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Vural MG, Temel HY, Turunc E, Akdemir R, Tatli E, Agac MT. Transcoronary Gradients of Mechanosensitive MicroRNAs as Predictors of Collateral Development in Chronic Total Occlusion. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:590. [PMID: 38674237 PMCID: PMC11052456 DOI: 10.3390/medicina60040590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: In this present study, we investigated the impact of mechanosensitive microRNAs (mechano-miRs) on the collateral development in 126 chronic total occlusion (CTO) patients, selected from 810 undergoing angiography. Materials and Methods: We quantified the collateral blood supply using the collateral flow index (CFI) and assessed the transcoronary mechano-miR gradients. Results: The patients with favorable collaterals had higher CFI values (0.45 ± 0.02) than those with poor collaterals (0.38 ± 0.03, p < 0.001). Significant differences in transcoronary gradients were found for miR-10a, miR-19a, miR-21, miR-23b, miR-26a, miR-92a, miR-126, miR-130a, miR-663, and let7d (p < 0.05). miR-26a and miR-21 showed strong positive correlations with the CFI (r = 0.715 and r = 0.663, respectively), while let7d and miR-663 were negatively correlated (r = -0.684 and r = -0.604, respectively). The correlations between cytokine gradients and mechano-miR gradients were also significant, including Transforming Growth Factor Beta with miR-126 (r = 0.673, p < 0.001) and Vascular Endothelial Growth Factor with miR-10a (r = 0.602, p = 0.002). A regression analysis highlighted the hemoglobin level, smoking, beta-blocker use, miR-26a, and miR-663 as significant CFI determinants, indicating their roles in modulating the collateral vessel development. Conclusions: These findings suggest mechanosensitive microRNAs as predictive biomarkers for collateral circulation, offering new therapeutic perspectives for CTO patients.
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Affiliation(s)
- Mustafa Gökhan Vural
- Department of Cardiology, University of Health Sciences, Ankara Training and Research Hospital, Ankara 06230, Turkey
| | - Hulya Yilmaz Temel
- Department of Bioengineering, Faculty of Engineering, Ege University, Bornova 35040, Turkey;
| | - Ezgi Turunc
- Department of Biochemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir 35620, Turkey;
| | - Ramazan Akdemir
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
| | - Ersan Tatli
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
| | - Mustafa Tarik Agac
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
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2
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Roukoz H, Tholakanahalli V. Epicardial ablation of ventricular tachycardia in ischemic cardiomyopathy: A review and local experience. Indian Pacing Electrophysiol J 2024; 24:84-93. [PMID: 38340957 PMCID: PMC11010455 DOI: 10.1016/j.ipej.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/29/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Myocardial scar in ischemic cardiomyopathy is predominantly endocardial, however, between 5% and 15% of these patients have an arrhythmogenic epicardial substrate. Percutaneous epicardial ablation should be considered in patients with ICM and VT especially if they failed an endocardial ablation. Simultaneous epicardial and endocardial ablation of VT in ICM may reduce short- and medium-term VT recurrence compared with an endocardial only approach. Cardiac imaging could be used to help guide patient selection for a combined epi-endo approach. Complications related to epicardial access can happen in up to 7% of patients. Epicardial ablation in these patients should be referred to experienced tertiary centers. We review the literature and share interesting cases.
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3
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Sciagrà R, Linguanti F. The Never-ending Story: Assessing coronary collateral circulation with myocardial perfusion imaging. J Nucl Cardiol 2023; 30:2346-2348. [PMID: 37291456 DOI: 10.1007/s12350-023-03294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
The role of coronary collateral circulation has been thoroughly studied, and myocardial perfusion imaging has been a frequently employed method. Even angiographic invisible collaterals can support some degree of tracer uptake, but the clinical role of this evaluation is still uncertain, and this remains the main issue that should be clarified.
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Affiliation(s)
- Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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4
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Merkus D, Muller-Delp J, Heaps CL. Coronary microvascular adaptations distal to epicardial artery stenosis. Am J Physiol Heart Circ Physiol 2021; 320:H2351-H2370. [PMID: 33961506 DOI: 10.1152/ajpheart.00992.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Until recently, epicardial coronary stenosis has been considered the primary outcome of coronary heart disease, and clinical interventions have been dedicated primarily to the identification and removal of flow-limiting stenoses. However, a growing body of literature indicates that both epicardial stenosis and microvascular dysfunction contribute to damaging myocardial ischemia. In this review, we discuss the coexistence of macro- and microvascular disease, and how the structure and function of the distal microcirculation is impacted by the hemodynamic consequences of an epicardial, flow-limiting stenosis. Mechanisms of endothelial dysfunction as well as alterations of smooth muscle function in the coronary microcirculation distal to stenosis are discussed. Risk factors including diabetes, metabolic syndrome, and aging exacerbate microvascular dysfunction in the myocardium distal to a stenosis, and our current understanding of the role of these factors in limiting collateralization and angiogenesis of the ischemic myocardium is presented. Importantly, exercise training has been shown to promote collateral growth and improve microvascular function distal to stenosis; thus, the current literature reporting the mechanisms that underlie the beneficial effects of exercise training in the microcirculation distal to epicardial stenosis is reviewed. We also discuss recent studies of therapeutic interventions designed to improve microvascular function and stimulate angiogenesis in clinically relevant animal models of epicardial stenosis and microvascular disease. Finally, microvascular adaptation to removal of epicardial stenosis is considered.
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Affiliation(s)
- Daphne Merkus
- Institute for Surgical Research, Walter Brendel Center of Experimental Medicine (WBex), University Clinic, LMU Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Munich Heart Alliance (MHA), Munich, Germany.,Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Judy Muller-Delp
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida
| | - Cristine L Heaps
- Department of Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas.,Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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5
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Hollander MR, Jansen MF, Schumacher SP, Stuijfzand WJ, van Leeuwen MAH, van de Ven PM, Horrevoets AJ, Nap A, Knaapen P, van Royen N. Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index: Indicating Systemic Collateral Coherence in Individual Patients-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:1830-1836. [PMID: 33730875 DOI: 10.1161/atvbaha.121.316092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maurits R Hollander
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Matthijs F Jansen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Wijnand J Stuijfzand
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Maarten A H van Leeuwen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.,Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics (P.M.v.d.V.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Anton J Horrevoets
- Department of Molecular Cell Biology and Immunology (A.J.H.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Alex Nap
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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6
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Red-Horse K, Das S. New Research Is Shining Light on How Collateral Arteries Form in the Heart: a Future Therapeutic Direction? Curr Cardiol Rep 2021; 23:30. [PMID: 33655379 DOI: 10.1007/s11886-021-01460-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Collateral arteries create artery-artery anastomoses that could serve as natural bypasses that in the heart could relieve the various complications of ischemia heart disease. Recent work using animal models have begun to reveal details of how coronary collateral arteries form. RECENT FINDINGS Mouse genetics has been used to study the cellular and molecular mechanisms of collateral artery development. Collateral arteries are not pre-existing in the mouse heart, and only form in response to injury. Myocardial infarction creates tissue hypoxia that triggers the expression of growth factors and chemokines that guide collaterogenesis. Collateral development is more robust in neonatal hearts when compared with adults, and contributes to neonatal heart regeneration. The identification of signaling pathways and cellular responses underlying coronary collateral artery development suggests potential translational strategies. Continued investigation into this subject could lead to the identification of targetable pathways that induce collateral arteries for cardiac revascularization.
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Affiliation(s)
- Kristy Red-Horse
- Department of Biology, Stanford University, Stanford, CA, 94305, USA. .,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Soumyashree Das
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, 560065, India
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7
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Lee S, Park JM, Ann SJ, Kang M, Cheon EJ, An DB, Choi YR, Lee CJ, Oh J, Park S, Kang SM, Lee SH. Cholesterol Efflux and Collateral Circulation in Chronic Total Coronary Occlusion: Effect-Circ Study. J Am Heart Assoc 2021; 10:e019060. [PMID: 33634702 PMCID: PMC8174259 DOI: 10.1161/jaha.120.019060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The mechanism through which high‐density lipoprotein (HDL) induces cardioprotection is not completely understood. We evaluated the correlation between cholesterol efflux capacity (CEC), a functional parameter of HDL, and coronary collateral circulation (CCC). We additionally investigated whether A1BP (apoA1‐binding protein) concentration correlates with CEC and CCC. Methods and Results In this case‐control study, clinical and angiographic data were collected from 226 patients (mean age, 58 years; male, 72%) with chronic total coronary occlusion. CEC was assessed using a radioisotope and J774 cells, and human A1BP concentration was measured using enzyme‐linked immunosorbent assay. Differences between the good and poor CCC groups were compared, and associations between CEC, A1BP, and other variables were evaluated. Predictors of CCC were identified by multivariable logistic regression analysis. The CEC was higher in the good than in the poor CCC group (22.0±4.6% versus 20.2±4.7%; P=0.009). In multivariable analyses including age, sex, HDL‐cholesterol levels, age (odds ratio [OR], 0.96; P=0.003), and CEC (OR, 1.10; P=0.004) were identified as the independent predictors of good CCC. These relationships remained significant after additional adjustment for diabetes mellitus, acute coronary syndrome, and Gensini score. The A1BP levels were not significantly correlated with CCC (300 pg/mL and 283 pg/mL in the good CCC and poor CCC groups, respectively, P=0.25) or CEC. Conclusions The relationship between higher CEC and good CCC indicates that well‐functioning HDL may contribute to CCC and may be cardioprotective; this suggests that a specific function of HDL can have biological and clinical consequences.
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Affiliation(s)
- Seonhwa Lee
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Jung Mi Park
- Department of Biostatistics and Computing Graduate School Yonsei University Seoul Korea
| | - Soo-Jin Ann
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases Yonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Moonjong Kang
- Department of Biostatistics and Computing Graduate School Yonsei University Seoul Korea
| | - Eun Jeong Cheon
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases Yonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Dan Bi An
- Graduate Program of Science for Aging Graduate School Yonsei University Seoul Korea
| | - Yu Ri Choi
- Graduate Program of Science for Aging Graduate School Yonsei University Seoul Korea
| | - Chan Joo Lee
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Jaewon Oh
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Sungha Park
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Seok-Min Kang
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
| | - Sang-Hak Lee
- Division of Cardiology Department of Internal Medicine Severance HospitalYonsei University College of MedicineYonsei University Health System Seoul Korea
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8
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Chinyere IR, Moukabary T, Hutchinson MD, Lancaster JJ, Juneman E, Goldman S. Progression of infarct-mediated arrhythmogenesis in a rodent model of heart failure. Am J Physiol Heart Circ Physiol 2021; 320:H108-H116. [PMID: 33164577 PMCID: PMC7847079 DOI: 10.1152/ajpheart.00639.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Heart failure (HF) post-myocardial infarction (MI) presents with increased vulnerability to monomorphic ventricular tachycardia (mmVT). To appropriately evaluate new therapies for infarct-mediated reentrant arrhythmia in the preclinical setting, chronologic characterization of the preclinical animal model pathophysiology is critical. This study aimed to evaluate the rigor and reproducibility of mmVT incidence in a rodent model of HF. We hypothesize a progressive increase in the incidence of mmVT as the duration of HF increases. Adult male Sprague-Dawley rats underwent permanent left coronary artery ligation or SHAM surgery and were maintained for either 6 or 10 wk. At end point, SHAM and HF rats underwent echocardiographic and invasive hemodynamic evaluation. Finally, rats underwent electrophysiologic (EP) assessment to assess susceptibility to mmVT and define ventricular effective refractory period (ERP). In 6-wk HF rats (n = 20), left ventricular (LV) ejection fraction (EF) decreased (P < 0.05) and LV end-diastolic pressure (EDP) increased (P < 0.05) compared with SHAM (n = 10). Ten-week HF (n = 12) revealed maintenance of LVEF and LVEDP (P > 0.05), (P > 0.05). Electrophysiology studies revealed an increase in incidence of mmVT between SHAM and 6-wk HF (P = 0.0016) and ERP prolongation (P = 0.0186). The incidence of mmVT and ventricular ERP did not differ between 6- and 10-wk HF (P = 1.0000), (P = 0.9831). Findings from this rodent model of HF suggest that once the ischemia-mediated infarct stabilizes, proarrhythmic deterioration ceases. Within the 6- and 10-wk period post-MI, no echocardiographic, invasive hemodynamic, or electrophysiologic changes were observed, suggesting stable HF. This is the necessary context for the evaluation of experimental therapies in rodent HF.NEW & NOTEWORTHY Rodent model of ischemic cardiomyopathy exhibits a plateau of inducible monomorphic ventricular tachycardia incidence between 6 and 10 wk postinfarction.
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Affiliation(s)
- Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, Arizona
- MD-PhD Program, College of Medicine, University of Arizona, Tucson, Arizona
| | - Talal Moukabary
- Sarver Heart Center, University of Arizona, Tucson, Arizona
- Division of Cardiology, Banner-University Medical Center, Tucson, Arizona
| | - Mathew D Hutchinson
- Sarver Heart Center, University of Arizona, Tucson, Arizona
- Division of Cardiology, Banner-University Medical Center, Tucson, Arizona
| | | | - Elizabeth Juneman
- Sarver Heart Center, University of Arizona, Tucson, Arizona
- Division of Cardiology, Banner-University Medical Center, Tucson, Arizona
| | - Steven Goldman
- Sarver Heart Center, University of Arizona, Tucson, Arizona
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9
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Kern MJ, Seto AH. Collaterals in STEMI patients: An uncommon but critical lifeline. Catheter Cardiovasc Interv 2020; 96:534-535. [PMID: 32935939 DOI: 10.1002/ccd.29208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
Angiographically visible collaterals are seen in a minority of STEMI patients, predominantly to the RCA and in patients with delays to reperfusion. Patients with visible collaterals were less likely to have cardiogenic shock and tended to have a longer survival. Further studies will determine the mechanisms of collateral formation and their protective associations.
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Affiliation(s)
- Morton J Kern
- Department of Medicine, VA Long Beach Healthcare System, Long Beach, CA
| | - Arnold H Seto
- Department of Medicine, VA Long Beach Healthcare System, Long Beach, CA
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10
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Mansiroglu AK, Sincer I, Gunes Y. Assessment of neutrophil and neutrophil/lymphocyte ratio in coronary collateral developed patients with acute coronary syndrome. ACTA ACUST UNITED AC 2020; 66:954-959. [PMID: 32844936 DOI: 10.1590/1806-9282.66.7.954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Inflammation-related markers provide diagnostic and prognostic information for coronary artery disease and acute coronary syndrome. We aimed to compare neutrophil count and neutrophil/lymphocyte ratio (NLR) in acute coronary syndrome patients with coronary collateral development in our study. METHODS A total of 426 patients (102 unstable angina pectoris (USAP), 223 non-ST-elevation myocardial infarction (non-STEMI), 103 ST-elevation myocardial infarction (STEMI) were compared regarding hemoglobin, platelet, lymphocyte, neutrophil count, and NLR. RESULTS Neutrophil count and NLR were significantly lower in USAP patients and higher in STEMI patients; 5.14± 1.79 vs. 7.21± 3.05 vs. 9.93±4.67 and 2.92±2.39 vs. 5.19±4.80 vs. 7.93±6.38, p <0.001. Other parameters, i.e., hemoglobin, platelet, and lymphocyte count, were not significantly different between the groups. CONCLUSIONS In our study, it was concluded that there may be a statistically significant difference in the number of neutrophil counts and NLR among the types of acute coronary syndromes with coronary collateral development.
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Affiliation(s)
| | - Isa Sincer
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Yilmaz Gunes
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
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11
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Sahinturk Y, Kucukseymen S, Avci R, Akarsu A, Yolcular BO, Koker G, Tokuc A, Bayar N, Arslan S. Visceral fat index: a novel predictor for coronary collateral circulation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:150-158. [PMID: 32236316 PMCID: PMC10118954 DOI: 10.20945/2359-3997000000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.
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Affiliation(s)
- Yasin Sahinturk
- Departments of Internal Medicine, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Selcuk Kucukseymen
- Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Rauf Avci
- Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Ayse Akarsu
- Departments of Internal Medicine, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | | | - Gokhan Koker
- Departments of Internal Medicine, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Abdullah Tokuc
- Departments of Internal Medicine, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Nermin Bayar
- Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
| | - Sakir Arslan
- Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey
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12
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Karadeniz M, Karadeniz T, Sarak T, Alp Ç. The relationship between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.657326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Chen K, Zhang X, Li D, Chen H, Zhang Z, Chen L. A noninvasive and highly sensitive approach for the assessment of coronary collateral circulation by 192-slice third-generation dual-source computed tomography. Medicine (Baltimore) 2019; 98:e17014. [PMID: 31567938 PMCID: PMC6756702 DOI: 10.1097/md.0000000000017014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).Eight hundred patients (450 men and 350 women, mean age: 56 ± 11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ± 3.7 days (Range: 1-15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91-0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ± 0.04 mSv (range, 0.35-0.43 mSv).The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.
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Affiliation(s)
- Kebin Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Xiaoge Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Daling Li
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Honglei Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Zhixu Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Lei Chen
- Department of Lab Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
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14
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Coppel R, Lagache M, Finet G, Rioufol G, Gómez A, Dérimay F, Malvé M, Yazdani SK, Pettigrew RI, Ohayon J. Influence of Collaterals on True FFR Prediction for a Left Main Stenosis with Concomitant Lesions: An In Vitro Study. Ann Biomed Eng 2019; 47:1409-1421. [DOI: 10.1007/s10439-019-02235-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/20/2019] [Indexed: 12/20/2022]
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15
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Liu GY, Meng XX, Zhang Z. Triglyceride to HDL-cholesterol ratio as an independent risk factor for the poor development of coronary collateral circulation in elderly patients with ST-segment elevation myocardial infarction and acute total occlusion. Medicine (Baltimore) 2018; 97:e12587. [PMID: 30278570 PMCID: PMC6181613 DOI: 10.1097/md.0000000000012587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To determine the prognostic role of triglyceride (TG) to high-density lipoprotein cholesterol (HDL) ratio for poorly developed coronary collateral circulation (CCC) in elderly patients with ST-segment elevation myocardial infarction (STEMI) and acute total occlusion (ATO).As a retrospective case-control study, elderly patients (age ≥60 years) with both STEMI and ATO (n = 346) were classified as having either poorly- or well-developed CCC (Rentrop grades 0-1 and 2-3, respectively). The ratio of TG/HDL was calculated according to the detected levels of TG and HDL. The difference of TG/HDL ratio in those 2 groups was compared by Student t test, and multivariate logistic regression analysis indicating occurrence of poorly developed CCC was performed. Receiver operator characteristic curve (ROC) analysis of TG/HDL ratio which determine the optimal cut-off value of TG/HDL ratio was applied.The TG/HDL ratio was significantly higher in patients with poorly developed CCC than in those with well-developed CCC (2.88 ± 2.52 vs 1.81 ± 1.18, P < .001). In multivariate logistic regression analysis, higher TG/HDL ratio (OR 1.789, 95% CI 1 . 346-2.378, P < .001) and the presence of left circumflex branch of coronary artery (LCX) occlusion (OR6.235, 95% CI 2.220-17.510, P = .001) were emerged as independent positive predictors of poor development of CCC, whereas presence of right coronary artery (RCA) occlusion (OR 0.474, 95% CI 0.265-0.850, P = .002) and onset time (OR 0.693, 95% CI 0.620-0.775, P < .001) were found as negative indicators. The optimal cut-off value of TG/HDL ratio was found as 1.58 in ROC analysis, which yielded an area under the curve value of 0.716 (95% CI 0.654-0.778, P < .001) and demonstrated a sensitivity of 80.9% and a specificity of 59.3% for prediction of poorly developed CCC.TG/HDL ratio is an independent risk factor for predicting poor development of CCC in elderly patients with STEMI and ATO.
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Affiliation(s)
- Guo-Yong Liu
- Heart Center, The First Affiliated Hospital, Lanzhou University, Lanzhou
- Department of Cardiology, Qinghai Provincial People's Hospital, Xining, China
| | - Xiao-Xue Meng
- Heart Center, The First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Zheng Zhang
- Heart Center, The First Affiliated Hospital, Lanzhou University, Lanzhou
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16
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Whayne TF, Wells G, Messerli A. Prognostic Implications of Coronary Collaterals in Transmural Infarct-Related Percutaneous Coronary Interventions. Angiology 2018; 70:193-196. [PMID: 29747518 DOI: 10.1177/0003319718775843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Thomas F Whayne
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Gretchen Wells
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Adrian Messerli
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
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17
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Chen XP, Shang XS, Wang YB, Fu ZH, Gao Y, Feng T. Correlation between GDF-15 gene polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction. ACTA ACUST UNITED AC 2018; 63:1049-1054. [PMID: 29489980 DOI: 10.1590/1806-9282.63.12.1049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the correlation between growth differentiation factor 15 (GDF-15) -3148C/G polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction (STEMI) in Han population of Taiyuan area. METHOD The present study included 92 STEMI patients and 56 normal controls based on coronary angiography; STEMI group was divided into collateral group and non-collateral group according to Rentrop's grading method. Polymerase chain reaction (PCR) and DNA sequencing methods were used to detect and analyze the GDF-15 -3148C/G polymorphism in all participants. RESULTS There was significant difference in GDF-15 -3148C/G CC and GC distribution between STEMI group and control group (p=0.009); the allele frequencies between these two groups were also significant different (p=0.016); and the risk genotype for STEMI was CC with increased OR=2.660. For STEMI group, GDF-15 -3148C/G CC and GC distribution was also significantly different between patients with and without collateral (p=0.048), and CC genotype significantly promote the formation of collateral circulation. However, there were no significant differences in allele frequencies between these two subgroups of STEMI. CONCLUSION There was correlation between GDF-15-3148C/G polymorphism and the formation of collateral circulation in patients with acute STEMI.
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Affiliation(s)
- Xiao-Ping Chen
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
| | - Xiao-Sen Shang
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
| | - Yan-Bin Wang
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
| | - Zhi-Hua Fu
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
| | - Yu Gao
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
| | - Tao Feng
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, Shanxi, China
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18
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Sigala F, Oikonomou E, Antonopoulos AS, Galyfos G, Tousoulis D. Coronary versus carotid artery plaques. Similarities and differences regarding biomarkers morphology and prognosis. Curr Opin Pharmacol 2018; 39:9-18. [DOI: 10.1016/j.coph.2017.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 01/09/2023]
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Oikonomou E, Tsalamandris S, Mourouzis K, Tousoulis D. Biology of the Vessel Wall. Coron Artery Dis 2018. [DOI: 10.1016/b978-0-12-811908-2.00001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Heinen SGH, van den Heuvel DAF, Huberts W, de Boer SW, van de Vosse FN, Delhaas T, de Vries JPPM. In Vivo Validation of Patient-Specific Pressure Gradient Calculations for Iliac Artery Stenosis Severity Assessment. J Am Heart Assoc 2017; 6:JAHA.117.007328. [PMID: 29275367 PMCID: PMC5779042 DOI: 10.1161/jaha.117.007328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Currently, the decision to treat iliac artery stenoses is mainly based on visual inspection of digital subtraction angiographies. Intra‐arterial pressure measurements can provide clinicians with accurate hemodynamic information. However, pressure measurements are rarely performed because of their invasiveness and the time required. Therefore, the aim of the study was to test the feasibility of a computational model that can predict translesional pressure gradients across iliac artery stenoses on the basis of imaging data only. Methods and Results Patients (N=21) with symptomatic peripheral arterial disease and a peak systolic velocity ratio between 2.5 and 5.0 were included in the study. Patients underwent per‐procedural 3‐dimensional rotational angiography and hyperemic intra‐arterial translesional pressure measurements. Vascular anatomical features were reconstructed from the 3‐dimensional rotational angiography data into an axisymmetrical 2‐dimensional computational mesh, and flow was estimated on the basis of the stenosis geometry. Computational fluid dynamics were performed to predict the pressure gradient and were compared with the measured pressure gradients. A good agreement by overlapping error bars of the predicted and measured pressure gradients was found in 21 of 25 lesions. Stratification of the stenosis on the basis of the predicted pressure gradient into hemodynamic not significant (<10 mm Hg) and hemodynamic significant (≥10 mm Hg) resulted in sensitivity, specificity, and overall predictive values of 95%, 60%, and 88%, respectively. Conclusions The feasibility of the patient‐specific computational model to predict the hyperemic translesional pressure gradient over iliac artery stenosis was successfully tested. Presented results suggest that, with further optimization and corroboration, the model can become a valuable aid to the diagnosis of equivocal iliac artery stenosis. Clinical Trial Registration URL: http://www.trialregister.nl. Unique identifier: NTR5085.
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Affiliation(s)
- Stefan G H Heinen
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands .,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Wouter Huberts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sanne W de Boer
- Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
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21
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Avci E, Yildirim T, Kadi H. Contrast-Induced Nephropathy Is Less Common in Patients with Good Coronary Collateral Circulation. Cardiorenal Med 2017; 7:316-323. [PMID: 29118770 DOI: 10.1159/000479013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Background/Aims Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. Methods Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. Results A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent (p < 0.001). Furthermore, collateral circulation was an independent predictor of CIN. Conclusion Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.
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Affiliation(s)
- Eyup Avci
- Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | - Tarik Yildirim
- Cardiology Clinic, Balikesir State Hospital, Balikesir, Turkey
| | - Hasan Kadi
- Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey
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22
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Liu Z, Pericak-Vance MA, Goldschmidt-Clermont P, Seo D, Wang L, Rundek T, Beecham GW. Coronary collateralization shows sex and racial-ethnic differences in obstructive artery disease patients. PLoS One 2017; 12:e0183836. [PMID: 29016599 PMCID: PMC5634541 DOI: 10.1371/journal.pone.0183836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/12/2017] [Indexed: 12/14/2022] Open
Abstract
Background Coronary collateral circulation protects cardiac tissues from myocardial infarction damage and decreases sudden cardiac death. So far, it is unclear how coronary collateralization varies by race-ethnicity groups and by sex. Methods We assessed 868 patients with obstructive CAD. Patients were assessed for collateral grades based on Rentrop grading system, as well as other covariates. DNA samples were genotyped using the Affymetrix 6.0 genotyping array. To evaluate genetic contributions to collaterals, we performed admixture mapping using logistic regression with estimated local and global ancestry. Results Overall, 53% of participants had collaterals. We found difference between sex and racial-ethnic groups. Men had higher rates of collaterals than women (P-value = 0.000175). White Hispanics/Latinos showed overall higher rates of collaterals than African Americans and non-Hispanic Whites (59%, 50% and 48%, respectively, P-value = 0.017), and especially higher rates in grade 1 and grade 3 collateralization than the other two populations (P-value = 0.0257). Admixture mapping showed Native American ancestry was associated with the presence of collaterals at a region on chromosome 17 (chr17:35,243,142-41,251,931, β = 0.55, P-value = 0.000127). African ancestry also showed association with collaterals at a different region on chromosome 17 (chr17: 32,266,966-34,463,323, β = 0.38, P-value = 0.00072). Conclusions In our study, collateralization showed sex and racial-ethnic differences in obstructive CAD patients. We identified two regions on chromosome 17 that were likely to harbor genetic variations that influenced collateralization.
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Affiliation(s)
- Zhi Liu
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Pascal Goldschmidt-Clermont
- Division of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - David Seo
- Division of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Liyong Wang
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida, United States of America
- * E-mail:
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23
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Fan Y, Hu JS, Guo F, Lu ZB, Xia H. Lipoprotein(a) as a predictor of poor collateral circulation in patients with chronic stable coronary heart disease. ACTA ACUST UNITED AC 2017; 50:e5979. [PMID: 28700032 PMCID: PMC5505520 DOI: 10.1590/1414-431x20175979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Abstract
As a mechanism compensating for obstructive coronary artery disease, coronary collateral circulation (CCC) has attracted cardiologists for a long time to explore its potential impact. In the present study, Chinese patients suffering from ≥95% coronary stenosis, as diagnosed by angiography, have been investigated for the correlation between CCC and lipoprotein(a) [Lp(a)] levels. A cohort of 654 patients was divided into four categories according to Rentrop grades 0, 1, 2, and 3. Lp(a) levels were divided into model 1, discretized with critical values of 33 and 66%, and model 2, discretized with a cutoff value of 30.0 mg/dL. Furthermore, we evaluated the correlation between CCC and serum Lp(a) levels. The four groups had significantly different Lp(a) levels (25.80±24.72, 18.99±17.83, 15.39±15.80, and 8.40±7.75 mg/dL; P<0.001). In model 1, concerning R0, the risk in the third Lp (a) tertile (OR=3.34, 95%CI=2.32-4.83) was greater than that in the first tertile. In model 2, concerning R0, the risk in Lp(a) >30.0 group (OR=6.77, 95%CI=4.44-10.4) was greater than that of Lp(a) <30.0 mg/dL. The worst condition of CCC can be predicted independently by Lp(a) levels. In addition to clinical usage, Lp(a) levels can also be utilized as biological markers.
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Affiliation(s)
- Y Fan
- Department of Cardiology, Renmin Hospital, Wuhan University Hubei General Hospital, Wuhan, Hubei Province, China.,Department of Cardiology, The Fifth Hospital of Wuhan and Affiliated Guangci Hospital, Wuhan University, Wuhan, Hubei Province, China
| | - J-S Hu
- Department of Cardiology, The Fifth Hospital of Wuhan and Affiliated Guangci Hospital, Wuhan University, Wuhan, Hubei Province, China
| | - F Guo
- Department of Cardiology, The Fifth Hospital of Wuhan and Affiliated Guangci Hospital, Wuhan University, Wuhan, Hubei Province, China
| | - Z-B Lu
- Department of Cardiology, Renmin Hospital, Wuhan University Hubei General Hospital, Wuhan, Hubei Province, China
| | - H Xia
- Department of Cardiology, Renmin Hospital, Wuhan University Hubei General Hospital, Wuhan, Hubei Province, China
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Kundi H, Gok M, Kiziltunc E, Cetin M, Ornek E. Association of IGF-1 with coronary collateral circulation in stable coronary artery disease. Biomark Med 2017; 11:527-534. [PMID: 28685580 DOI: 10.2217/bmm-2016-0354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of the present study is to evaluate the relationship between coronary collateral circulation (CCC) grade and serum IGF-1 levels in patients diagnosed with stable coronary artery disease. Methods: Totally, 190 consecutive patients with stable coronary artery disease who underwent coronary angiography were included in this study. Results: The patients with good CCC had significantly higher IGF-1 levels compared with the poor ones. On the contrary, hs-CRP was significantly lower in the good CCC group. We also demonstrated that IGF-1 level was significantly related with the grade of CCC. Conclusion: We believe that measurement of IGF-1 level may help clinicians for predicting CCC development.
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Affiliation(s)
- Harun Kundi
- Cardiology Department, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Murat Gok
- Cardiology Department, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunc
- Cardiology Department, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- Cardiology Department, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Ender Ornek
- Cardiology Department, Ankara Numune Education & Research Hospital, Ankara, Turkey
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Kurtul A, Duran M. The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients. Biomark Med 2016; 11:43-52. [PMID: 27917651 DOI: 10.2217/bmm-2016-0179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM Coronary collateral circulation (CCC) has an important impact on cardiovascular prognosis and well-developed CCC is associated with better clinical outcomes. We investigated whether lymphocyte/monocyte ratio (LMR) has an association with CCC in patients with stable coronary artery disease (SCAD). METHODS The study population consisted of 245 patients with SCAD. Patients were classified into a poor CCC group (Rentrop grades 0/1, n = 87), or good CCC group (Rentrop grades 2/3, n = 158). RESULTS LMR values were significantly higher in patients with good CCC than in those with poor CCC (4.41 ± 1.58 vs 2.76 ± 1.10; p < 0.001). In receiver operating characteristic analysis, optimal cutoff of LMR for predicting well-developed CCC was 3.38. In multivariate analysis, LMR >3.38 (OR 4.637; p = 0.004), high sensitivity C-reactive protein (OR 0.810, p < 0.001), dyslipidemia (OR 2.485; p = 0.039), and presence of chronic total occlusion (OR 16.836; p < 0.001) were independent predictors of well-developed CCC. CONCLUSION Increased LMR predicts well-developed CCC in SCAD patients.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education & Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education & Research Hospital, Ankara, Turkey
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The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with non-ST segment elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:224-30. [PMID: 27625685 PMCID: PMC5011538 DOI: 10.5114/aic.2016.61644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/30/2015] [Indexed: 01/17/2023] Open
Abstract
Introduction Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a significant inflammatory marker and a novel predictor of major adverse consequences in cardiovascular disease. Aim In this study, we aimed to explore the relationship between PLR and coronary collateral circulation (CCC) in patients with non-ST elevation myocardial infarction (NSTEMI). Material and methods Clinical and laboratory data of 386 patients who underwent coronary angiography were evaluated retrospectively. The patients were classified into 2 groups as follows: poor CCC (group 1: Rentrop grades 0–1) and good CCC (group 2: Rentrop grades 2–3). The PLR was calculated from the complete blood count. Results The PLR values of the patients with poor CCC were significantly higher than those of patients with good CCC (153.9 ±26.6 vs. 129.8 ±23.5, p < 0.001). In the multiple logistic regression tests, PLR (odds ratio: 1.51, 95% confidence interval: 1.27–1.74; p < 0.001) and hs-CRP (odds ratio: 1.56, 95% CI: 1.03–2.11; p < 0.001) were found to be independent predictors of poor CCC. The receiver operating characteristic (ROC) curve analysis yielded a cutoff value of 140.5 for PLR to predict poor CCC with 79% sensitivity and 71% specificity, with the area under the ROC curve being 0.792 (95% CI: 0.721–0.864). Conclusions Our study revealed that high PLR is independently associated with poor coronary collateral circulation in patients with NSTEMI.
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Amoah V, Wrigley B, Holroyd E, Smallwood A, Armesilla AL, Nevill A, Cotton J. Vascular endothelial growth factor and hypoxia-inducible factor-1α gene polymorphisms and coronary collateral formation in patients with coronary chronic total occlusions. SAGE Open Med 2016; 4:2050312116654403. [PMID: 27621802 PMCID: PMC5006805 DOI: 10.1177/2050312116654403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/10/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction: We evaluated the association between two single nucleotide polymorphisms of the vascular endothelial growth factor gene and one of the hypoxia-inducible factor-1α gene and the degree of coronary collateral formation in patients with a coronary chronic total occlusion. Methods: Totally, 98 patients with symptomatic coronary artery disease and a chronic total occlusion observed during coronary angiography were recruited. Genotyping of two vascular endothelial growth factor promoter single nucleotide polymorphisms (−152G>A and −165C>T) and the C1772T single nucleotide polymorphism of hypoxia-inducible factor-1α were performed using polymerase chain reaction and restriction fragment length polymorphism analysis. The presence and extent of collateral vessel filling was scored by blinded observers using the Rentrop grade. Results: We found no association between the vascular endothelial growth factor −152G>A, −165C>T and hypoxia-inducible factor-1α −1772C>T with the presence and filling of coronary collateral vessels. A history of percutaneous coronary intervention and transient ischaemic attack/cerebrovascular accident were associated with the presence of enhanced collateral vessel formation following binary logistic regression analysis. Conclusion: The study findings suggest that coronary collateral formation is not associated with the tested polymorphic variants of vascular endothelial growth factor and hypoxia-inducible factor-1α in patients with symptomatic coronary artery disease and the presence of a chronic total occlusion.
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Affiliation(s)
- Vincent Amoah
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Benjamin Wrigley
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Eric Holroyd
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Andrew Smallwood
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Angel L Armesilla
- Research Institute in Healthcare Science, School of Pharmacy, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - James Cotton
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
- James Cotton, Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, West Midlands WV10 0QP, UK.
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Fan Y, Li S, Li XL, Lin XL, Zhu CG, Xu RX, Qing P, Wu NQ, Jiang LX, Xu B, Gao RL, Li JJ. Plasma endothelin-1 level as a predictor for poor collaterals in patients with ≥95% coronary chronic occlusion. Thromb Res 2016; 142:21-5. [PMID: 27105310 DOI: 10.1016/j.thromres.2016.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary collateral circulation (CCC) plays an important role in protecting myocardium from ischemic damage. The studies on factors which impact on CCC might be of great clinical interest. The aim of the present study was to evaluate endothelin-1 (ET-1) as a potential predictor for poor or good CCC in patients with angiography-proven ≥95% coronary occlusion. METHODS We screened 1038 consecutive patients with ≥95% occlusion in at least one major epicardial coronary artery detected by coronary angiography. Of these, 663 patients were classified into the poor CCC group with Rentrop 0-2 grade collateral circulation and 375 patients into the good CCC group with Rentrop 3 grade. The association of plasma ET-1 levels with collateral status was assessed. RESULTS We found that patients in the poor CCC group had a higher ET-1 level than those in the good CCC group (0.59±0.48 vs. 0.39±0.32pmol/L, p<0.001), and the ET-1 values increased with the descent of the Rentrop grades (p for trend<0.001). Moreover, multivariate logistic regression analysis revealed an independent association between ET-1 and collateral status (odds ratio [95% CI] for poor CCC 2.27 [1.60-3.22], p<0.001). Additionally, the association presented significance in both men (odds ratio [95% CI] for poor CCC 3.18 [2.20-4.74], p<0.001) and women (odds ratio [95% CI] for poor CCC 3.10 [1.36-7.85], p=0.011) when the sex-specific analysis was performed. CONCLUSIONS Plasma ET-1 level may be a useful, easily available marker for predicting the degree of CCC in patients with ≥95% coronary chronic occlusion.
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Affiliation(s)
- Ying Fan
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China; Department of Cardiology, The Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University, Wuhan 430050, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Xian-Liang Lin
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Ping Qing
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Li-Xin Jiang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Bo Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Run-Lin Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xi Cheng District, Beijing, 100037, China.
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McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC. The collateral circulation of coronary chronic total occlusions. EUROINTERVENTION 2016; 11:e1596-603. [PMID: 27056120 DOI: 10.4244/eijv11i14a310] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs. METHODS AND RESULTS We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the U.K. over four years. Detailed angiographic analysis was performed by interventional cardiologists specialising in CTO percutaneous coronary intervention (PCI). All visible collaterals with a collateral connection (CC) grade ≥1 were recorded. A subgroup of CTOs (n=277) was assessed for interventional capability, defined as whether the collateral supply was able to facilitate retrograde access. We described 45 different collateral patterns: 20 in right coronary artery (RCA), 13 in left anterior descending (LAD), and 12 in circumflex artery CTOs. Septal collaterals from the LAD to the right posterior descending artery (RPDA), and from the posterior descending artery to the LAD were most common, and most often considered as having "interventional capability". CONCLUSIONS This is the largest analysis of collateral circulation anatomy in a population of patients with CTOs. We anticipate that these data will be of significant benefit in angiographic analysis and procedure planning for CTO PCI.
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Möbius-Winkler S, Uhlemann M, Adams V, Sandri M, Erbs S, Lenk K, Mangner N, Mueller U, Adam J, Grunze M, Brunner S, Hilberg T, Mende M, Linke AP, Schuler G. Coronary Collateral Growth Induced by Physical Exercise: Results of the Impact of Intensive Exercise Training on Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease (EXCITE) Trial. Circulation 2016; 133:1438-48; discussion 1448. [PMID: 26979085 DOI: 10.1161/circulationaha.115.016442] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 02/12/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND A well-developed coronary collateral circulation provides a potential source of blood supply in coronary artery disease. However, the prognostic importance and functional relevance of coronary collaterals is controversial with the association between exercise training and collateral growth still unclear. METHODS AND RESULTS This prospective, open-label study randomly assigned 60 patients with significant coronary artery disease (fractional flow reserve ≤0.75) to high-intensity exercise (group A, 20 patients) or moderate-intensity exercise (group B, 20 patients) for 4 weeks or to a control group (group C, 20 patients). The primary end point was the change of the coronary collateral flow index (CFI) after 4 weeks. Analysis was based on the intention to treat. After 4 weeks, baseline CFI increased significantly by 39.4% in group A (from 0.142±0.07 at beginning to 0.198±0.09 at 4 weeks) in comparison with 41.3% in group B (from 0.143±0.06 to 0.202±0.09), whereas CFI in the control group remained unchanged (0.7%, from 0.149±0.09 to 0.150±0.08). High-intensity exercise did not lead to a greater CFI than moderate-intensity training. After 4 weeks, exercise capacity, Vo2 peak and ischemic threshold increased significantly in group A and group B in comparison with group C with no difference between group A and group B. CONCLUSIONS A significant improvement in CFI was demonstrated in response to moderate- and high-intensity exercise performed for 10 hours per week. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01209637.
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Affiliation(s)
- Sven Möbius-Winkler
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Madlen Uhlemann
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.).
| | - Volker Adams
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Marcus Sandri
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Sandra Erbs
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Karsten Lenk
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Norman Mangner
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Ulrike Mueller
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Jennifer Adam
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Martin Grunze
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Susanne Brunner
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Thomas Hilberg
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Meinhard Mende
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Axel P Linke
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
| | - Gerhard Schuler
- From University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Germany (A.M.-W., M.U., V.A., M.S., S.E., K.L., N.M., U.M., J.A., A.P.L., G.S.); Asklepios Clinic Weißenfels, Germany (S.M.-W., K.L.); MediClin Dünenwald Klinik Trassenheide, Germany (M.G., S.B.); Department of Sports Medicine, University Wuppertal, Germany (T.H.); and Coordination Centre for Clinical Trials, University of Leipzig, Germany (M.M.)
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Fan Y, Li S, Li XL, Zhu CG, Guo YL, Wu NQ, Qing P, Gao Y, Dong Q, Liu G, Li JJ. C-reactive protein as a predictor for poor collateral circulation in patients with chronic stable coronary heart disease. Ann Med 2016; 48:83-8. [PMID: 26790524 DOI: 10.3109/07853890.2015.1136429] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To investigate the association between serum C-reactive protein (CRP) levels and coronary collateral circulation (CCC) in Chinese patients with angiography-proven ≥95% coronary stenosis. METHODS In this study, 1158 patients with angiography-proven ≥95% occlusion in ≥1 major epicardial coronary artery were enrolled, and then classified into two groups: poor CCC (Rentrop grades 0-1) and good CCC (Rentrop grades 2-3). CRP levels were grouped using the following two models: Model 1 discretized CRP group with 33.33% and 66.66% as the critical values and Model 2 with 1.0 and 3.0 mg/L as the cut off values. RESULTS There were significant differences in serum CRP levels between the two groups (5.76 ± 3.45 vs. 3.49 ± 2.44 mg/L, respectively; p < 0.001), and compared with the first CRP tertile, the risks of poor CCC were higher in the second and third CRP tertiles (OR 2.31, 95%CI [1.67-3.19], OR 6.25, 95%CI [4.52-8.62], respectively). The receiver operating characteristic curve analysis indicated that the optimal cutoff value of CRP to predict poor CCC was 4.21 mg/L with 59.6% sensitivity and 74.33% specificity. CONCLUSIONS CRP levels are an independent predictor for poor CCC and might supply a useful biomarker in clinical applications. Key messages C-reactive protein (CRP) is a non-specific inflammatory marker that is regarded as an independent risk and prognostic factor for individuals who suffer from coronary artery disease (CAD) and cardiovascular disorders. In a Chinese cohort of patients with coronary artery occlusion or stenosis of ≥95% TIMI grade 1 anterograde-flow, the relationship between CRP concentrations and angiographically visible coronary collateral (CC) was assessed. Our data indicated that elevated CRP associated with a significant impairment in CC development, and might supply a useful biomarker in clinical applications.
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Affiliation(s)
- Ying Fan
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China ;,b Department of Cardiology , the Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University , Wuhan , China
| | - Sha Li
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Xiao-Lin Li
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Cheng-Gang Zhu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yuan-Lin Guo
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Na-Qiong Wu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Ping Qing
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Ying Gao
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Qian Dong
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Geng Liu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jian-Jun Li
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital , National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Abstract
Formation of arterial vasculature, here termed arteriogenesis, is a central process in embryonic vascular development as well as in adult tissues. Although the process of capillary formation, angiogenesis, is relatively well understood, much remains to be learned about arteriogenesis. Recent discoveries point to the key role played by vascular endothelial growth factor receptor 2 in control of this process and to newly identified control circuits that dramatically influence its activity. The latter can present particularly attractive targets for a new class of therapeutic agents capable of activation of this signaling cascade in a ligand-independent manner, thereby promoting arteriogenesis in diseased tissues.
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Affiliation(s)
- Michael Simons
- From the Department of Internal Medicine, Yale Cardiovascular Research Center, Section of Cardiovascular Medicine (M.S., A.E.) and Departments of Cell Biology (M.S.) and Molecular Physiology (A.E.), Yale University School of Medicine, New Haven, CT.
| | - Anne Eichmann
- From the Department of Internal Medicine, Yale Cardiovascular Research Center, Section of Cardiovascular Medicine (M.S., A.E.) and Departments of Cell Biology (M.S.) and Molecular Physiology (A.E.), Yale University School of Medicine, New Haven, CT.
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Chen YY, Zhang WG, Yang S, Yun H, Deng SM, Fu CX, Zeng MS, Jin H, Guo L. Extracellular volume fraction in coronary chronic total occlusion patients. Int J Cardiovasc Imaging 2015; 31:1211-21. [DOI: 10.1007/s10554-015-0680-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
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Duran J, Olavarría PS, Mola M, Götzens V, Carballo J, Pelegrina EM, Petit M, Abdul-Jawad O, Otaegui I, del Blanco BG, García-Dorado D, Reig J, Cordero A, de Anta JM. Genetic association study of coronary collateral circulation in patients with coronary artery disease using 22 single nucleotide polymorphisms corresponding to 10 genes involved in postischemic neovascularization. BMC Cardiovasc Disord 2015; 15:37. [PMID: 25959001 PMCID: PMC4493944 DOI: 10.1186/s12872-015-0027-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collateral growth in patients with coronary artery disease (CAD) is highly heterogeneous. Although multiple factors are thought to play a role in collateral development, the contribution of genetic factors to coronary collateral circulation (CCC) is largely unknown. The goal of this study was to assess whether functional single nucleotide polymorphisms (SNPs) in genes involved in vascular growth are associated with CCC. METHODS 677 consecutive CAD patients were enrolled in the study and their CCC was assessed by the Rentrop method. 22 SNPs corresponding to 10 genes involved in postischemic neovascularization were genotyped and multivariate logistic regression models were adjusted using clinically relevant variables to estimate odds ratios and used to examine associations of allelic variants, genotypes and haplotypes with CCC. RESULTS Statistical analysis showed that the HIF1A rs11549465 and rs2057482; VEGFA rs2010963, rs1570360, rs699947, rs3025039 and rs833061; KDR rs1870377, rs2305948 and rs2071559; CCL2 rs1024611, rs1024610, rs2857657 and rs2857654; NOS3 rs1799983; ICAM1 rs5498 and rs3093030; TGFB1 rs1800469; CD53 rs6679497; POSTN rs3829365 and rs1028728; and LGALS2 rs7291467 polymorphisms, as well as their haplotype combinations, were not associated with CCC (p < 0.05). CONCLUSIONS We could not validate in our cohort the association of the NOS3 rs1799983, HIF1A rs11549465, VEGFA rs2010963 and rs699947, and LGALS2 rs7291467 variants with CCC reported by other authors. A validated SNP-based genome-wide association study is required to identify polymorphisms influencing CCC.
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Affiliation(s)
- Joan Duran
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
| | - Pilar Sánchez Olavarría
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain. .,Departamento de Estadística, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile.
| | - Marina Mola
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain. .,Neurovascular Research Group (NEUVAS), Institut Municipal d'Investigació Mèdica. Hospital del Mar, PRBB, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
| | - Víctor Götzens
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
| | - Julio Carballo
- Department of Cardiology and Hemodynamics, Centre Cardiovascular Sant Jordi, Barcelona, Spain.
| | - Eva Martín Pelegrina
- Department of Cardiology and Hemodynamics, Centre Cardiovascular Sant Jordi, Barcelona, Spain.
| | - Màrius Petit
- Department of Cardiology and Hemodynamics, Centre Cardiovascular Sant Jordi, Barcelona, Spain.
| | - Omar Abdul-Jawad
- Department of Cardiology, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain.
| | - Imanol Otaegui
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Josep Reig
- Departament of Morphological Sciences, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain.
| | - Alex Cordero
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain. .,Àrea Epigenetics and Cancer Biology Area, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Maria de Anta
- Unitat d'Anatomia i Embriologia Humanes, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Campus de Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
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de Marchi SF. Determinants of human coronary collaterals. Curr Cardiol Rev 2015; 10:24-8. [PMID: 23638830 PMCID: PMC3968591 DOI: 10.2174/1573403x1001140317114411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 01/09/2023] Open
Abstract
The human coronary collateral circulation is prognostically relevant. The understanding of collateral formation and its determinants may guide future therapeutic strategies aiming at promoting collateral growth and functionality, and hence reducing the global burden of coronary artery disease (CAD).
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Stoller M, Seiler C. Pathophysiology of coronary collaterals. Curr Cardiol Rev 2015; 10:38-56. [PMID: 23701025 PMCID: PMC3968593 DOI: 10.2174/1573403x113099990005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary
collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to
be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent
with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be
unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood
flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be
attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary
collaterals to acute alterations in the coronary circulation.
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Affiliation(s)
| | - Christian Seiler
- Department of Cardiology, University Hospital, CH-3010 Bern, Switzerland.
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Söğüt E, Kadı H, Karayakalı M, Mertoğlu C. The association of plasma vitamin A and E levels with coronary collateral circulation. Atherosclerosis 2015; 239:547-51. [PMID: 25728388 DOI: 10.1016/j.atherosclerosis.2015.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/15/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate if plasma levels of vitamin A and E have an association with coronary collateral development. METHODS A total of 189 patients who underwent coronary angiography and had total occlusion in at least one major epicardial coronary artery were enrolled in the study. To classify coronary collateral circulation (CCC), the Rentrop scoring system was used. Patients were classified as having poor CCC (Rentrop grades 0-1) or good CCC (Rentrop grades 2-3), and all patients were also screened for hypertension, hypercholesterolemia, diabetes, and smoking history. RESULTS There were no differences in plasma vitamin A and E levels between the two groups (vitamin A: 2.37 ± 0.65 vs. 2.35 ± 0.78, p = 0.253; vitamin E: 47.1 ± 12.8 vs. 44.6 ± 15.1, p = 0.082), and plasma vitamin A and E levels were not associated with CCC. Serum high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with poor CCC (4.68 ± 2.52 vs. 3.89 ± 1.78, p = 0.001). The higher frequency of diabetes and higher serum hs-CRP levels were found to be an independent predictor for poor CCC (odds ratio = 2.44, p = 0.006; odds ratio = 1.24, p = 0.007, respectively). And a higher frequency of total occluded RCA was found to be a positive predictor for good CCC (odds ratio = 2.36, p = 0.06) in a multivariate logistic regression analysis. CONCLUSIONS We found that serum hs-CRP levels, presence of diabetes, and total occlusion of RCA have an effect on coronary collateral development. We found no correlation between plasma vitamin A and E levels and CCC.
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Affiliation(s)
- Erkan Söğüt
- Izmir Kâtip Çelebi University, Faculty of Medicine, Department of Biochemistry, Izmir, Turkey.
| | - Hasan Kadı
- Gaziosmanpaşa University, Faculty of Medicine, Department of Cardiology, Tokat, Turkey
| | - Metin Karayakalı
- Gaziosmanpaşa University, Faculty of Medicine, Department of Cardiology, Tokat, Turkey
| | - Cuma Mertoğlu
- Gaziosmanpaşa University, Faculty of Medicine, Department of Biochemistry, Tokat, Turkey
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Börekçi A, Gür M, Şeker T, Baykan AO, Özaltun B, Karakoyun S, Karakurt A, Türkoğlu C, Makça I, Çaylı M. Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score. Perfusion 2014; 30:457-64. [PMID: 25358476 DOI: 10.1177/0267659114558287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. OBJECTIVES The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. METHODS We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. RESULTS The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (p<0.05 for both). Compared to the well-developed CCC group, the SYNTAX score, Hs-cTnT, hs-CRP, NT-proBNP, uric acid, neutrophil count and mean platelet volume (MPV) values were higher in patients with poorly developed CCC (p<0.05 for all). On multivariate logistic regression analysis, hs-cTnT (β=0.658, 95% CI=0.589-0.735, p<0.001) and NT-proBNP (β=0.991, 95% CI=0.987-0.995, p<0.001) as well as hs-CRP and diabetes were independent predictors of CCC. CONCLUSION Cardiac risk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion.
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Affiliation(s)
- A Börekçi
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - M Gür
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - T Şeker
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - A O Baykan
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - B Özaltun
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - S Karakoyun
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - A Karakurt
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - C Türkoğlu
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - I Makça
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - M Çaylı
- Department of Cardiology, Dicle University School of Medicine, Adana, Turkey
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Sahin I, Okuyan E, Gungor B, Kaya A, Avci II, Biter Hİ, Cetin S, Enhos A, Avsar M, Dinçkal MH. Lower vitamin D level is associated with poor coronary collateral circulation. SCAND CARDIOVASC J 2014; 48:278-83. [PMID: 24978423 DOI: 10.3109/14017431.2014.940062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Vitamin D regulates calcium and bone homeostasis, and parathyroid hormone (PTH) secretion. Cross-sectional associations between lower vitamin D levels and cardiovascular diseases have been reported, but the relationship between vitamin D levels and collateral arteries in stable coronary artery disease (CAD) has not been reported before. DESIGN Two hundred and fourteen patients with above 95% stenosis in at least one epicardial coronary artery were consecutively recruited after coronary angiography (CAG) during the winter season. The coronary collateral circulation (CCC) was graded using Rentrop classification. Poor CCC group included patients with Rentrop Grade 0-1 CCC and control group included patients with Rentrop Grade 2-3 CCC. Vitamin D and PTH levels were measured on the day of CAG. RESULTS In the poor CCC group, vitamin D levels were lower (34 ± 25 pmol/L vs. 49 ± 33 pmol/L; p = 0.01) and the prevalence of vitamin D deficiency (< 37 pmol/L) was higher (67% vs. 43%; p = 0.01) compared to the controls. PTH levels, calcium, and phosphate levels were not significantly different between the groups. Female gender, lower HDL cholesterol, and lower vitamin D levels were independently correlated with poor CCC in the study population. CONCLUSION Lower vitamin D levels may be associated with poor collateral development in patients with stable CAD.
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Affiliation(s)
- Irfan Sahin
- Department of Cardiology, Bagcilar Training and Research Hospital , Istanbul , Turkey
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Akboga MK, Akyel A, Sahinarslan A, Demirtas CY, Yayla C, Boyaci B, Yalcin R. Relationship between plasma apelin level and coronary collateral circulation. Atherosclerosis 2014; 235:289-94. [DOI: 10.1016/j.atherosclerosis.2014.04.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/17/2014] [Accepted: 04/23/2014] [Indexed: 11/17/2022]
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El polimorfismo de un solo nucleótido PLAU P141L se asocia con el grado de circulación colateral en pacientes con enfermedad arterial coronaria. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Chronic total occlusions (CTOs) are often detected on diagnostic coronary angiograms, but percutaneous coronary intervention (PCI) for CTO is currently infrequently performed owing to high technical difficulty, perceived risk of complications, and a lack of randomized data. However, successful CTO-PCI can significantly increase a patient's quality of life, improve left ventricular function, reduce the need for subsequent CABG surgery, and possibly improve long-term survival. A number of factors must be taken into account for the selection of patients for CTO-PCI, including the extent of ischaemia surrounding the occlusion, the level of myocardial viability, coronary location of the CTO, and probability of procedural success. Moreover, in patients with ST-segment elevation myocardial infarction, a CTO in a noninfarct-related artery might lead to an increase in infarct area, increased end-diastolic left ventricular pressure, and decreased left ventricular function, which are all associated with poor clinical outcomes. In this Review, we provide an overview of the anatomy and histopathology of CTOs, perceived benefits of CTO-PCI, considerations for patient selection for this procedure, and a summary of emerging techniques for CTO-PCI.
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Duran J, Sánchez-Olavarría P, Mola M, Götzens V, Carballo J, Martín-Pelegrina E, Petit M, García Del Blanco B, García-Dorado D, de Anta JM. The PLAU P141L single nucleotide polymorphism is associated with collateral circulation in patients with coronary artery disease. ACTA ACUST UNITED AC 2014; 67:552-7. [PMID: 24952395 DOI: 10.1016/j.rec.2013.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/13/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Urokinase-type plasminogen activator, which is encoded by the PLAU gene, plays a prominent role during collateral arterial growth. We investigated whether the PLAU P141L (C > T) polymorphism, which causes a mutation in the kringle domain of the protein, is associated with coronary collateral circulation in a cohort of 676 patients with coronary artery disease. METHODS The polymorphism was genotyped in blood samples using a TaqMan-based genotyping assay, and collateral circulation was assessed by the Rentrop method. Multivariate logistic regression models adjusted by clinically relevant variables to estimate odds ratios were used to examine associations of PLAU P141L allelic variants and genotypes with collateral circulation. RESULTS Patients with poor collateral circulation (Rentrop 0-1; n = 547) showed a higher frequency of the TT genotype than those with good collateral circulation (Rentrop 2-3; n = 129; P = .020). The T allele variant was also more common in patients with poor collateral circulation (P = .006). The odds ratio of having poorly developed collaterals in patients bearing the T allele (adjusted for clinically relevant variables) was statistically significant under the dominant model (odds ratio = 1.83 [95% confidence interval, 1.16-2.90]; P = .010) and the additive model (odds ratio = 1.73 [95% confidence interval, 1.14-2.62]; P = .009). CONCLUSIONS An association was found between coronary collateral circulation and the PLAU P141L polymorphism. Patients with the 141L variant are at greater risk of developing poor coronary collateral circulation.
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Affiliation(s)
- Joan Duran
- Unidad de Anatomía y Embriología Humanas, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina, Campus de Ciencias de la Salud de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Sánchez-Olavarría
- Unidad de Anatomía y Embriología Humanas, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina, Campus de Ciencias de la Salud de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Estadística, Universidad de Valparaíso, Valparaíso, Chile
| | - Marina Mola
- Unidad de Anatomía y Embriología Humanas, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina, Campus de Ciencias de la Salud de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Investigación Neurovascular (NEUVAS), IMIM-Hospital del Mar, PRBB-Parque de Investigación Biomédica de Barcelona, Barcelona, Spain
| | - Víctor Götzens
- Unidad de Anatomía y Embriología Humanas, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina, Campus de Ciencias de la Salud de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Carballo
- Departamento de Cardiología y Hemodinamia, Centro Cardiovascular Sant Jordi, Barcelona, Spain
| | - Eva Martín-Pelegrina
- Departamento de Cardiología y Hemodinamia, Centro Cardiovascular Sant Jordi, Barcelona, Spain
| | - Màrius Petit
- Departamento de Cardiología y Hemodinamia, Centro Cardiovascular Sant Jordi, Barcelona, Spain
| | | | - David García-Dorado
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep M de Anta
- Unidad de Anatomía y Embriología Humanas, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina, Campus de Ciencias de la Salud de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
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Choi JH, Kim EK, Kim SM, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Choe YH, Oh JK. Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. Circ Cardiovasc Imaging 2014; 7:482-90. [PMID: 24700691 DOI: 10.1161/circimaging.113.001637] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Coronary collateral flow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral flow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral flow. METHODS AND RESULTS We enrolled 325 coronary computed tomographic angiography cases with angiographically confirmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which reflects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the flow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral flow (P<0.001). Well-developed collaterals, defined by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfield units/10 mm; c-statistics, 0.72; sensitivity, 65%; specificity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) flows in distal artery (cutoff, 0.0 Hounsfield unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specificity, 85%; positive predictive value, 87%; negative predictive value, 75%). CONCLUSIONS TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately reflected the functional extent and direction of collateral flow.
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Affiliation(s)
- Jin-Ho Choi
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
| | - Eun Kyoung Kim
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sung Mok Kim
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Young Bin Song
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Joo-Yong Hahn
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Seung Hyuk Choi
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Hyeon-Cheol Gwon
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sang Hoon Lee
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Yeon Hyeon Choe
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jae K Oh
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
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Zhang J, Li Y, Li M, Pan J, Lu Z. Collateral vessel opacification with CT in patients with coronary total occlusion and its relationship with downstream myocardial infarction. Radiology 2014; 271:703-10. [PMID: 24555634 DOI: 10.1148/radiol.13131637] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the correlation between the filling pattern of distal coronary vessels in patients with chronic total occlusion (CTO) observed at coronary computed tomographic (CT) angiography and the extent of downstream myocardial infarction (MI). MATERIALS AND METHODS All patients gave written informed consent, and the institutional review board approved the study protocol. A total of 97 patients (mean age, 68.5 years ± 11.5 [standard deviation]; age range, 38-87 years; 77 men, 20 women) with 106 CTOs were prospectively enrolled. Distal filling of the epicardial segment was semiquantitatively classified by using a four-point scale according to patterns at coronary CT angiography (0 = absence of distal filling; 1 = partial distal filling, with a length less than one-third of the segment; 2 = partial distal filling, with a length between one-third and two-thirds of the segment; 3 = complete or partial distal filling, with a length longer than two-thirds of the segment). A coronary CT angiography score of 3 was considered indicative of well-developed collaterals. Downstream MI transmurality and wall motion abnormality were verified semiquantitatively with cardiac magnetic resonance imaging. Mann-Whitney U test and t test were used for comparison. RESULTS Coronary CT angiography revealed three lesions with a score of 0, 21 with a score of 1, 35 with a score of 2, and 47 with a score of 3. The non-MI subgroup was associated with higher collateral grading at CT angiography, whereas the transmural MI subgroup was associated with lower collateral grading (P = .005). When compared with the poorly developed (score 0-2) collaterals group, the well-developed (score 3) collateral group correlated to a lower summed transmurality score (P < .001) and a lower summed regional wall motion abnormality score (P = .029). CONCLUSION The presence of well-developed distal collaterals as revealed by coronary CT angiography in patients with CTO lesions correlates with the lower frequency and extent of downstream MI.
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Affiliation(s)
- Jiayin Zhang
- From the Departments of Radiology (J.Z., Y.L., M.L.) and Cardiology (J.P., Z.L.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai 200233, China
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Kalkan M, Sahin M, Kalkan A, Güler A, Taş M, Bulut M, Demir S, Acar R, Arslantaş U, Oztürkeri B, Güler Y, Akçakoyun M. The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion. Perfusion 2014; 29:360-366. [PMID: 24534889 DOI: 10.1177/0267659114521102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO). METHODS A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts. RESULTS Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity. CONCLUSION NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.
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Affiliation(s)
- Me Kalkan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - M Sahin
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Ak Kalkan
- Mehmet Akif Ersoy, Department of Cardiology, Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - A Güler
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Mh Taş
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - M Bulut
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - S Demir
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Rd Acar
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - U Arslantaş
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - B Oztürkeri
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Y Güler
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - M Akçakoyun
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
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The J-curve relationship between diastolic pressure and coronary collateral circulation in patients with single chronic total occlusion. Atherosclerosis 2014; 232:220-3. [DOI: 10.1016/j.atherosclerosis.2013.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022]
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van der Hoeven NW, van Royen N. The effect of heart rate reduction by ivabradine on collateral function in patients with chronic stable coronary artery disease, another funny aspect of the funny channel? Heart 2013; 100:98-9. [DOI: 10.1136/heartjnl-2013-305045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Seiler C. Assessment and Impact of the Human Coronary Collateral Circulation on Myocardial Ischemia and Outcome. Circ Cardiovasc Interv 2013; 6:719-28. [DOI: 10.1161/circinterventions.113.000555] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Christian Seiler
- From the Department of Cardiology, University Hospital Bern, Switzerland
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Khand A, Fisher M, Jones J, Patel B, Perry R, Mitsudo K. The collateral circulation of the heart in coronary total arterial occlusions in man: systematic review of assessment and pathophysiology. Am Heart J 2013; 166:941-52. [PMID: 24268207 DOI: 10.1016/j.ahj.2013.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 09/10/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Anatomical and functional assessment of the collateral circulation of the heart in total arterial occlusions is challenging, and this is particularly true of the microcirculation. The pathophysiology of the collateral circulation has historically been and remains of considerable research focus but with diverging and sometimes conflicting results. Our purpose was to conduct a systematic review on the assessment and pathophysiology of the collateral circulation of the heart in total coronary arterial occlusions. METHODS We extracted data from Pubmed, Ovid, EMBASE, and Cochrane database from 1966 to December 2012. Two investigators independently reviewed the identified articles for eligibility and extracted the data. RESULTS Seventy-seven studies met inclusion criterion. An invasive assessment of the collateral circulation with pressure and/or Doppler wires is the gold standard in the assessment of collateral physiology and anatomy, although this can only be undertaken after successful passage of the sensor in the true lumen of the occluded vessel. A collateral circulation can provide resting metabolic requirements for the heart but invariably cannot meet demands on stress irrespective of the degree of collateralization as assessed by coronary angiography. In the case of myocardium subtending a totally occluded epicardial artery coronary collateral grading systems or physiological assessment of collateral flow is only moderately sensitive and poorly specific at predicting viability. Regression of collaterals seems more profound in totally occluded arteries versus nonoccluded lesions postrevascularization. CONCLUSIONS Key controversies in the assessment and pathophysiology of the collateral circulation of the heart in total coronary arterial occlusions are systematically evaluated.
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Affiliation(s)
- Aleem Khand
- University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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