Comparison of coronary collateral circulation in diabetic and nondiabetic patients suffering from coronary artery disease (original) (raw)
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Coronary Collateral Circulation
Clinical Cardiology, 1991
The occurrence and influence of coronary collateral circulation and obstruction of the supplying coronary arteries on left ventricular contractility, prevalence of myocardial infarction, and bicycle exercise ergometer test were studied in a random sample of 286 patients with angioprdphically documented coronary artery disease. Collaterals appeared increasingly in all three main coronary arteries with grade of obstruction. The highest prevalence of collatcrals occurred in stenosis of the right coronary artery (60%), followed by the left descending artery (45%); they occurred least in the left circumflex artery (21 74) (p<O.OOl). The frequency of intra-arterial collateral circulation was 4 2 % , 11 %, and 12%, respectively (p<O.OOI). With total occlusion of the left anterior descending coronary artery, 22 % of the patients had normokinetic anterior and apical left ventricular wall when collaterals were present. More often, the inferior wall showed normid contraction with total occlusion of the right coronary artely and collaterals [52 %, p < 0.001 compared with left anterior descending artery (LAD)]. The prevalence of inferior myocardial infarction was 39%, with collateral circulation to the totally occluded right coronary artery. The respective prevalence of anterior infarction and total occlusion in the left coronary artery was 58% (p <0.02). The presence or absence of collaterals had no obvious influence on ST-segment response during bicycle ergometer test. In triple-vessel disease, peak work capacity was better when collaterals to LAD were not jeopardized (427 kpm) than when jeopardized (32 1 kpm) (p<0.02).
The collateral circulation of the heart
BMC Medicine, 2013
The coronary arteries have been regarded as end arteries for decades. However, there are functionally relevant anastomotic vessels, known as collateral arteries, which interconnect epicardial coronary arteries. These vessels provide an alternative source of blood supply to the myocardium in cases of occlusive coronary artery disease. The relevance of these collateral arteries is a matter of ongoing debate, but increasing evidence indicates a relevant protective role in patients with coronary artery disease. The collateral circulation can be assessed by different methods; the gold standard involves intracoronary pressure measurements. While the first clinical trials to therapeutically induce growth of collateral arteries have been unavailing, recent pilot studies using external counterpulsation or growth factors such as granulocyte colony stimulating factor (G-CSF) have shown promising results.
World Journal of Cardiovascular Diseases
Background: Coronary artery disease is highly prevalent in India with onset at a younger age. Coronary collateral circulation plays an important role in protecting myocardium from infarction, preserving myocardial contractility and reducing cardiovascular events. The objective of the present study is to assess the pattern of coronary collateral circulation in known cases of coronary artery disease with correlation to age, gender and degree of occlusion. Method: This is a retrospective study done on 200 preoperative angiograms in patients with coronary artery disease. Patients were classified according to age, gender and degree of obstruction in major vessels. Collateral vessels were graded according to the Rentrop classification. Patients with collaterals were further classified on the basis of intensity of collaterals into 3 groups: those with no collateralization (Grade 0), poor collateralization (Grade 1) and those with adequate collateralization (Grade 2-3). Results: Collateral development was seen in 175 (87.5%) angiograms. Collaterals were seen in 66% for left anterior descending (LAD), 44.5% for circumflex (LCx) and 70.5% for right coronary artery (RCA) block. Coronary collaterals between LAD and posterior descending artery (PDA) via ventricular septal branches were most common pathways. Adequate collaterals were seen in 53% males and 29.3% females (p < 0.001), 53.14% in patients of age > 50 years and in 32% in cases with age < 50 years (p = 0.014) and 54.8% cases with arterial obstruction > 90%. Conclusion: Collateral circulation between LAD and PDA via ventricular septal branches is the commonest pathway to develop. Although prevalence of LAD occlusion is higher but collaterals develop more for RCA occlusion.
Determinants of coronary collateral circulation in patients with coronary artery disease
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2012
Objective: This study aims to identify possible determinants of coronary collaterals in patients with severe coronary artery disease. Methods: The current study has a retrospective cohort design. Seventy four patients with ≥90% stenosis or total occlusion of the left anterior descending artery (LAD) were enrolled; coronary collateral grades, high-sensitive C-reactive protein (hs-CRP), fibrinogen, protein C and S, lipids, uric acid levels and medications applied before coronary angiography were noted and compared. Multiple logistic regression analysis was used for the multivariate analyses of independent variables associated with the development of adequate coronary collateral vessels. Results: The presence of coronary collaterals was significantly higher in males (p=0.018), with higher hs-CRP (p=0.023), prior statin use (p=0.022), and higher Gensini scores (p<0.001). In multiple logistic regression analysis, hs-CRP levels (OR=0.94, 95.0% CI=0.883-1.000, p=0.048), male gender (OR=4.73, 95.0% CI=1.441-15.539, p=0.010) and prior statin usage (OR=4.70, 95.0% CI=1.264-17.452, p=0.021) were identified as independent predictors of coronary collateral development. Conclusion: Male gender, prior statin usage, and higher hs-CRP levels are determinants of coronary collaterals in patients with coronary artery disease.
The Correlation of Collateral Circulation and Age during Acute Ischemic Heart Disease
Backgroundː Coronary collaterals (CC) are alternative sources of blood supply to myocardium jeopardized by Ischemia. Aim: To investigate the dependence and influence of collateral circulation on age during acute ischemic heart disease. Methods: Analysis shows that 673 patients were studied from the SamgoriMedi Clinic (Tbilisi, Georgia) aged 27-94 years (64.7+11.48) with acute coronary syndromes. Basic medical data such as sex, age, cardiovascular risk factors, angina pectoris, revascularization history, echocardiography, and laboratory data were obtained from the patient's medical records. CC vessels were graded according to the Rentrop grading system of 0 to 3. Resultsː The development index of collateral circulations visibly increases with age. Average age increases accordingly as follows: rentrop 0-62.85+12.01, rentrop 1-64.90+10.79, rentrop 2-66.84+10.49, and rentrop 3-69.04+9.68 (p<0.0001). There is positive significant correlation between the development of collateral circulation and age groups r=0.170 ** , p<0.001. The cases of female sex, hypertension, acute MI without ST elevation, CABG frequency (also EF%-35-45%, <35%), and multiple vessel coronary lesion are noticed to increase with age, while the male sex and EF (ejection fraction) >45% cases decreases with age. Conclusion Collateral circulation shows significantly positive correlation with age and female sex. However, it should be mentioned that in elderly patients with a high ejection fraction and normal diastolic function, the development of collateral vessels is low.
Backgroundː Coronary collaterals (CC) are alternative sources of blood supply to myocardium jeopardized by Ischemia. Aim: To investigate the dependence and influence of collateral circulation on age during acute ischemic heart disease. Methods: Analysis shows that 673 patients were studied from the SamgoriMedi Clinic (Tbilisi, Georgia) aged 27-94 years (64.7+11.48) with acute coronary syndromes. Basic medical data such as sex, age, cardiovascular risk factors, angina pectoris, revascularization history, echocardiography, and laboratory data were obtained from the patient's medical records. CC vessels were graded according to the Rentrop grading system of 0 to 3. Resultsː The development index of collateral circulations visibly increases with age. Average age increases accordingly as follows: rentrop 0 -62.85+12.01, rentrop 1 -64.90+10.79, rentrop 2 -66.84+10.49, and rentrop 3 -69.04+9.68 (p<0.0001). There is positive significant correlation between the development of collateral circulation and age groups r=0.170 ** , p<0.001. The cases of female sex, hypertension, acute MI without ST elevation, CABG frequency (also EF% -35-45%, <35%), and multiple vessel coronary lesion are noticed to increase with age, while the male sex and EF (ejection fraction) >45% cases decreases with age. Conclusion Collateral circulation shows significantly positive correlation with age and female sex. However, it should be mentioned that in elderly patients with a high ejection fraction and normal diastolic function, the development of collateral vessels is low.
A brief etymology of the collateral circulation
Arteriosclerosis, thrombosis, and vascular biology, 2014
It is well known that the protective capacity of the collateral circulation falls short in many individuals with ischemic disease of the heart, brain, and lower extremities. In the past 15 years, opportunities created by molecular and genetic tools, together with disappointing outcomes in many angiogenic trials, have led to a significant increase in the number of studies that focus on: understanding the basic biology of the collateral circulation; identifying the mechanisms that limit the collateral circulation's capacity in many individuals; devising methods to measure collateral extent, which has been found to vary widely among individuals; and developing treatments to increase collateral blood flow in obstructive disease. Unfortunately, accompanying this increase in reports has been a proliferation of vague terms used to describe the disposition and behavior of this unique circulation, as well as the increasing misuse of well-ensconced ones by new (and old) students of collat...