Quantification of collateral flow in humans: A comparison of angiographic,electrocardiographic and hemodynamic variables

OBJECTIVES Evaluation of collateral vascular circulation according to hemod ynamic variables and its relation to myocardial ischemia. BACKGROUND There is limited information regarding the hemodynamic quantific ation of recruitable collateral vessels. METHODS Angiography of the donor coronary artery was performed before and d uring balloon coronary occlusion in 63 patients xith one vessel disease. Pa tients were divided into groups of-those with an absence of collateral vess els (group 1, n = 10), those with recruitable collateral vessels (group 2, n = 23) and those with spontaneously visible collateral vessels (group 3, n =30). During balloon inflation the coronary wedge/aortic pressure ratio (Pw /Pao) was determined as were collateral blood flow velocity variables, usin g a 0.014 " Doppler guide wire. Myocardial ischemia was defined as greater than or equal to 0.1 mV ST-shift on a 12 lead electrocardiogram at 1 min co ronary occlusion. RESULTS Myocardial ischemia was present in all patients of group 1, in 14 p atients of group 2 and in 3 patients of group 3. Recruitable collateral Aom without ischemia showed similar hemodynamic values as in group 3 while the se values were similar to group 1 in regard to the presence of recruitable collateral vessels showing ischemia. Logistic regression analysis revealed both Pw/Pao and Vi(col) as independent predictors for the function of colla teral vessels. CONCLUSIONS Hemodynamic variables of collateral vascular circulation are be tter markers of the functional significance of collateral vessels than is c oronary angiography. The total collateral blood flow velocity integral and coronary wedge/aortic pressure ratio are good and independent predictors of the function of collateral vessels producing complementary information. a Am (C) 1999 by the American College of Cardiology.