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Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of

G S Werner1, M Ferrari, S Betge

  • 1Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Jena, Germany. gerald.werner@med.uni-jena.de

Circulation
|December 6, 2001
PubMed

Insights

Collateral function in chronic total coronary occlusion (TCO) is better with normal heart muscle function. Impaired function shows time-dependent improvement, but recanalization attenuates collateral flow due to increased resistance.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Myocardial Physiology

Background:

  • Collateral circulation is crucial for maintaining myocardial viability in chronic total coronary occlusion (TCO).
  • Understanding the relationship between myocardial function, occlusion duration, and collateral function is essential for treatment strategies.

Purpose of the Study:

  • To evaluate the correlation between myocardial function and the duration of chronic total coronary occlusion (TCO).
  • To assess the impact of recanalization on collateral function and resistance.

Main Methods:

  • Assessed collateral function using intracoronary Doppler and pressure recordings in 50 patients undergoing TCO recanalization.
  • Measured collateral flow indices (CFI(D), CFI(P)) and resistance indices (R(Coll), R(P)) before and after percutaneous transluminal coronary angioplasty (PTCA).

Main Results:

  • Patients with normokinesia (normal heart muscle movement) had significantly lower collateral and peripheral resistance than those with akinesia (lack of movement).
  • Akinesia with TCO duration ≤3 months showed the highest resistance; longer durations had similar resistance to normokinetic patients.
  • Recanalization significantly decreased collateral flow indices and increased collateral and peripheral resistance, with less attenuation for epicardial collaterals.

Conclusions:

  • Collateral function is superior in TCO patients with preserved regional myocardial function.
  • In patients with impaired function, collateral improvement is time-dependent.
  • Recanalization attenuates recruitable collateral function due to increased resistance.
Abstract

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