Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium.

Vanoverschelde, Jean–Louis; Wijns, William; Depré, Christophe; Essamri, Baija; Heyndrickx, Guy R.; Borgers, M.; Bol, Anne; Melin, Jacques

doi:10.1161/01.cir.87.5.1513

Cited by 625 publications

(213 citation statements)

References 43 publications

Supporting

Mentioning

192

Contrasting

Unclassified

Order By: Relevance

“…A Ͼ2-fold increase of myocardial perfusion can be provided solely by collaterals. 16 Myocardial FFR takes into account the contribution of collateral circulation to hyperemic myocardial flow, because the distal coronary pressure is determined by aortic pressure and by the extent of collateral circulation in case of isolated epicardial stenosis. Measurements of P w obtained during coronary occlusion determine the separate contributions of antegrade flow and of collateral flow to total hyperemic myocardial perfusion.…”

Section: Importance Of Collateral Flowmentioning

confidence: 99%

Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses

et al. 2000

View full text Add to dashboard Cite

Background-Fractional flow reserve (FFR) is an index of stenosis severity validated for isolated stenoses. This study develops the theoretical basis and experimentally validates equations for predicting FFR of sequential stenoses separately. Methods and Results-For 2 stenoses in series, equations were derived to predict FFR (FFR pred ) of each stenosis separately (ie, as if the other one were removed) from arterial pressure (P a ), pressure between the 2 stenoses (P m ), distal coronary pressure (P d ), and coronary occlusive pressure (P w ). In 5 dogs with 2 stenoses of varying severity in the left circumflex coronary artery, FFR pred was compared with FFR app (ratio of the pressure just distal to that just proximal to each stenoses) and to FFR true (ratio of the pressures distal to proximal to each stenosis but after removal of the other one) in case of fixed distal and varying proximal stenoses (nϭ15) and in case of fixed proximal and varying distal stenoses (nϭ20). The overestimation of FFR true by FFR app was larger than that of FFR true by FFR pred (0.070Ϯ0.007 versus 0.029Ϯ0.004, PϽ0.01 for fixed distal stenoses, and 0.114Ϯ0.01 versus 0.036Ϯ0.004, PϽ0.01 for fixed proximal stenoses). This overestimation of FFR true by FFR app was larger for fixed proximal than for fixed distal stenoses. Conclusions-The interaction between 2 stenoses is such that FFR of each lesion separately cannot be calculated by the equation for isolated stenoses (P d /P a during hyperemia) applied to each separately but can be predicted by more complete equations taking into account P a , P m , P d , and P w .

show abstract

Section: Importance Of Collateral Flowmentioning

confidence: 99%

Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Also, several PET studies in patients with left ventricular dysfunction observed relatively normal regional coronary blood flow in hibernating segments. [135][136][137][138] Other groups have observed normal oxidative metabolism in these regions, suggesting that oxygen delivery to hibernating segments actually may be normal. 139 One area of active debate is whether hibernating myocardium in patients truly is characterized by reduced flow or normal flow with reduced coronary vasodilator reserve.…”

Section: Time Course Of Recovery Of Hibernating Myocardiummentioning

confidence: 99%

Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning

et al. 1998

View full text Add to dashboard Cite

“…1,2 In some patients, microvascular vasodilation during exercise or pharmacological stimulation leads to a decrease of blood flow to the collateral-dependent myocardium, an observation described as coronary steal. [3][4][5][6][7][8][9] This becomes clinically relevant when specific drugs are prescribed for patients with coronary artery disease.…”

mentioning

confidence: 99%

Direct Assessment of Coronary Steal and Associated Changes of Collateral Hemodynamics in Chronic Total Coronary Occlusions

Werner

Figulla

2002

Circulation

View full text Add to dashboard Cite

Background-Coronary steal can occur in collateral-dependent myocardium during pharmacologically induced vasodilation. This study assessed coronary steal invasively in chronic total coronary occlusions (TCOs). Methods and Results-In 35 consecutive patients with a percutaneous transluminal coronary angioplasty of a TCO (duration Ͼ4 weeks), coronary flow velocity (APV) by a Doppler wire and distal pressure (P D ) by a pressure wire were assessed in the collateral-dependent vascular bed before dilatation. Indexes of peripheral resistance (R P ) and for the collateral pathway, including the donor artery segment (R CP ), were calculated. Changes of these parameters were assessed during intravenous adenosine (140 g · kg Ϫ1 · min Ϫ1 ). Adenosine caused a decrease of APV, ie, coronary steal, in 13 patients (37%; group S), an increase in 11 patients (group R), and no change in 11 patients (group N). Angiographic analysis of collateral pathways showed no difference between the groups, except that in group S all collateral connections were continuously visible but no large collaterals (Ͼ0.5 mm) were found. In group N, collaterals were least developed. The increase of APV in group R was associated with a decrease of R P , whereas R CP remained unchanged. In contrast, group S showed no change in R P but a significant increase of R CP , indicating an increased resistance of the donor segment. Conclusions-Coronary

show abstract

Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium.

Cited by 625 publications

References 43 publications

Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses

Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses

Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning

Direct Assessment of Coronary Steal and Associated Changes of Collateral Hemodynamics in Chronic Total Coronary Occlusions

Contact Info

Product

Resources

About