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Coronary collateral circulation and diastolic function
1Second Department of Internal Medicine, Fukuoka University School of Medicine, Japan.
Insights
Coronary collaterals in patients with effort-induced angina are linked to impaired left ventricular diastolic function. Visible collaterals may indicate more severe coronary stenosis and poorer diastolic function.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary artery disease (CAD) is associated with impaired left ventricular (LV) filling.
- Coronary collaterals may influence diastolic function in patients with CAD.
Purpose of the Study:
- To evaluate the impact of coronary collaterals on diastolic function in patients experiencing effort-induced angina.
- To determine if visible coronary collaterals serve as a marker for the severity of coronary stenosis and LV diastolic dysfunction.
Main Methods:
- Resting radionuclide ventriculography was performed in 14 patients with severe isolated left anterior descending coronary artery stenosis and 7 normal subjects.
- Patients were categorized based on the presence and grade (Rentrop classification) of collateral vessels.
- Systolic and diastolic functional indices were compared between groups with and without collateral vessels.
Main Results:
- Global peak filling rate was significantly reduced in patients with collateral vessels (P < 0.01).
- Septal, apical, and lateral peak filling rates were also reduced, with lateral peak filling rate showing statistical significance (P < 0.05).
- Exercise tolerance, measured by rate-pressure product, was significantly lower in patients with collaterals (P < 0.01).
Conclusions:
- Angiographically visible coronary collaterals are associated with impaired left ventricular diastolic function in patients with effort-induced angina.
- The presence of collaterals may signify more severe coronary stenosis and a greater degree of diastolic dysfunction.
Abstract:
Patients with coronary artery disease reportedly have an impaired left ventricular filling. To evaluate the effects of coronary collaterals on diastolic function in patients with effort-induced angina, resting radionuclide ventriculography was performed in 14 patients with severe isolated (> or = 90% diameter) stenosis of the left anterior descending coronary artery and in seven normal subjects. Contrast ventriculography showed normal wall motion in all patients. Functional indices obtained by radionuclide ventriculography were compared between those patients with collateral vessels, Rentrop classification grades 1 (n = 7) and 3 (n = 1), and those patients without (n = 6) collateral vessels. Global peak filling rate was significantly (P < 0.01) reduced in the patients with collaterals. The septal, apical and lateral peak filling rates were also reduced in patients with collateral vessels, with the reduction in lateral peak filling rate being statistically significant (P < 0.05). The indices of systolic function and the temporal diastolic asynchronous index were similar, irrespective of the presence of collaterals. The exercise tolerance as evaluated by the rate-pressure product at peak treadmill exercise stress testing in 12 patients was significantly (P < 0.01) lower in those with collateral vessels. Angiographically visible collaterals could be a marker for more severe coronary stenosis in patients with effort-induced angina, and an indicator of the severity of deterioration in left ventricular diastolic function.