Coronary collateral circulation in coronary artery disease and systemic hypertension

Kyriakides, Zenon S.; Kremastinos, Dimitrios Th.; Michelakakis, N.; Matsakas, Evangelos; Demovelis, Thomas; Toutouzas, Pavlos

doi:10.1016/0002-9149(91)90522-m

Cited by 53 publications

(37 citation statements)

References 16 publications

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“…In addition to ischemic burden as explored in the present study, genetic factors and a number of other patient characteristics including age, physical exercise, body mass index, hyperlipidemia, hyperhomocysteinemia, diabetes mellitus, hypertension, and use of various cardiovascular drugs have been proposed [7,11,[19][20][21][22][23][24][25][26][27][28][29]. Yet, results of these studies are conflicting and, therefore, their pathophysiologic role and importance is still unclear [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Ischemic Score Determines the Presence of Coronary Collateral Circulation

Koerselman

Jaegere²,

Verhaar

et al. 2005

Cardiovasc Drugs Ther

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Summary. Purpose:The presence of coronary collaterals is of vital importance during acute ischemia, however, marked interindividual variability exists. We examined the extent to which the burden of cardiac ischemia, expressed as a cardiac ischemic score, affects coronary collateral presence.Methods: Cross-sectional study in 244 patients, admitted for elective coronary angioplasty. Collaterals were graded with Rentrop's classification. Coronary collateral presence was defined as Rentrop-grade ≥1. The cardiac ischemic score (range 0-4) was calculated by adding 1 point for each of the following four clinical factors present: angina pectoris on exertion, angina pectoris during emotions, previous myocardial infarction, and previous coronary intervention. These four clinical factors were chosen because they can be easily assessed in every patient. We used logistic regression with adjustment for gender, age, hypertension, diabetes mellitus, and hyperlipidemia.Results: The extent of the cardiac ischemic score (odds ratio 1.8 per score-point; 95% confidence interval 1.3-2.5) was strongly associated with coronary collateral presence. Additional adjustment for multivessel coronary disease left the relation essentially unchanged. Also, if the definition of collateral presence was limited to Rentrop-grade 2 and 3, results were effectively the same.Conclusion: The extent of the cardiac ischemic score determines the presence of coronary collaterals, and may provide a new index for simple assessment of collateral vascular development.

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Section: Discussionmentioning

confidence: 99%

Cardiac Ischemic Score Determines the Presence of Coronary Collateral Circulation

Koerselman

Jaegere²,

Verhaar

et al. 2005

Cardiovasc Drugs Ther

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“…In addition to high BP as explored in the present study, genetic factors and a number of other patient characteristics including age, myocardial ischaemia, physical exercise, smoking, body mass index, hyperlipidaemia, hyperhomocysteinaemia, diabetes mellitus, and use of various cardiovascular drugs have been proposed. [6][7][8][9]16,[25][26][27][28][29][30][31][32][33][34][35] Yet, results of these studies are conflicting and the pathophysiologic role and importance of these patient characteristics is still unclear. 2,3,36 To our knowledge, this is the first study to show an inverse association between (high) BP and the presence and extent of CCs.…”

Section: Discussionmentioning

confidence: 99%

“…A positive relation between BP or hypertension and the presence of CCs may be explained by an increased myocardial oxygen demand, which may trigger the formation or development of collaterals, 10 or enlargement of collateral arteries. 9 Another potential explanation for this controversy may be in the vasculature under study. We examined functional collateral vessels that were spontaneously visible with contrast angiography, thus vessels of at least 100 mm.…”

Section: Discussionmentioning

confidence: 99%

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High Blood Pressure Is Inversely Related With Presence and Extent of Coronary Collaterals

Grobbee

Koerselman

Jaegere

et al. 2004

Journal of Hypertension

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Patients with hypertension have an increased case fatality during acute myocardial infarction (MI). Coronary collateral (CC) circulation has been proposed to reduce the risk of death during acute ischaemia. We determined whether and to which degree high blood pressure (BP) affects the presence and extent of CC circulation. A cross-sectional study in 237 patients (84% males), admitted for elective coronary angioplasty between January 1998 and July 2002, was conducted. Collaterals were graded with Rentrop's classification (grade 0-3). CC presence was defined as Rentrop-grade X1. BP was measured twice with an inflatable cuff manometer in seated position. Pulse pressure was calculated by systolic blood pressure (SBP)Àdiastolic blood pressure (DBP). Mean arterial pressure was calculated by DBP þ 1/3 Â (SBPÀDBP). Systolic hypertension was defined by a reading X140 mmHg. We used logistic regression with adjustment for putative confounders. SBP (odds ratio (OR) 0.86 per 10 mmHg; 95% confidence interval (CI) 0.73-1.00), DBP (OR 0.67 per 10 mmHg; 95% CI 0.49-0.93), mean arterial pressure (OR 0.73 per 10 mmHg; 95% CI 0.56-0.94), systolic hypertension (OR 0.49; 95% CI 0.26-0.94), and antihypertensive treatment (OR 0.53; 95% CI 0.27-1.02), each were inversely associated with the presence of CCs. Also, among patients with CCs, there was a graded, significant inverse relation between levels of SBP, levels of pulse pressure, and collateral extent. There is an inverse relationship between BP and the presence and extent of CC circulation in patients with ischaemic heart disease.

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“…Limited reports suggest that there is a paradoxical increase in collateral circulation in patients with hypertension and coronary artery disease. 13 In this issue of the Journal of Human Hypertension, Koerselman et al 14 add to the information available by their study suggesting that high blood pressure in patients with obstructive coronary artery disease impairs the formation of the coronary collateral circulation. They recruited 237 patients undergoing coronary angioplasty and blood pressures were measured prior to intervention twice over a 15 min period, and the average was used to define whether the patients had hypertension (at that time) or not.…”

mentioning

confidence: 99%

Is there an association between hypertension and the development of coronary collateral flow?

2005

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Coronary collateral circulation in coronary artery disease and systemic hypertension

Cited by 53 publications

References 16 publications

Cardiac Ischemic Score Determines the Presence of Coronary Collateral Circulation

Cardiac Ischemic Score Determines the Presence of Coronary Collateral Circulation

High Blood Pressure Is Inversely Related With Presence and Extent of Coronary Collaterals

Is there an association between hypertension and the development of coronary collateral flow?

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