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Relation between collateral flow assessed by Doppler guide wire and angiographic collateral grades
1Department of Cardiology, Hiroshima Prefectural Hiroshima Hospital, Japan.
Insights
Doppler guide wire assessment of coronary collateral flow velocity reveals a strong correlation between flow duration and angiographic collateral grade in angina pectoris patients. This method aids in evaluating collateral function.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hemodynamics
Background:
- Coronary collateral circulation plays a vital role in myocardial perfusion during ischemia.
- Assessing collateral function is crucial for predicting outcomes in patients with coronary artery disease.
Purpose of the Study:
- To investigate the relationship between angiographic collateral grade (Rentrop's classification) and collateral flow velocity patterns.
- To determine the utility of Doppler guide wire measurements in assessing collateral function.
Main Methods:
- Doppler guide wire was used to measure collateral flow velocity during balloon occlusion in 43 angina pectoris patients.
- Collateral flow direction and velocity parameters were analyzed.
- Correlation with Rentrop's angiographic collateral grade was assessed.
Main Results:
- Collateral flow was detected in 21 patients; 6 had no visible collaterals angiographically prior to intervention.
- Peak collateral flow velocity did not correlate with angiographic grade.
- Collateral flow duration ratio and peak velocity integral correlated significantly with angiographic grades (p < 0.0005 and p < 0.05, respectively).
- Unidirectional and longer duration collateral flow patterns were associated with reduced ischemic signs.
Conclusions:
- Collateral flow duration and peak velocity integral measured by Doppler guide wire are valuable indicators of collateral function.
- Doppler guide wire assessment provides a functional correlate to angiographic collateral grading.
- This technique may enhance the evaluation of collateral status in patients with coronary artery disease.
Abstract:
We investigated the relation between the angiographic collateral grade (Rentrop's classification) and the collateral flow velocity pattern in 43 patients with angina pectoris. Collateral flow velocity was measured with a Doppler guide wire during balloon occlusion in coronary angioplasty. Collateral flow was detected in 21 of the 43 patients. In 6 of the 21 patients, collateral vessels were not seen angiographically before angioplasty. The direction of collateral flow was classified as forward, backward, or bidirectional. Forward and backward collateral flows were seen in all angiographic grades. Bidirectional collateral flows were observed only in grades 0 to 2. The peak collateral flow velocity was not correlated with the angiographic grades, but the ratio of the collateral flow duration to a cardiac cycle length was correlated with them (grade 0, 44% +/- 15%; grade 1, 70% +/- 16%; grade 2, 84% +/- 11%; and grade 3, 93% +/- 3%; p < 0.0005, analysis of variance). The peak velocity integral was also correlated with the angiographic collateral grades (p < 0.05; analysis of variance). The peak velocity integral was also correlated with the angiographic collateral grades (p < 0.05; analysis of variance). Electrocardiographic signs of ischemia were less observed in patients with unidirection and longer duration of collateral flow pattern (p < 0.05, respectively). A Doppler guide wire may be useful in assessing collateral flow grade.