Gs. Werner et al., Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion, CIRCULATION, 104(23), 2001, pp. 2784-2790
Citations number
33
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Collateral circulation can maintain myocardial function and viab
ility in chronic total coronary occlusion (TCO). The present study evaluate
s the relation of myocardial function and duration of occlusion to collater
al function.
Methods and Results-A total of 50 patients underwent a successful recanaliz
ation of a TCO (>4 weeks' duration). Collateral function was assessed by in
tracoronary Doppler and pressure recordings before the first balloon inflat
ion and after PTCA had been completed. Collateral function was assessed by
Doppler- (CFID) and pressure-derived collateral flow indices (CFIP), as wel
l as indices of collateral (R-Coll) and peripheral resistance (R-P). Patien
ts with normokinesia had lower R-Coll (4.9 +/-2.5 versus 11.8 +/-8.2 mm Hg
. cm(-1) . s(-1); P=0.033) and lower R-P (3.8 +/-1.9 versus 6.1 +/-4.1 min
Hg . cm(-1) . s(-1); P=0.031) than those with akinesia. Patients with akine
sia and a TCO duration of less than or equal to3 months had the highest R-C
oll and R-P, whereas those with akinesia and a longer TCO duration had simi
lar collateral function as patients with normokinesia, After PTCA, CFID and
CFIP decreased from 0.37 +/-0.20 to 0.21 +/-0.17 (P <0.001) and from 0.44
+/-0.12 to 0.36 +/-0.11 (P <0.001), respectively, With an increase in R-Col
l of 139 +/- 28% (P <0.001) and R-P by 65 +/- 99% (P=0.003). This attenuati
on of collateral function was less pronounced with epicardial collaterals t
han with intramyocardial collaterals.
Conclusions-Collateral function was better in patients with TCO and normal
regional function than in those with impaired regional function. In the lat
ter group, collateral function improvement was time dependent. After recana
lization, the recruitable collateral function was attenuated because of an
increase of R-Coll and R-P.