Importance of coronary collaterals for restoration of left ventricular function after intracoronary thrombolysis

Saito, Yoshihiko; Yasuno, Masao; Ishida, Moriharu; Suzuki, Katsuhiro; Matoba, Yoshiki; Emura, Masahito; Takahashi, Masaaki

doi:10.1016/0002-9149(85)90485-0

Cited by 81 publications

(15 citation statements)

References 18 publications

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“…Our investigation revealed that preexistent well-developed coronary collateral circulation plays an important role in the LV functional recovery of patients who undergo early reperfusion, findings that were in agreement with those of earlier studies [16][17][18] in which the LV function has been shown to improve during the convalescent period of infarction if patients had early reperfusion in the presence of well-developed collateral circulation.…”

Section: Effect Of Preexistent Coronary Collateral Circulation On LV supporting

confidence: 92%

Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial Infarction.

Miyamoto

Fujita²,

Ueda

et al. 2002

Circ J

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atients with severe, symptomatic coronary artery disease (CAD) not amenable to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting surgery present a difficult clinical problem. An option for the management of these patients is transmyocardial laser or ultrasound 1 revascularization (TMLR). Frazier et al used 201 Tl single photon emission computed tomography to demonstrate that myocardial perfusion at rest and after dipyridamole administration showed a significant improvement among the treated ischemic segments in patients with angina who were not considered suitable for standard revascularization. 2 On the other hand, Allen et al concluded that the symptomatic benefit of TMLR (holium laser) did not improve myocardial perfusion in the laser-treated areas. 3 However, other studies have shown that TMLR relieves angina by causing myocardial sympathetic denervation. Al-Sheikh et al reported that TMLR does not significantly affect resting or stress myocardial perfusion, but does increase the extent of sympathetic denervation observed on positron emission tomography (decreased myocardial [ 11 C]hydroxyephedrine uptake). 4 Thus, the functional role of newly created channels as a result of TMLR has not been elucidated, and it also remains Circulation Journal Vol.66, July 2002 unclear whether the channels formed in reptile hearts, which permit a substantial amount of myocardial perfusion from the ventricular chamber, are created in the presence of severe coronary stenoses in human patients with CAD. 5 The purpose of this study was twofold: to characterize the incidence of channels and to evaluate their functional significance in patients with acute myocardial infarction (AMI). Methods Patient PopulationBetween April 1997 and March 2000, we successfully performed primary PTCA for an acutely occluded proximal left anterior descending coronary artery (LAD) within 24 h of the onset of symptoms in 60 consecutive patients with their first anterior AMI. 6 Of this group of patients, we studied 51 patients who did not have angiographic restenosis, which was defined as stenosis ≥50%, at follow-up coronary angiography (CAG) performed 2 weeks after the onset of AMI. There were 44 men and 7 women with a mean age of 60 years (range, 34-81). Treatment ProtocolAll patients were administered 5,000 U of heparin intravenously and transported promptly to the catheterization laboratory. A second 5,000 U bolus of heparin was administered intravenously after circulatory access was obtained. Coronary angiography was first performed in the noninfarct-related artery to evaluate the extent of collateral circulation to the area perfused by the completely occluded infarct-related artery. Angioplasty was performed in a routine manner with the use of appropriately sized angio- Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial InfarctionShoichi Miyamoto, MD; Masatoshi Fujita, MD*; Kinzo Ueda, MD**; Shun-ichi Tamaki, MD**; Koji Hasegawa, MD; Norito...

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Section: Effect Of Preexistent Coronary Collateral Circulation On LV supporting

confidence: 92%

Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial Infarction.

Miyamoto

Fujita²,

Ueda

et al. 2002

Circ J

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“…In the latter group of patients, acute coronary occlusion results in evolutional changes in LV function that are dependent on myocardial flow after recanalization by thrombolysis or through collaterals to occluded arteries. 11,13,15 However, in our study of patients with chronic LV dysfunction, the anatomic status of the infarct-related artery may not represent the status in the critical early phase of a myocardial infarction. Coronary artery occlusion may have developed gradually, allowing for the development of adequate collateral channels that may or may not be visualized with routine angiography.…”

Section: Discussionmentioning

confidence: 81%

Impact of Severity of Coronary Artery Stenosis and the Collateral Circulation on the Functional Outcome of Dyssynergic Myocardium After Revascularization in Patients With Healed Myocardial Infarction and Chronic Left Ventricular Dysfunction

Elhendy

Cornel

Roelandt

et al. 1997

The American Journal of Cardiology

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The aim of this study was to assess the influence of the severity of coronary artery stenosis and the grade of collateral circulation on myocardial viability in patients with chronic left ventricular (LV) dysfunction undergoing coronary artery bypass grafting. Forty patients (age 59 { 8 years) with old myocardial infarction were studied by dobutamine stress echocardiography (DSE) before coronary artery bypass grafting. LV function was assessed using a 16-segment, 5-grade score model. Viability and functional recovery were respectively defined as a reduction in wall motion score ¢1 at low-dose DSE and at follow-up echocardiograms obtained 3 months after surgery. There were 56 stenotic coronary arteries subtending severely dyssynergic myocardial segments, of which 38 were occluded. Among 186 severely dyssynergic segments, functional recovery occurred in 42 (23%). There was no significant difference between myocardial regions with patent or occluded coronary arteries with respect to prevalence of viability or functional recovery and percentage of viable or recovered segments relative to the total number of dyssynergic segments. In patients with total occlusion, these parameters were not different between regions with different collateral grades. Sensitivity, specificity, and accuracy of low-dose DSE for prediction of regional functional recovery were 71%, 90%, and 86%, respectively. It is concluded that in patients with chronic LV dysfunction, the presence of total occlusion of coronary arteries supplying severely dyssynergic regions does not imply a lower prevalence or extent of functional recovery after revascularization, regardless of the grade of angiographically visualized collaterals. Low-dose DSE can identify myocardial regions with a high probability of functional improvement after revascularization regardless of the severity of underlying coronary stenosis or collateralization of the involved coronary vessel. ᮊ1997 by Excerpta Medica, Inc.( Am J Cardiol 1997;79:883-888) P revious studies have demonstrated the value of coronary artery bypass grafting in amelioration of symptoms, improvement of left ventricular (LV) function and prolongation of survival in patients with chronic ischemic LV dysfunction. 1,2 The assessment of myocardial viability is important to predict the occurrence of functional improvement of dyssynergic myocardium after revascularization. 3,4 The utility of various techniques in this setting has been established. These include positron emission tomography, thallium-201 scintigraphy, and low-dose dobutamine echocardiography. [2][3][4] Few studies have asFrom the Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands. This study was supported in part by the Department of Cardiology, Cairo University Hospital, Cairo, Egypt and Grant NHS 94.135 from the Dutch Heart Foundation, Den Haag, The Netherlands. Manuscript received July 8, 1996; revised manuscript received and accepted November 8, 1996.Address for reprints: Abdou Elhendy, MD, PhD, Thora...

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“…The remaining 47 patients constituted the study population. Among them, 13 patients underwent mechanical recanalization during the acute phase of a myocardial infarction. The remaining 34 underwent an elective procedure for a .…”

Section: Patients and Methods Patientsmentioning

confidence: 99%

Potential protective effect of high coronary wedge pressure on left ventricular function after coronary occlusion.

et al. 1988

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To assess the potential of coronary collateral circulation to protect myocardium after occlusion of a coronary vessel, the mean coronary wedge pressure, the angiographic grade of Experimentally, the coronary collateral circulation has been studied mainly in the dog heart. Because collaterals are more developed in dogs than in healthy humans, the results can not necessarily be extrapolated to the human coronary circulation. The hemodynamics of coronary collaterals have been studied directly in humans during aortocoronary bypass surgery,17 and, more recently, the From the Cardiology Center, University Hospital, Geneva, Switzerland.Address for correspondence: B. Meier, MD, Cardiology Center, University Hospital, 1211 Geneva 4, Switzerland.Received November 20, 1987; revision accepted April 28, 1988. pressure distally to coronary lesions was measured during percutaneous angioplasty18-22 and the relation of the coronary wedge pressure (pressure in the distal part of the occluded artery) to spontaneously visible and recruitable collaterals has been established.22 To evaluate the protective role of the coronary collateral circulation, we studied the relation between the mean coronary wedge pressure measured during percutaneous transluminal coronary angioplasty and the left ventricular function in patients with occlusion of a major coronary vessel. Patients and Methods PatientsCoronary wedge pressure measurements were done in 53 of 108 consecutive patients with attempted recanalization of a total coronary occlusion. Four patients with a previous myocardial infarction in a region other than that supplied by the attempted vessel were excluded. Two additional patients were excluded because of unsatisfactory quality of the left ventriculogram. The remaining 47 patients constituted the study population. Among them, 13 patients underwent mechanical recanalization during the acute phase of a myocardial infarction. The remaining 34 underwent an elective procedure for a

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Importance of coronary collaterals for restoration of left ventricular function after intracoronary thrombolysis

Cited by 81 publications

References 18 publications

Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial Infarction.

Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial Infarction.

Impact of Severity of Coronary Artery Stenosis and the Collateral Circulation on the Functional Outcome of Dyssynergic Myocardium After Revascularization in Patients With Healed Myocardial Infarction and Chronic Left Ventricular Dysfunction

Potential protective effect of high coronary wedge pressure on left ventricular function after coronary occlusion.

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