Analysis of coronary collaterals in ischaemic heart disease by angiography during pacing induced ischaemia.

Abstract

Studies were made using ordinary selective coronary angiography and angiography during ischaemia produced by right atrial pacing, on a series of 41 patients with ischaemic heart disease, to examine the response of the collaterals to the ischaemia stimulus. Regional myocardial perfusion was determined under the same circumstances by measuring regional 133Xenon washout curves. No collaterals were found in 8 patients, none of whom demonstrated collaterals when angiography was repeated during ischaemia. Eleven of the 33 patients with prepacing collaterals (33%) responded to ischaemia with an increase in the collaterals, 16 patients (49%) showed no change, 5 patients (15%) showed a decrease in the collaterals, and one patient exhibited a bidirectional change. Regional myocardial perfusion responses closely paralleled the angiographic changes, yielding suggestive evidence that the collaterals were intimately involved in the enhancement of the flow. Despite different collateral and flow responses to ischaemia, the data on exercise tolerance, left ventricular end-diastolic pressure, ejection fraction, prevalence of left ventricular asynergy, and the topographic relation between synergy and collaterals, were largely similar. The data show that in some patients the collateral circulation reacts to ischaemia by enhancement, but the functional significance of this response is obscure.

Global and regional left ventricular contractility and coronary collaterals in stable ischemic heart disease

“…(ECI = 1976a), and the flow responses are inferior to flow through coronary arteries obstructed less than 50% (Frick et al .• 1976b). These observations lend support to the thesis that colIaterals are insufficient to prevent ischemia evoked either by physical exercise (Frick and Valle, in press;Helfant et al .• 1971) or atrial pacing (Frick et al .. 1976a).…”

An appraisal of symptom relief after coronary bypass grafting

“…Lack of simultaneously recorded data favouring and opposing the disappearance of angina makes it impossible to analyse in detail the role of other relevant variables evoking a change in the anginal pattern. Intra-operative myocardial infarctions (Achuff et al, 1972;Bartel et al, 1973;Lapin et al, 1973) seem to play an independent role since they are not related to graft patency or occlusion (Fruehan et al, 1974;Frick et al, 1975a). Pericoronary denervation is an interesting theoretical possibility (Soloff, 1973) but it tends to occur equally in patients with patent and occluded grafts.…”

“…The greatest incidence of progression takes place proximal to graft anastomosis and is not related to serum lipids or the presence of hypertension (Frick et al, 1975b). This phenomenon is clearly a factor opposing pain relief since it causes myocardial infarction if it occurs in connection with graft occlusion.…”

“…(symptom-free) Griffith et al (1973) 65 86 71 86 Guiney et al (1973) 40 75 40 92 Lapin et al (1973) 46 59 46 85 Balcon et al (1974) 31 65 50 96 Hammermeister et al (1974) 40 50 40 80 Frick (1974) 52 79 52 92 * Not necessarily the exact size of the series but the amount of patients amenable for analysis.…”

Koroner Kollateral Dolaşimin Sol Ventri̇kül Si̇stoli̇k Ve Di̇yastoli̇k Fonksi̇yonlari Üzeri̇ne Etki̇si̇: Doku Doppler Ekokardi̇yografi̇ Çalişmasi

“…Obstrüksiyon durumunda ortaya çıkan ve dolaşım fonksiyonu üstlenen KKD'nin fonksiyonel önem-ine yönelik yapılan çalışmalarda net sonuçlar alınamamıştır. Koroner arter hastalığında KKD varlığının angina eşiği, egzersiz kapasitesi, aritmi gelişimi ve ani ölüm üzerine etkilerine yönelik yapılan çalışmalarda net sonuçlar elde edilememiştir (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Biz çalışmamızda KAH'lı hastalarda KKD varlığının ve evresinin LV fonksiyonları üzerinde olumlu yönde bir etkisinin olduğunu saptayamadık.…”