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Published on: February 13, 2021
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.
Insights
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.
Aims:
The aim of our study in patients with coronary artery disease (CAD) and present, or absent, myocardial ischaemia during coronary occlusion was to test whether (i) left ventricular (LV) filling pressure is influenced by the collateral circulation and, on the other hand, that (ii) its resistance to flow is directly associated with LV filling pressure.
Methods And Results:
In 50 patients with CAD, the following parameters were obtained before and during a 60 s balloon occlusion: LV, aortic (Pao) and coronary pressure (Poccl), flow velocity (Voccl), central venous pressure (CVP), and coronary flow velocity after coronary angioplasty (V(Ø-occl)). The following variables were determined and analysed at 10 s intervals during occlusion, and at 60 s of occlusion: LV end-diastolic pressure (LVEDP), velocity-derived (CFIv) and pressure-derived collateral flow index (CFIp), coronary collateral (Rcoll), and peripheral resistance index to flow (Rperiph). Patients with ECG signs of ischaemia during coronary occlusion (insufficient collaterals, n = 33) had higher values of LVEDP over the entire course of occlusion than those without ECG signs of ischaemia during occlusion (sufficient collaterals, n = 17). Despite no ischaemia in the latter, there was an increase in LVEDP from 20 to 60 s of occlusion. In patients with insufficient collaterals, CFIv decreased and CFIp increased during occlusion. Beyond an occlusive LVEDP > 27 mmHg, Rcoll and Rperiph increased as a function of LVEDP.
Conclusion:
Recruitable collaterals are reciprocally tied to LV filling pressure during occlusion. If poorly developed, they affect it via myocardial ischaemia; if well grown, LV filling pressure still increases gradually during occlusion despite the absence of ischaemia indicating transmission of collateral perfusion pressure to the LV. With low, but not high, collateral flow, resistance to collateral as well as coronary peripheral flow is related to LV filling pressure in the high range.
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