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Coronary collateral circulation in coronary artery disease and systemic hypertension
Z S Kyriakides1, D T Kremastinos, N A Michelakakis
1Department of Cardiology, Hippokration Hospital, Athens Unversity Medical School, Greece.
Insights
Systemic hypertension in patients with coronary artery disease is linked to enhanced coronary collateral circulation. This increase in collateral blood flow correlates with greater left ventricular wall thickness in hypertensive individuals.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary collateral circulation's role in systemic hypertension is not well understood.
- Systemic hypertension is a major risk factor for coronary artery disease.
Purpose of the Study:
- To investigate the relationship between systemic hypertension, left ventricular hypertrophy, and coronary collateral circulation.
- To determine if hypertension influences the extent and functional capacity of coronary collateral circulation.
Main Methods:
- Study included 313 patients with coronary artery disease and significant coronary artery obstruction.
- Patients were divided into hypertensive (n=61) and normotensive (n=252) groups.
- Coronary collateral circulation was evaluated in relation to systemic hypertension and left ventricular hypertrophy.
Main Results:
- Hypertensive patients exhibited more severe angina and less myocardial infarction history.
- Left ventricular wall thickness was significantly greater in the hypertensive group.
- Hypertensive patients demonstrated more extensive coronary collateral circulation, positively correlating with left ventricular wall thickness.
Conclusions:
- Systemic hypertension is associated with increased coronary collateral circulation in patients with coronary artery disease.
- The degree of left ventricular wall thickness is a key factor in this augmented collateralization.
- Findings suggest a compensatory mechanism in hypertensive hearts facing coronary artery disease.
Abstract:
The extent and functional capacity of coronary collateral circulation in patients with systemic hypertension has not been elucidated. In the present study, 313 patients with coronary artery disease were studied to evaluate coronary collateral circulation in relation to the presence of systemic hypertension and left ventricular hypertrophy. Patients had greater than or equal to 95% diameter luminal obstruction of either the left anterior descending or the right coronary artery. Patients were classified into 2 groups: The hypertensive group consisted of 61 patients, mean age 55 +/- 9 years, with systemic hypertension, and the normotensive group consisted of 252 patients, mean age 53 +/- 8 years, without hypertension. The hypertensive group had more severe angina pectoris and less history of healed myocardial infarction than the normotensive group (p less than 0.001). Left ventricular wall thickness was 1.26 +/- 0.1 cm in the hypertensive and 1.03 +/- 0.06 cm in the normotensive group (p less than 0.001). The hypertensive group had more extensive coronary collateral circulation than the normotensive group (p less than 0.01). There was a positive relation between coronary collateral circulation and left ventricular wall thickness (p less than 0.001). These results indicate that patients with systemic hypertension and coronary artery disease have an increase in coronary collateral circulation corresponding to the degree of left ventricular wall thickness.