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PubMed1993

Effects of intracoronary injection of acetylcholine on coronary collateral circulation.

To clarify the effect of intracoronary injection of acetylcholine on coronary collateral circulation, acetylcholine (20 and 50 micrograms) was injected directly into the donor artery of 5 patients with rest angina who had angiographically demonstrable collateral channels. Coronary spasm was defined as severe vasoconstriction (> or = 90% of luminal diameter) with chest pain and/or ischemic ST-segment changes. The intracoronary injection of acetylcholine induced spasm in all the 5 patients. The site of spasm was collateral vessels in 3, and the recipient coronary artery in 2 of the 5 patients. The spasm resolved spontaneously without administration of nitroglycerin. The contralateral intracoronary injection of acetylcholine also induced diffuse coronary spasm in 4 patients. These findings indicate that collateral vessels and recipient coronary arteries of the collateral circulation are susceptible to acetylcholine. Impaired relaxation and vasospastic responses to acetylcholine presumably due to endothelial dysfunction in the collateral and recipient coronary vessels may explain, at least in part, myocardial ischemia in patients with a well-developed collateral circulation.

Acetylcholine↗
PubMed1987

Development of coronary collateral circulation in left circumflex Ameroid-occluded swine myocardium.

Coronary collateral development was examined in 34 pigs after gradual occlusion of the left circumflex coronary artery (LCX) with an Ameroid constrictor. Collateral development was assessed by measurements of myocardial blood flow and regional myocardial function at rest and during exercise over a 16-wk period after placement of the constrictor. Coronary collateral development was adequate to prevent severe infarction and restore blood flow to the collateral-dependent LCX region within 3-7 wk. Infarction averaged 5.0 +/- 1.3% of the LCX region. Blood flows at rest were 1.05 +/- 0.14 and 1.13 +/- 0.15 ml.min-1.g-1 in the subendocardium of the collateral and control regions, respectively, 7 wk postoperatively. Concurrently, collateral vessel development supported normal myocardial function at rest as determined by systolic wall thickening in the LCX region. However, collateral development was limited, since blood flows during moderate and severe exercise were reduced in the LCX region compared with control and left anterior descending and right coronary regions. Blood flow ratios (collateral/control flow) during severe exercise 3 wk postoperatively were 0.23 +/- 0.03 and 0.57 +/- 0.05 in the subendocardium and subepicardium and were constant throughout the 16-wk period throughout the study. Myocardial function of the collateral region also was reduced during exercise and a 30-min recovery period. We suggest that this limited coronary collateral circulation, which develops in response to gradual coronary occlusion in swine, serves as a model for the human collateral circulation for the study of protocols to alter growth and development of coronary collateral vessels.

Animals↗
PubMed1980

An electrographic study on the functional capacity of the coronary collateral circulation in dogs with chronic coronary occlusion.

The functional capacity of coronary collaterals was investigated under resting and stress conditions in 15 dogs with chronic occlusion of the anterior descending coronary artery. ST-elevation in epicardial and intramyocardial electrograms was used for assessing the degree of regional myocardial ischemia. In resting condition, epicardial and intramyocardial electrograms from collateral, intermediate and circumflex areas revealed no significant ischemic changes. In 6 of 15 dogs in which atrial pacing was performed, ST-elevation appeared in electrograms from collateral and intermediate areas. In another 9 dogs, pacing tachycardia produced no significant changes in all electrograms. In these dogs more than 50% constriction of the donor coronary artery was necessary to induce ST-elevation in electrogram from collateral area. These findings indicate that the coronary collateral vessels in dog play beneficial role to prevent the myocardium from ischemic injury under stress condition, although their functional capacity is not comparable to that of normal coronary artery.

Animals↗
PubMed1992

Recent insights into coronary collateral circulation.

The functional significance of coronary collaterals in humans has been debated for many years. Correlations have now been made between the anatomic appearance of coronary collateral vessels visualized at the time of intracoronary thrombolytic therapy during the acute phase of myocardial infarction and the creatine kinase time--activity curve, infarct size, and aneurysm formation. These studies demonstrate a protective role of collaterals in hearts with coronary obstructive disease, showing smaller infarcts, less aneurysm formation, and improved ventricular function compared with patients in whom collaterals were not visualized. There is ample evidence that collaterals respond to myocardial ischemia by opening preexistent channels. When the cardiac myocyte is rendered ischemic, collaterals develop actively by growth with DNA replication and mitosis of endothelial and smooth muscle cells. Heparin-binding growth factors are present in the heart, but their biological activity is quiescent under normal physiological conditions. Once ischemia develops, these factors are activated and become available for receptor occupation, which may initiate angiogenesis after exposure to exogenous heparin. This characteristic of heparin to potentiate the mitogenic activity of acidic fibroblast growth factor has recently been used in the clinical setting as a possible therapeutic modality in patients with coronary artery disease. Patients performing 20 rounds of exercise serially after receiving intravenous injection of heparin showed significantly greater increases in exercise capacity and improvement of clinical symptoms compared with the control group who performed the same exercise without heparin. Further study of neovascularization may lead to a new therapeutic strategy for ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

Temporal evolution of the human coronary collateral circulation after myocardial infarction.

An analysis of the coronary collateral circulation in a consecutive series of 116 postinfarction angiograms from patients with persistent 100% occlusion of their infarct artery is reported. Patients were classified into four groups according to the interval between acute infarction and angiography. Of 42 patients studied within 6 hours of infarction (Group I), 52% had no evidence of any coronary collateral development as compared with only 8% (1 of 16 patients) studied 1 day to 2 weeks after infarction (Group II). Virtually all patients studied beyond 2 weeks after myocardial infarction (14 to 45 days, Group III) and later than 45 days (Group IV) had visible collateral flow. Angiographically "well developed" collateral channels were seen in only 16% of Group I patients compared with 62, 75 and 84% of patients in Groups II to IV, respectively. Of six patients studied twice, on the day of the infarction and 2 weeks later, only one patient had collateral vessels on the day of infarction, whereas all six patients did at follow-up study. Group I patients were studied as part of a randomized acute myocardial infarction reperfusion trial, whereas the other patients were referred for angiography primarily because of post-infarction ischemia. Within the limitations imposed by the patient selection process, it is concluded that well developed coronary collateral vessels are rarely present at the time of infarction. After infarction, they develop rapidly and are generally demonstrable within 2 weeks. It may also be inferred that the preservation of ischemic myocardium by well developed coronary collateral vessels at the time of myocardial infarction may be an uncommon occurrence.

Collateral Circulation↗
PubMed1981

Importance of coronary collateral circulation in interpreting exercise test results.

The importance of the coronary collateral circulation as a cause of false negative exercise tests was studied in 37 patients who had a 90 percent or greater isolated stenosis of the luminal diameter in one major coronary artery. Sixteen patients had large collateral vessels and 21 patients had either minimal or no collateral circulation. Myocardial scintigraphy was performed in 22 of the 37 patients. The final treadmill time was similar in both groups (521 +/- 192 versus 554 +/- 144 seconds [mean +/- standard error of the mean]). The presence and depth of S-T segment depression was not influenced by the degree of collateralization. The sensitivity of the exercise electrocardiogram was greater for patients with disease in the left anterior descending than in the right or left circumflex coronary arteries (95 versus 60 percent, p < 0.03). Among the 22 patients with thallium-201 scintigrams, myocardial perfusion defects were more common in patients without collateral circulation (100 versus 40 percent, p < 0.01) and involved more myocardial segments (p < 0.005). The overall sensitivity of exercise electrocardiography for the detection of single vessel stenosis 90 percent or greater was similar to that of myocardial scintigraphy (81 versus 73 percent). In conclusion, large intercoronary collateral vessels are not a cause of false negative exercise electrocardiograms in patients with single vessel disease but are a common cause of false negative scintigrams. Large collateral vessels may limit the quantity and location of myocardial ischemia, but exercise electrocardiography and thallium-201 scintigraphy may detect different aspects of ischemia.

Adult↗
PubMed2002

[Prevalence and significance of coronary collateral circulation in patients with acute myocardial infarct].

UNLABELLED: Angiograms from consecutive and unselected patients with acute myocardial infarction were studied with respect to the prevalence as well as the significance of coronary collateral circulation to myocardium distal to the acute coronary occlusion. METHODS: Coronary angiograms were obtained from 700 consecutive and unselected patients with an acute transmural infarction within 3.7 +/- 3 hours (0.5-12) of symptom onset. No patient had undergone i.v. thrombolysis prior to angiography. Complete and acute vessel occlusion was found in 626/700 patients (89%). Coronary collaterals were detected and graded using Rentrop's classification. The grade of collateral circulation was related to the clinical course after 30 days and to the global and regional left ventricular wall motion. RESULTS: Collaterals were found in 334 patients (69%); 242 patients (38%) had collateral flow grade 2 or 3. Collaterals were demonstrated more frequently in women vs men and in patients with multivessel disease. The prevalence of collaterals was unrelated to age and the presence of diabetes mellitus. Patients who had angiography within 3 hours of symptom onset had collaterals detected less frequently than patients who had angiography beyond 6 hours (66% vs 75%, p < 0.05). No collaterals were found in 17/37 patients (47%) in cardiogenic shock and inferior MI but in only 30/164 patients (18%, p < 0.01) without shock. Global and regional left ventricular wall motion after 2 weeks was unrelated to the degree of coronary collateral circulation during acute myocardial infarction. CONCLUSION: Collateral circulation to myocardium distal to an acutely occluded coronary artery is detected in 2/3 patients during the acute infarct phase. The absence of collaterals is related to the early occurrence of cardiogenic shock in patients with inferior MI but not to the presence of diabetes mellitus. After direct angioplasty of the infarct vessel, the protective effects of coronary collaterals on chronic LV function remain uncertain.

Aged↗
PubMedDate not supplied

Physiologic assessment of the coronary collateral circulation in transplanted human hearts.

Coronary arteries of transplanted hearts frequently develop a vasculopathy characterized by severe lumenal narrowing in the distal coronary arteries. It has been thought, on the basis of angiographic studies, that the coronary circulation of transplanted hearts with vasculopathy fails to develop collateral vessels normally. To determine the extent of the collateral circulation in transplanted hearts with a significant coronary stenosis, we measured an index of the collateral circulation, the coronary artery occlusion pressure, during single-vessel coronary angioplasty in seven patients with allograft vasculopathy and 18 patients with atherosclerotic disease who did not undergo transplantation. Aortic and coronary artery pressure distal to the stenosis in the epicardial artery were measured during balloon occlusion (> or = 45 seconds). Measurement variability for determination of coronary occlusion pressure was assessed by measuring occlusion pressure on two separate balloon inflations (n = 17). The severity of the dilated stenotic lesion was assessed with quantitative angiography (Reiber-PIE Data method). The indexes of stenosis severity were similar in coronary arteries of transplanted and native hearts. Coronary occlusion pressure measurements were highly reproducible (mean absolute difference between measurements, 1 +/- 1 mm Hg, r = 0.98). Coronary occlusion pressure in transplanted hearts (32 +/- 4 mm Hg) was nearly identical to that measured in coronary arteries of native hearts (29 +/- 2 mm Hg). When vessels with total occlusion were excluded and corrections were made for minor differences in hemodynamics (heart rate and blood pressure) were made, the coronary occlusion pressure in transplanted hearts remained nearly identical to native hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1996

[Effects of nicorandil on coronary collateral circulation depend on the donor arteries].

The effects of nicorandil on coronary collateral circulation during exercise-induced ischemia were compared between the different donor arteries in 13 patients with effort angina, 7 with complete obstruction of the left anterior descending artery (LAD) with well-developed collateral vessels from the right coronary artery (RCA) (LAD group), and 6 with complete occlusion of the RCA (segment 2-3) with well-developed collateral vessels from the LAD (RCA group). Initial percentage thallium (%TI) uptake (thallium-201 single photon emission computed tomography) and washout rate were measured in the anterior, septal and posterior regions during ergometer exercise. The submaximal treadmill exercise test was also performed using a cardiopulmonary monitoring system to measure Vo2 at anaerobic threshold (AT). After the controls were obtained, nicorandil (15 mg/day) was administered for 4 weeks, during which ergometer exercise and treadmill exercise tests were carried out repeatedly. A significant improvement of initial %TI uptake on exercise was observed in the LAD group with nicorandil therapy, but no improvement was shown in the RCA group. The AT significantly increased after nicorandil treatment in the LAD group (13.9 +/- 0.38-->16.8 +/- 1.18 ml/min/kg), reflecting the improvement of cardiac function through the increased collateral flow. However, in the RCA group, it remained unchanged, suggesting no improvement of cardiac function. Nicorandil was effective to increase collateral flow from the RCA, but ineffective on that from the LAD. Nicorandil is an effective coronary dilator and is reported to affect both large and small coronary arteries. The effect on the collateral circulation is dependent on the donor artery supplying different areas. The vasodilator effect of nicorandil is mainly on the LAD, which is large enough to supply blood to a wider area of the heart, rather than the RCA.

Adult↗
PubMedDate not supplied

Contractile performance, mitochondrial function and blood flow distribution in porcine heart with induced coronary collateral circulation.

Progressive stenosis of the proximal left anterior descending coronary artery in young pigs was surgically induced over eight weeks and was accompanied by the development of a coronary collateral circulation originating from the right coronary artery. The antero-apical left ventricular myocardium dependent on this induced collateral blood supply became hypokinetic compared with the other regions of the left ventricle in the same hearts, and compared with the same region in different hearts, where the native circulation exists. Regional myocardial mechanics determined as fractional systolic shortening was 12.5 +/- 1.5% in normal regions, 0.7 +/- 2.4% in collateral-dependent myocardium, and in acutely ischemic myocardium was -2.0 +/- 1.3%, indicative of systolic lengthening. The rate of state 3 respiration of isolated mitochondria was depressed by 20% in collateral regions and by 64% in acutely ischemic regions relative to values obtained in mitochondria from respective normal myocardium (300 natoms of oxygen/min/mg mitochondria protein). Regional myocardial blood flow determined by 15 mu radionuclide labelled spheres revealed subendocardial hypoperfusion of 0.34 +/- 0.11 ml/min/g tissue in the collateral-dependent regions compared to 1.06 +/- 0.26 ml/min/g tissue in the normal regions. Transmural ischemia was observed (less than 0.10 ml/min/g tissue) in regions subjected to acute coronary artery ligation. Light microscopy revealed patchy fibrotic lesions predominately associated with the subendocardial half of the collateral dependent myocardial wall. Accordingly, the hypokinesia of collateral-dependent myocardium is more likely the result of blood flow abnormalities and loss of contractile elements than from mitochondrial dysfunction.

Animals↗
PubMed1991

[Correlations between redistribution areas observed on exercise thallium-201 myocardial SPECT images and the coronary collateral circulations in patients with myocardial infarction].

The significance of coronary collateral circulation for redistribution in the infarcted zone was evaluated in 16 patients with history of myocardial infarction and severe stenosis (> or = 90%) of the coronary artery. Redistribution areas were quantitatively measured using the redistribution ratios and redistribution indices on the infarction-redistribution map obtained by thallium-201 scintigraphy with single photon emission computed tomography. Coronary collateral findings were categorized in 4 classes according to the Rentrop's grading. There was good, positive linear correlation between the redistribution ratio (Y) and collateral grading (X) (Y = 0.21X + 0.10, r = 0.92, p < 0.01). The redistribution index (X) also correlated well with the collateral grading (Y) using a good, positive quadratic equation (Y = 0.32X2 + 0.24X + 0.04, r = 0.89, p < 0.01). These results suggest that the measurements of the redistribution areas in the ischemic zone in myocardial infarction correlated well with collateral perfusion. Collateral perfusion severer than Rentrop's grade 2 markedly reduces the severity of ischemia and increases redistribution areas.

Collateral Circulation↗
PubMed1994

Effect of coronary collateral circulation on myocardial ischemia and ventricular dysfunction.

Although a functional role of coronary collaterals has been continuously debated, we observed the following facts in our studies during intracoronary thrombolytic therapy: (a) Myocardial ischemia is important for the development of collateral circulation, (b) collaterals can perfuse the infarcted myocardium, and (c) the presence of collaterals prevents the left ventricular aneurysm formation in acute myocardial infarction, even when the amount of the salvaged tissue is small. Thus, coronary collaterals are not merely markers of severe ischemia but help to preserve the functional integrity of the myocardium in the presence of coronary obstruction. We then attempted to promote collateralization to treat patients with angina pectoris. Patients with chronic stable effort angina were treated with heparin followed by treadmill exercise twice a day for 10 days. Treadmill capacity was found to improve in association with an increase in coronary collateral circulation. Heparin treatment of ischemic patients was found to be a noninvasive alternative to percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients who are not candidates for invasive procedures.

Collateral Circulation↗
PubMedDate not supplied

[Coronary collateral circulation: its importance and significance in ischemic cardiopathy].

With the purpose of studying coronary collateral circulation and if it has influence in manifestations, complications, prognosis and mortality in patients with ischemic heart disease, we studied 52 patients, 41 male and 11 female, mean age 56 years, who died. All of them had a complete medical record and were seen with regularity until death. They had good quality coronaragraphy and ventriculography. Post-mortem study was done in all of them. They were placed in two groups: group I (27 patients) who had adequate collateral circulation and group II (25 patients) without adequate collateral circulation. We found that group I patients had angina more frequently prior to myocardial infarction (p less than 0.005) with greater duration (30 months). Complications during the acute phase of myocardial infarction were more common in patients without collateral circulation (p less than 0.001). Although we did not find statistically significant differences, we could observe that patients without adequate collateral circulation have less survival, disturbances in ventricular wall mo-motion are more frequently found and there is more incidence of sudden death. There was no significant difference between the apparition of myocardial infarction in patients with or without adequate coronary collateral circulation. Diabetic patients had less collateral circulation than non diabetics (p less than 0.05). We conclude that the protective role of collateral circulation in ischemic heart disease is established, diminishing complications during acute myocardial infarction and providing for longer survival.

Adult↗