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Quantification of collateral flow in humans: a comparison of angiographic, electrocardiographic and hemodynamic
R A van Liebergen1, J J Piek, K T Koch
1Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Hemodynamic variables, including coronary wedge/aortic pressure ratio and collateral blood flow velocity, effectively predict the functional significance of coronary collateral vessels. These measures offer better insights into myocardial ischemia than angiography alone.
Area of Science:
- Cardiology
- Hemodynamics
- Vascular Physiology
Background:
- Limited understanding of hemodynamic quantification for recruitable coronary collateral vessels.
- Assessing collateral vessel function is crucial for managing myocardial ischemia.
Purpose of the Study:
- To evaluate collateral vascular circulation using hemodynamic variables.
- To determine the relationship between hemodynamic parameters and myocardial ischemia.
- To compare the efficacy of hemodynamic assessment versus coronary angiography in evaluating collateral vessels.
Main Methods:
- 63 patients with one-vessel disease underwent coronary angiography and balloon occlusion.
- Coronary wedge/aortic pressure ratio (Pw/Pao) and collateral blood flow velocity were measured using a Doppler guide wire.
- Myocardial ischemia was defined by ST-shift on ECG during occlusion.
Main Results:
- Myocardial ischemia varied across groups based on collateral vessel presence and recruitable capacity.
- Hemodynamic values differed significantly between patients with and without ischemia.
- Pw/Pao and collateral blood flow velocity integral (Vi(col)) were identified as independent predictors of collateral vessel function.
Conclusions:
- Hemodynamic variables are superior to coronary angiography for assessing the functional significance of collateral vessels.
- The Pw/Pao and Vi(col) are reliable predictors of collateral vessel function, providing complementary information.
- This study highlights the importance of hemodynamic assessment in understanding coronary collateral circulation and its impact on myocardial ischemia.
Objectives:
Evaluation of collateral vascular circulation according to hemodynamic variables and its relation to myocardial ischemia.
Background:
There is limited information regarding the hemodynamic quantification of recruitable collateral vessels.
Methods:
Angiography of the donor coronary artery was performed before and during balloon coronary occlusion in 63 patients with one vessel disease. Patients were divided into groups of those with an absence of collateral vessels (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, using a 0.014" Doppler guide wire. Myocardial ischemia was defined as > or =0.1 mV ST-shift on a 12 lead electrocardiogram at 1 min coronary occlusion.
Results:
Myocardial ischemia was present in all patients of group 1, in 14 patients of group 2 and in 3 patients of group 3. Recruitable collateral flow without ischemia showed similar hemodynamic values as in group 3 while these 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 collateral vessels.
Conclusions:
Hemodynamic variables of collateral vascular circulation are better markers of the functional significance of collateral vessels than is coronary 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.