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The preservation effect of coronary collateral circulation on left ventricular function in chronic total occlusion
Yuxiang Dai1, Shufu Chang1, Shen Wang2
1Department of Cardiology, Fudan University Affiliated Zhongshan Hospital, Shanghai, China.
Insights
Good coronary collateral circulation preserves left ventricular ejection fraction (LVEF) in patients with coronary chronic total occlusion (CTO). Vascular endothelial growth factor-A (VEGF-A) may promote collateral formation, aiding heart function.
Area of Science:
- Cardiology
- Vascular Biology
- Molecular Medicine
Background:
- Coronary chronic total occlusion (CTO) often presents with collateral circulation, which can mitigate ischemia and preserve ventricular function.
- Understanding the role of these collaterals in maintaining left ventricular (LV) function is crucial for patient outcomes.
Purpose of the Study:
- To investigate the impact of coronary collateral circulation on left ventricular (LV) function in patients with coronary CTO.
- To explore the underlying mechanisms involved in the development of coronary collateral circulation.
Main Methods:
- 102 coronary CTO patients were categorized by left ventricular ejection fraction (LVEF) into preserved (≥50%) and decreased (<50%) groups.
- Clinical, angiographic, and laboratory data were analyzed, including serum VEGF-A levels and VEGF-A gene mRNA expression.
- Multivariate logistic regression identified predictors of LVEF preservation.
Main Results:
- Rentrop grades 2-3 and coexisting collateral pathways independently predicted LVEF preservation in coronary CTO patients.
- Patients with better collateralization (Rentrop grades 2-3) exhibited smaller LV dimensions and higher LVEFs.
- Higher serum VEGF-A and mRNA expression were observed in patients with better collateralization.
Conclusions:
- Coronary collateral circulation is significantly associated with preserved LVEF in coronary CTO.
- VEGF-A is implicated as a potential promoter of coronary collateral circulation formation.
Background:
Patients with coronary chronic total occlusion (CTO) typically have collateralization of the distal vessel, and these collaterals can contribute to the relief of ischemia and anginal symptoms and to the preservation of ventricular function.
Objectives:
To investigate the preservation effect of coronary collateral circulation on left ventricular (LV) function in coronary CTO, and to explore the potential mechanism behind the development of coronary collateral circulation.
Material And Methods:
A total of 102 consecutive patients with coronary CTO were divided into 2 groups: the left ventricular ejection fraction (LVEF)-preserved group (LVEF ≥ 50%; n = 46) and the LVEF-decreased group (LVEF < 50%; n = 56). Clinical, angiographic and laboratory data was collected for all patients. The association between LVEF and coronary collateral circulation in coronary CTO patients was analyzed with multivariate logistic regression analysis, and the serum levels of VEGF-A and the mRNA expression levels of the VEGF-A gene were compared between different grades of coronary collateral circulation.
Results:
Multivariate analysis revealed that Rentrop grades 2-3 and coexisting collateral pathways were independent predictors of LVEF preservation in coronary CTO patients. Patients with Rentrop grades 2-3 had smaller left ventricular end diastolic diameters (LVDd) and left ventricular end systolic diameters (LVSd), and they had larger LVEFs than the patients with Rentrop grades 0-1. Patients with Rentrop grades 2-3 also had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in their peripheral blood mononuclear cells (PBMCs) than patients with Rentrop grades 0-1. Patients with coexisting collateral pathways had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in PBMCs than patients without coexisting collateral pathways.
Conclusions:
Coronary collateral circulation is significantly associated with LVEF preservation, and VEGF-A might promote the formation of coronary collateral circulation.
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