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Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral
Stefano F de Marchi1, Philipp Oswald, Stephan Windecker
1Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland.
European Heart Journal
|December 25, 2004
Summary
Coronary artery disease (CAD) patients with poor collateral circulation experience higher left ventricular (LV) filling pressures during occlusion due to myocardial ischemia. Even with good collaterals, LV filling pressure rises, indicating its link to collateral flow resistance.
Area of Science:
- Cardiology
- Vascular Biology
- Physiology
Background:
- Coronary artery disease (CAD) impacts myocardial perfusion.
- Left ventricular (LV) filling pressure is a critical hemodynamic parameter.
- The role of collateral circulation in modulating LV filling pressure during ischemia is not fully understood.
Purpose of the Study:
- To investigate the influence of collateral circulation on LV filling pressure in CAD patients.
- To determine the relationship between collateral resistance and LV filling pressure during coronary occlusion.
Main Methods:
- Fifty patients with CAD underwent 60-second balloon occlusion.
- Measurements included LV pressure, aortic pressure, coronary pressure, flow velocity, and central venous pressure.
- Collateral flow index (CFIv, CFIp), collateral resistance (Rcoll), and peripheral resistance (Rperiph) were analyzed during occlusion.
Main Results:
- Patients with ECG-indicated ischemia (insufficient collaterals) had higher LV end-diastolic pressure (LVEDP) during occlusion.
- LVEDP increased even in patients without ischemia (sufficient collaterals).
- Collateral resistance (Rcoll) and peripheral resistance (Rperiph) increased with LVEDP > 27 mmHg in insufficient collateral groups.
Conclusions:
- Recruitable collaterals and LV filling pressure are reciprocally related in CAD.
- Poor collaterals increase LV filling pressure via ischemia; well-developed collaterals still lead to gradual pressure increases.
- Collateral and peripheral resistance are linked to high-range LV filling pressure with low collateral flow.
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