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Influence of minimal angiographic visible collateral circulation on myocardial function during PTCA
M Dittel1, H Prachar, W Enenkel
1Medical Department of Cardiology, Krankenhaus Lainz, Vienna, Austria.
Insights
Minimal collateral circulation may offer some protection during percutaneous transluminal coronary angioplasty (PTCA). Patients with RENTROP class 1 collaterals experienced less regional left ventricular dysfunction compared to those without collaterals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Ischemia
Background:
- Collateral circulation plays a role in myocardial protection during coronary artery occlusion.
- The protective effect of minimal collateral circulation (RENTROP class 1) during percutaneous transluminal coronary angioplasty (PTCA) is not fully understood.
Purpose of the Study:
- To investigate the potential protective role of angiographically visible minimal collateral circulation (RENTROP class 1) on myocardial function during elective PTCA of the left anterior descending artery (LAD).
Main Methods:
- Two groups of patients undergoing elective PTCA of the LAD were studied.
- Left ventricular regional function and hemodynamic parameters were assessed.
- Collateral circulation was graded using diagnostic angiograms and visualized during LAD occlusion by injecting contrast into the right coronary artery.
Main Results:
- No significant difference in global left ventricular function was observed between patients with and without minimal collaterals.
- Patients without collaterals showed significantly more pronounced regional left ventricular dysfunction in specific segments.
- Left ventricular end-diastolic pressure increase during ischemia was significantly higher in patients without collaterals compared to those with RENTROP class 1 collaterals.
Conclusions:
- Minimal collateral circulation (RENTROP class 1) may offer some protection against regional left ventricular dysfunction during PTCA.
- Absence of collaterals is associated with greater myocardial impairment during LAD occlusion and PTCA.
Abstract:
The potential protective role of angiographically visible minimal collateral circulation in diagnostic angiograms, not reaching or filling the target vessel (RENTROP class 1), on myocardial function during percutaneous transluminal coronary angioplasty (PTCA), was studied in two groups of patients undergoing elective PTCA of the left anterior descending artery (LAD). In the first study group consisting of 22 patients, influence of collateral circulation class 1 on left ventricular regional function was evaluated. In this group, 14 patients showed no angiographic collaterals and 8 patients showed collateral circulation class 1 in diagnostic angiograms. Increase of end-diastolic and end-systolic volume indices as well as decrease of global left ventricular function was not significantly different inpatients with and without such minimal collateral circulation. In patients without collaterals, the decrease of regional left ventricular function was significantly more pronounced in the left anterior length segment (p less than 0.05) and a trend was observed in the anterolateral (p = 0.059) and apical (p = 0.053) segments. In a second group, consisting of 29 patients, hemodynamic parameters were measured and, in addition to grading of collateral circulation in diagnostic angiograms, angiographically visible collateral circulation was estimated during occlusion of the LAD by injecting contrast materials into the right coronary artery. An increase of angiographically visible collaterals during the ischemic period of various degrees was documented in 26 (90%) of 29 patients. Combining patients of both study groups, increase in left ventricular end-diastolic pressure during ischemia was significantly higher (p less than 0.05) in patients without collaterals on diagnostic angiography (n = 34) than in patients with collateral circulation class 1 (n = 14).(ABSTRACT TRUNCATED AT 250 WORDS)