Related Experiment Video

Updated: Oct 14, 2025

Myocardial Infarction and Functional Outcome Assessment in Pigs
12:03

Myocardial Infarction and Functional Outcome Assessment in Pigs

Published on: April 25, 2014

28.2K

Do collaterals visualized on coronary angiography impact left ventricle ejection fraction among Asian Indians

Kamal Sharma1, Bhavik Champaneri1, Iva Patel2

  • 1Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India.

Asian Cardiovascular & Thoracic Annals
|November 3, 2021
PubMed

Insights

Coronary collateral assessment in Asian Indians with acute coronary syndrome reveals a paradox: higher collateral grades correlate with worse left ventricle ejection fraction, particularly in multi-vessel disease. This finding challenges conventional understanding of coronary collateral function.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Interventional Cardiology

Background:

  • Coronary collaterals are recognized as a natural bypass for myocardial perfusion.
  • The impact of collateral extent on left ventricle function in acute coronary syndrome (ACS) among Asian Indians remains understudied.

Purpose of the Study:

  • To evaluate the relationship between coronary collateral extent and left ventricle ejection fraction (LVEF) in Asian Indians with ACS.
  • To investigate potential ethnic-specific differences in collateral function and its impact on cardiac outcomes.

Main Methods:

  • A retrospective analysis of 3614 consecutive ACS patients.
  • Coronary angiograms were assessed for collateral grading (Rentrop's classification).
  • Patients were categorized into low (grades 0-1) and high (grades 2-3) collateral groups.

Main Results:

  • Higher collateral grades (2-3) were observed in non-ST elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI).
  • LVEF was better preserved in the low collateral group (A) than the high collateral group (B) for specific subgroups (e.g., double/triple-vessel disease in NSTEMI).
  • An inverse correlation was found between LVEF and collateral grade (r=-0.111, P=0.000).

Conclusions:

  • Single-vessel disease patients were more likely to have poor coronary collaterals.
  • Despite higher collateral grades in Asian Indians with ACS, triple-vessel disease patients (both STEMI and NSTEMI) showed significantly lower LVEF.
  • This paradoxical finding of worse LVEF with higher collaterals in certain ACS subsets is termed the "Asian Indian Paradox".
Abstract

Keywords:
Coronary collateralsST elevation myocardial infarctionacute coronary syndromeleft ventricular ejection fractionnon-ST elevation myocardial infarction

More Related Videos

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats06:32

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Published on: June 28, 2019

8.2K
Left Coronary Artery Ligation: A Surgical Murine Model of Myocardial Infarction05:48

Left Coronary Artery Ligation: A Surgical Murine Model of Myocardial Infarction

Published on: August 9, 2022

4.7K

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
43
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
79
Coronary Artery Disease II: Pathophysiology01:26

Coronary Artery Disease II: Pathophysiology

Coronary Artery Disease (CAD) originates from a series of events that impair the function of coronary arteries, the blood vessels responsible for delivering oxygen-rich blood to the heart muscle. The pathophysiology of CAD is closely linked to atherosclerosis, a chronic inflammatory and lipid-driven condition affecting the vascular endothelium.1. Endothelial DamageThe process begins with damage to the vascular endothelium, which serves as a protective barrier between the blood and the vessel...
81
Coronary Artery Disease III: Clinical Manifestations01:30

Coronary Artery Disease III: Clinical Manifestations

Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
71
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
116
Coronary Artery Disease I: Introduction01:30

Coronary Artery Disease I: Introduction

Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
479