateral flow and peripheral blood monocyte concentration in patients treated with granulocyte-macrophage colony stimulating factor

Heart, 2004

E stablished options for revascularisation of coronary artery disease (CAD) are angioplasty or by... more E stablished options for revascularisation of coronary artery disease (CAD) are angioplasty or bypass surgery, both of which are unsuitable in about one in five patients because of the severity of atherosclerosis, comorbidities, or both. An alternative therapeutic option is to promote the endogenous development of collateral vessels.

Research paper thumbnail of Non-invasive gene-expression-based detection of well-developed collateral function in individuals with and without coronary artery disease

Heart, 2009

In patients with coronary artery disease (CAD), a well grown collateral circulation has been show... more In patients with coronary artery disease (CAD), a well grown collateral circulation has been shown to be important. The aim of this prospective study using peripheral blood monocytes was to identify marker genes for an extensively grown coronary collateral circulation. Collateral flow index (CFI) was obtained invasively by angioplasty pressure sensor guidewire in 160 individuals (110 patients with CAD, and 50 individuals without CAD). RNA was extracted from monocytes followed by microarray-based gene-expression analysis. 76 selected genes were analysed by real-time polymerase chain reaction (PCR). A receiver operating characteristics analysis based on differential gene expression was then performed to separate individuals with poor (CFI&lt;0.21) and well-developed collaterals (CFI&gt;or=0.21) Thereafter, the influence of the chemokine MCP-1 on the expression of six selected genes was tested by PCR. The expression of 203 genes significantly correlated with CFI (p = 0.000002-0.00267) in patients with CAD and 56 genes in individuals without CAD (p = 00079-0.0430). Biological pathway analysis revealed 76 of those genes belonging to four different pathways: angiogenesis, integrin-, platelet-derived growth factor-, and transforming growth factor beta-signalling. Three genes in each subgroup differentiated with high specificity among individuals with low and high CFI (&gt;or=0.21). Two out of these genes showed pronounced differential expression between the two groups after cell stimulation with MCP-1. Genetic factors play a role in the formation and the preformation of the coronary collateral circulation. Gene expression analysis in peripheral blood monocytes can be used for non-invasive differentiation between individuals with poorly and with well grown collaterals. MCP-1 can influence the arteriogenic potential of monocytes.

Research paper thumbnail of Influence of diabetes mellitus on coronary collateral flow: an answer to an old controversy

Heart, 2005

Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accura... more Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accurate means of collateral flow measurement in a large population with variable degrees of coronary artery disease. Methods: 200 patients (mean (SD) age 64 (9) years; 100 diabetic and 100 non-diabetic) were enrolled in the study. Coronary collateral flow was assessed in 174 stenotic and in 26 angiographically normal vessels with a pressure guidewire (n = 131), Doppler guidewire (n = 36), or both (n = 33) to calculate pressure or flow velocity derived collateral flow index (CFI). Diabetic patients were perfectly matched with a non-diabetic control group for clinical, haemodynamic, and angiographic parameters. Results: CFI did not differ between the diabetic and the non-diabetic patients (0.21 (0.12) v 0.19 (0.13), not significant). Likewise, CFI did not differ when only angiographically normal vessels (0.20 (0.09) v 0.15 (0.08), not significant) or chronic total coronary occlusions (0.30 (0.14) v 0.30 (0.17), not significant) were compared. Fewer patients in the diabetic group tended to have angina pectoris during the one minute vessel occlusion (60 diabetic v 69 non-diabetic patients, p = 0.15). Conclusion: Quantitatively measured coronary CFI did not differ between diabetic and non-diabetic patients with stable coronary artery disease.

Research paper thumbnail of Coronary collateral flow in response to endurance exercise training

European Journal of Cardiovascular Prevention & Rehabilitation, 2007

In humans, it is not known whether physical endurance exercise training promotes coronary collate... more In humans, it is not known whether physical endurance exercise training promotes coronary collateral growth. The following hypotheses were tested: the expected collateral flow reduction after percutaneous coronary intervention of a stenotic lesion is prevented by endurance exercise training; collateral flow supplied to an angiographically normal coronary artery improves in response to exercise training; there is a direct relationship between the change of fitness after training and the coronary collateral flow change. Forty patients (age 61+/-8 years) underwent a 3-month endurance exercise training program with baseline and follow-up assessments of coronary collateral flow. Patients were divided into an exercise training group (n=24) and a sedentary group (n=16) according to the fact whether they adhered or not to the prescribed exercise program, and whether or not they showed increased endurance (VO2max in ml/min per kg) and performance (W/kg) during follow-up versus baseline bicycle spiroergometry. Collateral flow index (no unit) was obtained using pressure sensor guidewires positioned in the coronary artery undergoing percutaneous coronary intervention and in a normal vessel. In the vessel initially undergoing percutaneous coronary intervention, there was an increase in collateral flow index among exercising but not sedentary patients from 0.155+/-0.081 to 0.204+/-0.056 (P=0.03) and from 0.189+/-0.084 to 0.212+/-0.077 (NS), respectively. In the normal vessel, collateral flow index changes were from 0.176+/-0.075 to 0.227+/-0.070 in the exercise group (P=0.0002), and from 0.219+/-0.103 to 0.238+/-0.086 in the sedentary group (NS). A direct correlation existed between the change in collateral flow index from baseline to follow-up and the respective alteration of VO2max (P=0.007) and Watt (P=0.03). A 3-month endurance exercise training program augments coronary collateral supply to normal vessels, and even to previously stenotic arteries having undergone percutaneous coronary intervention before initiating the program. There appears to be a dose-response relation between coronary collateral flow augmentation and exercise capacity gained.

Research paper thumbnail of Wohin sind die Elektroden verschwunden?

Research paper thumbnail of Is myocardial contrast echocardiography ready to assume 'gold standard' status for quantification of collateral flow in humans? Authors' reply

European Heart Journal, 2006

Research paper thumbnail of Abstract 2806: Percutaneous Intervention Leads to a Reduction in "Minimum" Microvascular Resistance

Circulation, Oct 31, 2006

Research paper thumbnail of Collateral vessel physiology and functional impact??? experimental evidence of collateral behaviour

Coronary Artery Disease, Dec 1, 2004

The existence and recruitment of collateral vessels within the coronary circulation may account f... more The existence and recruitment of collateral vessels within the coronary circulation may account for the tremendous variability in presentation, symptoms and outcome in patients with coronary atherosclerosis. Multiple episodes of ischemia have been found to produce the stimuli necessary for the growth of new vessels which result in collateral blood flow. Furthermore, there is also a subset of patients with readily recruitable collateral vessels that function to limit myocardial necrosis during an acute ischemic event. Promising early studies have utilized angiogenic growth factors as a means to stimulate collateral growth, bringing a renewal interest in their assessment and significance. We review, in brief, the significance and understanding of the development of coronary collaterals as well as the available means to assess them.

Research paper thumbnail of Cardiac magnetic resonance imaging in the diagnosis of anterolateral left ventricular ballooning, a variant of classic takotsubo cardiomyopathy

Case reports in cardiology, 2012

Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of t... more Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks.

Research paper thumbnail of Perimyocarditis and myocardial infarction: A rare manifestation of Churg-Strauss syndrome

Experimental and clinical cardiology, 2012

The present article reports a case involving a 58-year-old man without cardiovascular risk factor... more The present article reports a case involving a 58-year-old man without cardiovascular risk factors who was admitted to hospital with acute coronary syndrome. Coronary angiography revealed high-grade arteriosclerotic stenosis of the mid-left anterior descending coronary artery and 80% proximal intermediate branch stenosis, which were treated using three drug-eluting stents. Churg-Strauss syndrome was diagnosed based on the patient's history of asthma, sinusitis, eosinophilia, nasal polyps, transient radiological pulmonary infiltrations and transient paresthesia over the left tibia, and eosinophilic pericardial effusion and eosinophilic infiltrations revealed in a myocardial biopsy. Treatment with prednisone was initiated, followed by treatment with cyclophosphamide. Eosinophil levels returned to normal after nine days of treatment. There is evidence that Churg-Strauss syndrome may promote arteriosclerosis.

Research paper thumbnail of Coronary aneurysm formation in a patient early after everolimus-eluting stent implantation

The Journal of invasive cardiology, 2008

Coronary aneurysm formation after drug-eluting stent (DES) implantation is a rare complication wi... more Coronary aneurysm formation after drug-eluting stent (DES) implantation is a rare complication with late stent thrombosis as a potentially fatal sequela. One possible mechanism involved in aneurysm formation is thought to be late-acquired stent malapposition due to a local inflammatory response to the polymer and/or the drug. Coronary aneurysm formation has been documented with sirolimus- and paclitaxel-eluting stents. We report a case of coronary aneurysm formation in a patient with an everolimus-eluting stent (EES; Xience(R) Abbott Vascular, Redwood City, California) relatively early (3 months) after stent implantation. This case illustrates that even with second-generation DES like the EES, which is thought to be highly biocompatible, there can be adverse reactions to the polymer and/or to the drug.

Research paper thumbnail of Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable polymer everolimus-eluting stent for percutaneous coronary revascularisation (BIOSCIENCE): a randomised, single-blind, non-inferiority trial

The Lancet, 2014

Background Refi nements in stent design aff ecting strut thickness, surface polymer, and drug rel... more Background Refi nements in stent design aff ecting strut thickness, surface polymer, and drug release have improved clinical outcomes of drug-eluting stents. We aimed to compare the safety and effi cacy of a novel, ultrathin strut cobalt-chromium stent releasing sirolimus from a biodegradable polymer with a thin strut durable polymer everolimus-eluting stent.

Research paper thumbnail of Safety and Efficacy of Subcutaneous-Only Granulocyte-Macrophage Colony-Stimulating Factor for Collateral Growth Promotion in Patients With Coronary Artery Disease

Journal of the American College of Cardiology, 2005

This study was designed to investigate the safety and efficacy of a short-term subcutaneousonly g... more This study was designed to investigate the safety and efficacy of a short-term subcutaneousonly granulocyte-macrophage colony-stimulating factor (GM-CSF) protocol for coronary collateral growth promotion. BACKGROUND The safety and efficacy of an exclusively systemic application of GM-CSF in patients with coronary artery disease (CAD) and collateral artery promotion has not been studied so far.

Research paper thumbnail of Coronary Collateral Function Long After Drug-Eluting Stent Implantation

Journal of the American College of Cardiology, 2007

This study was designed to compare coronary collateral function in patients after bare-metal sten... more This study was designed to compare coronary collateral function in patients after bare-metal stent (BMS) or drug-eluting stent (DES) implantation.

Research paper thumbnail of 1045-198 Influence of diabetes mellitus on coronary collateral flow: A definite answer to a rather elderly controversy

Journal of the American College of Cardiology, 2004

lytic myofibers (IIb + IIx), and an overall decrease in capillary density was observed in CSQ/CHF... more lytic myofibers (IIb + IIx), and an overall decrease in capillary density was observed in CSQ/CHF mice compared to WT littermates. Analysis of fiber type-specific capillary density revealed an increase in type IIa myofiber capillary density and a concomitant decrease in type IIb + IIx myofiber capillary density in the CSQ/CHF mice. Conclusion. These results suggest that chronic heart failure causes skeletal muscle fiber type switching and dysregulation of angiogenesis in a fiber type-specific manner. Furthermore, these results support the use of the CSQ/CHF mouse model to further study the role of skeletal muscle maladaptation in chronic heart failure and to explore potential therapeutic targets.

Research paper thumbnail of 1045-190 Documentation of exercise-induced coronary collateral growth in humans

Journal of the American College of Cardiology, 2004

ABSTRACTS -Vascular Disease, Hypertension, and Prevention 457A Vascular Disease, Hypertension, an... more ABSTRACTS -Vascular Disease, Hypertension, and Prevention 457A Vascular Disease, Hypertension, and Prevention and IGF-1. RV mRNA levels were linearly related (p<0.01) with those of the LV, both for ACE (r=+0.88) and . The present study showed that LV dysfunction in a model of selective RV overload is accompanied by biventricular activation of regulatory (ACE and ET-1) systems, while counter-regulatory BNP is selectively activated in the RV. These findings might add to the understanding of the relative importance of load and autocrine/paracrine activation in the progression to heart failure.

Research paper thumbnail of Silent ischemia normalized for coronary collateral function in patients with and without diabetes mellitus

International Journal of Cardiology, 2011

Research paper thumbnail of Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up

Heart, 2011

Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in dive... more Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in divers. Design Prospective, non-randomised, longitudinal threearm study. Setting Tertiary referral centre. Population 104 scuba divers with a history of major decompression illness (DCI). Intervention Transcutaneous PFO closure. Main outcome measures Baseline and three follow-up examinations with a questionnaire about health status and diving habits/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations.

Research paper thumbnail of Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner

Research paper thumbnail of Stem cells to repair the broken heart: much ado about nothing?

Research paper thumbnail of Coronary collateral flow and peripheral blood monocyte concentration in patients treated with granulocyte-macrophage colony stimulating factor

Heart, 2004

E stablished options for revascularisation of coronary artery disease (CAD) are angioplasty or by... more E stablished options for revascularisation of coronary artery disease (CAD) are angioplasty or bypass surgery, both of which are unsuitable in about one in five patients because of the severity of atherosclerosis, comorbidities, or both. An alternative therapeutic option is to promote the endogenous development of collateral vessels.

Research paper thumbnail of Non-invasive gene-expression-based detection of well-developed collateral function in individuals with and without coronary artery disease

Heart, 2009

In patients with coronary artery disease (CAD), a well grown collateral circulation has been show... more In patients with coronary artery disease (CAD), a well grown collateral circulation has been shown to be important. The aim of this prospective study using peripheral blood monocytes was to identify marker genes for an extensively grown coronary collateral circulation. Collateral flow index (CFI) was obtained invasively by angioplasty pressure sensor guidewire in 160 individuals (110 patients with CAD, and 50 individuals without CAD). RNA was extracted from monocytes followed by microarray-based gene-expression analysis. 76 selected genes were analysed by real-time polymerase chain reaction (PCR). A receiver operating characteristics analysis based on differential gene expression was then performed to separate individuals with poor (CFI&lt;0.21) and well-developed collaterals (CFI&gt;or=0.21) Thereafter, the influence of the chemokine MCP-1 on the expression of six selected genes was tested by PCR. The expression of 203 genes significantly correlated with CFI (p = 0.000002-0.00267) in patients with CAD and 56 genes in individuals without CAD (p = 00079-0.0430). Biological pathway analysis revealed 76 of those genes belonging to four different pathways: angiogenesis, integrin-, platelet-derived growth factor-, and transforming growth factor beta-signalling. Three genes in each subgroup differentiated with high specificity among individuals with low and high CFI (&gt;or=0.21). Two out of these genes showed pronounced differential expression between the two groups after cell stimulation with MCP-1. Genetic factors play a role in the formation and the preformation of the coronary collateral circulation. Gene expression analysis in peripheral blood monocytes can be used for non-invasive differentiation between individuals with poorly and with well grown collaterals. MCP-1 can influence the arteriogenic potential of monocytes.

Research paper thumbnail of Influence of diabetes mellitus on coronary collateral flow: an answer to an old controversy

Heart, 2005

Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accura... more Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accurate means of collateral flow measurement in a large population with variable degrees of coronary artery disease. Methods: 200 patients (mean (SD) age 64 (9) years; 100 diabetic and 100 non-diabetic) were enrolled in the study. Coronary collateral flow was assessed in 174 stenotic and in 26 angiographically normal vessels with a pressure guidewire (n = 131), Doppler guidewire (n = 36), or both (n = 33) to calculate pressure or flow velocity derived collateral flow index (CFI). Diabetic patients were perfectly matched with a non-diabetic control group for clinical, haemodynamic, and angiographic parameters. Results: CFI did not differ between the diabetic and the non-diabetic patients (0.21 (0.12) v 0.19 (0.13), not significant). Likewise, CFI did not differ when only angiographically normal vessels (0.20 (0.09) v 0.15 (0.08), not significant) or chronic total coronary occlusions (0.30 (0.14) v 0.30 (0.17), not significant) were compared. Fewer patients in the diabetic group tended to have angina pectoris during the one minute vessel occlusion (60 diabetic v 69 non-diabetic patients, p = 0.15). Conclusion: Quantitatively measured coronary CFI did not differ between diabetic and non-diabetic patients with stable coronary artery disease.

Research paper thumbnail of Coronary collateral flow in response to endurance exercise training

European Journal of Cardiovascular Prevention & Rehabilitation, 2007

In humans, it is not known whether physical endurance exercise training promotes coronary collate... more In humans, it is not known whether physical endurance exercise training promotes coronary collateral growth. The following hypotheses were tested: the expected collateral flow reduction after percutaneous coronary intervention of a stenotic lesion is prevented by endurance exercise training; collateral flow supplied to an angiographically normal coronary artery improves in response to exercise training; there is a direct relationship between the change of fitness after training and the coronary collateral flow change. Forty patients (age 61+/-8 years) underwent a 3-month endurance exercise training program with baseline and follow-up assessments of coronary collateral flow. Patients were divided into an exercise training group (n=24) and a sedentary group (n=16) according to the fact whether they adhered or not to the prescribed exercise program, and whether or not they showed increased endurance (VO2max in ml/min per kg) and performance (W/kg) during follow-up versus baseline bicycle spiroergometry. Collateral flow index (no unit) was obtained using pressure sensor guidewires positioned in the coronary artery undergoing percutaneous coronary intervention and in a normal vessel. In the vessel initially undergoing percutaneous coronary intervention, there was an increase in collateral flow index among exercising but not sedentary patients from 0.155+/-0.081 to 0.204+/-0.056 (P=0.03) and from 0.189+/-0.084 to 0.212+/-0.077 (NS), respectively. In the normal vessel, collateral flow index changes were from 0.176+/-0.075 to 0.227+/-0.070 in the exercise group (P=0.0002), and from 0.219+/-0.103 to 0.238+/-0.086 in the sedentary group (NS). A direct correlation existed between the change in collateral flow index from baseline to follow-up and the respective alteration of VO2max (P=0.007) and Watt (P=0.03). A 3-month endurance exercise training program augments coronary collateral supply to normal vessels, and even to previously stenotic arteries having undergone percutaneous coronary intervention before initiating the program. There appears to be a dose-response relation between coronary collateral flow augmentation and exercise capacity gained.