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

Abstract

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

Quantitative evaluation of collateral circulation in patients with previous myocardial infarction: relation to myocardial ischemia, angiographic appearance and functional improvement of myocardium

“…It is also important to note that this relative expression of collateral flow seems more relevant than absolute collateral flow, as myocardial distribution area is unknown and varies widely in different arteries and different patients. Pijls et al [8] have found that the value of 0.30 may differentiate between patients with sufficient and insufficient recruitable collateral flow, which was very similar to previous findings of P w /P a of 0.30 and 0.31 [17,19,20]. In addition, Sieler et al [22] have shown that using collateral flow index using velocity measurement, the value of 0.30 also discriminate patients with sufficient collaterals with 100% sensitivity and 93% specificity.…”

“…The importance and protective role of collateral circulation has been appreciated both experimentally, as well as in the clinical settings [16][17][18][19][20]. Its clinical usefulness, however, has been limited probably because of two reasons: [1] no reliable quantitative method for evaluation of collateral circulation was available, and [2] clinical focus on treatment of coronary stenosis, with exponential rise and clinical interest in angioplasty over evaluation of coronary physiology.…”

Paradoxical Increase in Microvascular Resistance During Tachycardia Downstream From a Severe Stenosis in Patients With Coronary Artery Disease

“…The very low values of coronary pressure during balloon occlusion, however, suggest the lack of significant collateral circulation. 38 Moreover, the finding of decreased coronary…”

The relationship between gamma-glutamyltransferase and coronary collateral circulation in patients with chronic total occlusion

“…Coronary collaterals are 40 μm in diameter and are not angiographically visible in normal conditions (22). They are angiographically demonstrable only if severe CAD is present due to increased blood flow associated with pressure gradient (23).…”