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Nyvad J, Lerman A, Lerman LO. With a Little Help From My Friends: the Role of the Renal Collateral Circulation in Atherosclerotic Renovascular Disease. Hypertension 2022; 79:717-725. [PMID: 35135307 PMCID: PMC8917080 DOI: 10.1161/hypertensionaha.121.17960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The collateral circulation can adapt to bypass major arteries with limited flow and serves a crucial protective role in coronary, cerebral, and peripheral arterial disease. Emerging evidence indicates that the renal collateral circulation can similarly adapt and thereby limit kidney ischemia in atherosclerotic renovascular disease. These adaptations predominantly include recruitment of preexisting microvessels for arteriogenesis, with de novo vessel formation playing a limited role. Yet, adaptations of the renal collateral circulation in renovascular disease are often insufficient to fully compensate for the limited flow within an obstructed renal artery and may be hampered by the severity of obstruction or patient comorbidities. Experimental strategies have attempted to circumvent limitations of collateral formation and improve the prognosis of patients with various ischemic vascular territories. These have included pharmacological approaches such as endothelial growth factors, renin-angiotensin-aldosterone system blockade, and If-channel-blockers, as well as interventions like preconditioning, exercise, enhanced external counter-pulsation, and low-energy shock-wave therapy. However, few of these strategies have been implemented in atherosclerotic renovascular disease. This review summarizes current understanding regarding the development of renal collateral circulation in atherosclerotic renovascular disease. Studies are needed to apply lessons learned in other vascular beds in the setting of atherosclerotic renovascular disease to develop new treatment regimens for this patient group.
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Affiliation(s)
- Jakob Nyvad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. (J.N., L.O.L.).,Department of Nephrology and Hypertension, Aarhus University Hospital, Aarhus, Denmark (J.N.)
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. (A.L.)
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. (J.N., L.O.L.)
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Li Y, Chen X, Li S, Ma Y, Li J, Lin M, Wan J. Non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio serve as a predictor for coronary collateral circulation in chronic total occlusive patients. BMC Cardiovasc Disord 2021; 21:311. [PMID: 34162320 PMCID: PMC8223315 DOI: 10.1186/s12872-021-02129-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
Objective The present study investigated the potential correlation between non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (non-HDL-C/HDL) and the formation of coronary collateral circulation (CCC) in coronary artery disease cases with chronic total occlusive (CTO) lesions. Methods Two experienced cardiologists identified and selected patients with CTO lesions for retrospective analysis. The 353 patients were divided into a CCC poor formation group (Rentrop 0–1 grade, n = 209) and a CCC good formation group (Rentrop 2–3 grade, n = 144) based on the Cohen-Rentrop standard. A comparison of non-HDL-C/HDL ratios between the two groups was performed. The Spearman test was used to obtain the correlation between the cholesterol ratio and Rentrop grade. Independent predictors of CCC were analyzed using logistic regression. Receiver operating characteristic (ROC) curve analysis was also performed to quantify the predictive value of research indicator. Results The non-HDL-C/HDL ratio in the CCC poor formation group was elevated markedly compared to the CCC good formation group [( 3.86 ± 1.40) vs ( 3.31 ± 1.22), P = 0.000]. The Spearman test results indicated that non-HDL-C/HDL negatively correlated with Rentrop grade (r = − 0.115, P = 0.030). Multivariate logistic regression analysis showed that non-HDL-C/HDL ratio was an independent predictor of CCC formation (OR = 1.195, 95%CI = 1.020–1.400, P = 0.027). The area under the curve of ROC for detecting CCC poor formation was 0.611 (95% CI: 0.551–0.671, P = 0.000) with an optimal cut-off value of 2.77. Conclusion Non-HDL-C/HDL negatively correlated with the formation of CCC and served as an independent predictor of CCC formation, which may be used as a biomarker for the evaluation of CCC.
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Affiliation(s)
- Ya Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Xin Chen
- Department of Cardiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, China
| | - Shu Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Yulin Ma
- Department of Cardiology, Hubei Jianghan Oilfield General Hospital, Qianjiang, 433100, China
| | - Jialing Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Mingying Lin
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.
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Allahwala UK, Cistulli PA, Ekmejian A, Mughal N, Dissanayake HU, Ward M, Weaver JC, Bhindi R. Relation of Obstructive Sleep Apnea in Patients With a Coronary Chronic Total Occlusion to Coronary Collaterals and Mortality. Am J Cardiol 2021; 148:30-35. [PMID: 33675771 DOI: 10.1016/j.amjcard.2021.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
A chronic total occlusion (CTO) is frequently identified in patients undergoing coronary angiography. The prognostic implications of intermittent hypoxia from obstructive sleep apnea (OSA) on patients with a CTO, and effects on collateral recruitment are unknown. The aim of this study was to determine the prevalence, vascular effects, and prognostic implications of the presence of OSA in patients with a CTO. Patients with a CTO between July 2010 and December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA, demographics, and clinical course. Patients with robust collateral recruitment were defined as Rentrop grade 2 or 3. A total of 948 patients were included in the study, of which 127 (13.4%) had a documented history of OSA. These patients were younger (67.0 years vs 70.6 years, p < 0.01), had a higher body mass index (29.6 kg/m2 vs 26.7 kg/m2, p < 0.0001), higher rates of hypertension (91.3% vs 83.2%, p < 0.05), higher rates of smokers (63.3% vs 49.0%, p < 0.01) and more use of β-blockers (79% vs 68.5%, p < 0.05) and statins (92.7% vs 82.1%, p < 0.01). A documented history of OSA was independently associated with robust collaterals (OR 3.0 95%CI 1.5 to 5.8, p < 0.01) and lower mortality (HR 0.3 95% CI 0.1 to 0.7, p < 0.01) with a mean survival of 10.8 years, as compared to 8.1 years (log rank p < 0.0001). In conclusion, in patients with a CTO, documented OSA is independently associated with more robust coronary collaterals and lower mortality. The possible cardioprotective implications of intermittent hypoxia in OSA, as well as treatment effect requires further investigation.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia.
| | - Peter A Cistulli
- Centre for Sleep Health and Research, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Avedis Ekmejian
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nadeem Mughal
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - James C Weaver
- The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
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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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Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, Shen WF. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:26. [PMID: 29422093 PMCID: PMC5804044 DOI: 10.1186/s12933-018-0671-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of coronary collateral formation is a primary determinant of the severity of myocardial damage and mortality after coronary artery occlusion. Type 2 diabetes mellitus (T2DM) represents an important risk factor for impaired collateral vessel growth. However, the mechanism of reduced coronary collateralization in type 2 diabetic patients remains unclear. METHODS With the reference to the recent researches, this review article describes the pathogenic effects of T2DM on collateral development and outlines possible clinical and biochemical markers associated with reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion (CTO). RESULTS Diffuse coronary atherosclerosis in T2DM reduces pressure gradient between collateral donor artery and collateral recipient one, limiting collateral vessel growth and function. An interaction between advanced glycation end-products and their receptor activates several intracellular signaling pathways, enhances oxidative stress and aggravates inflammatory process. Diabetic condition decreases pro-angiogenic factors especially vascular endothelial growth factor and other collateral vessel growth related parameters. Numerous clinical and biochemical factors that could possibly attenuate the development of coronary collaterals have been reported. Increased serum levels of glycated albumin, cystatin C, and adipokine C1q tumor necrosis factor related protein 1 were associated with poor coronary collateralization in type 2 diabetic patients with stable coronary artery disease and CTO. Diastolic blood pressure and stenosis severity of the predominant collateral donor artery also play a role in coronary collateral formation. CONCLUSIONS T2DM impairs collateral vessel growth through multiple mechanisms involving arteriogenesis and angiogenesis, and coronary collateral formation in patients with T2DM and CTO is influenced by various clinical, biochemical and angiographic factors. This information provides insights into the understanding of coronary pathophysiology and searching for potential new therapeutic targets in T2DM.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
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Association of blood pressure and coronary collateralization in type 2 diabetic and nondiabetic patients with stable angina and chronic total occlusion. J Hypertens 2016; 33:621-6; discussion 626. [PMID: 25490709 DOI: 10.1097/hjh.0000000000000455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We investigated whether and to what extent blood pressure (BP) affects coronary collateralization in type 2 diabetic and nondiabetic patients with stable angina and chronic total occlusion. METHODS Brachial BP was measured using an inflatable cuff manometer in 431 diabetic and 287 nondiabetic patients with stable angina and angiographic total occlusion of at least one major coronary artery. They were classified according to the SBP (<100, 100-119, 120-139, 140-159, 160-179, and ≥180 mmHg), DBP (<60, 60-69, 70-79, 80-89, 90-99, and ≥100 mmHg), and pulse (<40, 40-49, 50-59, 60-69, 70-79, and ≥80 mmHg) BP ranges. The degree of coronary collaterals supplying the distal aspect of a total occlusion from the contralateral vessel was graded as poor (Rentrop score of 0 or 1) or good collateralization (Rentrop score of 2 or 3). RESULTS In diabetic patients, the incidence of poor collateralization was related to the DBP in a U-shaped pattern, with the lowest risk at 80-89 mmHg. In nondiabetic patients, an optimal DBP range was 90-99 mmHg for good collaterals, but no U-shaped relation between DBP and coronary collateralization was observed. After adjusting for the baseline characteristics in the logistic regression models, the increased risk of poor collateralization persisted for low or high DBP ranges in diabetic [odds ratio (OR) 2.02-7.29, P ≤ 0.04] and nondiabetic patients (OR 3.62-5.98, P ≤ 0.02). No such relations were observed between collateral grades and SBP and pulse BP. CONCLUSION This study demonstrates that 80-89 and 90-99 mmHg are the optimal ranges for DBP in diabetic and nondiabetic patients with stable angina and chronic total occlusion, within which the risk of poor collateralization is low.
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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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Moore SM, Zhang H, Maeda N, Doerschuk CM, Faber JE. Cardiovascular risk factors cause premature rarefaction of the collateral circulation and greater ischemic tissue injury. Angiogenesis 2015; 18:265-81. [PMID: 25862671 DOI: 10.1007/s10456-015-9465-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 04/06/2015] [Indexed: 01/09/2023]
Abstract
RATIONALE Collaterals lessen tissue injury in occlusive disease. However, aging causes progressive decline in their number and smaller diameters in those that remain (collateral rarefaction), beginning at 16 months of age in mice (i.e., middle age), and worse ischemic injury-effects that are accelerated in even 3-month-old eNOS(-/-) mice. These findings have found indirect support in recent human studies. OBJECTIVE We sought to determine whether other cardiovascular risk factors (CVRFs) associated with endothelial dysfunction cause collateral rarefaction, investigate possible mechanisms, and test strategies for prevention. METHODS AND RESULTS Mice with nine different models of CVRFs of 4-12 months of age were assessed for number and diameter of native collaterals in skeletal muscle and brain and for collateral-dependent perfusion and ischemic injury after arterial occlusion. Hypertension caused collateral rarefaction whose severity increased with duration and level of hypertension, accompanied by greater hindlimb ischemia and cerebral infarct volume. Chronic treatment of wild-type mice with L-N (G)-nitro-arginine methylester caused similar rarefaction and worse ischemic injury which were not prevented by lowering arterial pressure with hydralazine. Metabolic syndrome, hypercholesterolemia, diabetes mellitus, and obesity also caused collateral rarefaction. Neither chronic statin treatment nor exercise training lessened hypertension-induced rarefaction. CONCLUSION Chronic CVRF presence caused collateral rarefaction and worse ischemic injury, even at relatively young ages. Rarefaction was associated with increased proliferation rate of collateral endothelial cells, effects that may promote accelerated endothelial cell senescence.
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Affiliation(s)
- Scott M Moore
- Department of Cell Biology and Physiology, 6309 MBRB, University of North Carolina, Chapel Hill, NC, 27599-7545, USA
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Bhatt H, Kochar S, Htun WW, Julliard K, Fernaine G. Coronary Collateral Circulation and Cardiovascular Risk Factors: Is There a Paradox? Angiology 2014; 66:588-94. [PMID: 25092680 DOI: 10.1177/0003319714545342] [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] [Indexed: 11/17/2022]
Abstract
We sought to determine the association of major cardiovascular risk factors and other comorbidities with the presence or absence of coronary collateral (CC) circulation. All electronic medical records from 2010 to 2011 were retrospectively reviewed. A total of 563 patients were divided into 2 groups: CC present (180) and CC absent (383). Smoking (P = .012, odds ratio [OR] 1.58), hypercholesterolemia (P = .001, OR 2.21), and hypertension (P = .034, OR 1.75) were associated with the presence of CC. Increasing body mass index (BMI, P = .001) and decreasing estimated glomerular filtration rate (eGFR, P = .042) were associated with the absence of CC. On multivariable linear regression analysis, hypercholesterolemia (P = .001, OR 2.28), BMI (P = .012, OR 0.77), and eGFR (P = .001, OR 0.70) were found to be independently associated with CC. Our findings will help predict patient populations more likely to have presence or absence of CC circulation.
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Affiliation(s)
- Hemal Bhatt
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY, USA
| | - Suzi Kochar
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY, USA
| | - Wah Wah Htun
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY, USA
| | - Kell Julliard
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY, USA
| | - George Fernaine
- Department of Cardiology, Lutheran Medical Center, Brooklyn, NY, USA
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Ege MR, Zorlu A, Yilmaz MB, Acıkgoz S, Tandogan İ, Cinar Z. Central Diastolic Blood Pressure Is Associated With the Degree of Coronary Collateral Development. Angiology 2012; 64:546-52. [DOI: 10.1177/0003319712469276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.
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Affiliation(s)
| | - Ali Zorlu
- Private Malatya Hospital, Clinic of Cardiology, Malatya, Turkey
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Sivas Cumhuriyet University, Medical School, Sivas, Turkey
| | - Savas Acıkgoz
- Kavaklidere Umut Hospital, Clinic of Cardiology, Ankara, Turkey
| | - İzzet Tandogan
- Department of Cardiology, Sivas Cumhuriyet University, Medical School, Sivas, Turkey
| | - Ziynet Cinar
- Department of Biostatistics, Sivas Cumhuriyet University, Medical School, Sivas, Turkey
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Hsu PC, Juo SH, Su HM, Chen SC, Tsai WC, Lai WT, Sheu SH, Lin TH. Predictor of poor coronary collaterals in chronic kidney disease population with significant coronary artery disease. BMC Nephrol 2012; 13:98. [PMID: 22935602 PMCID: PMC3457843 DOI: 10.1186/1471-2369-13-98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 08/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events. Chronic kidney disease (CKD) is associated with poor coronary collateral development and cardiovascular outcome. However, limited research investigates the predictors for collateral development in the CKD population. METHODS We evaluated 970 consecutive patients undergoing coronary angiography and 202 patients with CKD, defined as a glomerular filtration rate less than 60 ml/min/1.73 m2, were finally analyzed. The collateral scoring system developed by Rentrop was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. RESULTS The patients with poor collateral (n = 122) had a higher incidence of hypertension (82% vs 63.8%, p = 0.005), fewer diseased vessels numbers (2.1 ± 0.9 vs 2.6 ± 0.6, p < 0.001) and a trend to be diabetic (56.6% vs. 43.8%, p = 0.085) or female sex (37.7% vs. 25.0%, p = 0.067). Multivariate analysis showed hypertension (odd ratio (OR) 2.672, p = 0.006), diabetes (OR 1.956, p = 0.039) and diseased vessels numbers (OR 0.402, p < 0.001) were significant predictors of poor coronary collaterals development. Furthermore, hypertension and diabetes have a negative synergistic effect on collateral development (p = 0.004 for interaction). CONCLUSIONS In the CKD population hypertension and diabetes might negatively influence the coronary collaterals development.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Suh-Hang Juo
- Department of Medical Research, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Faculty of Medicine, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Wei-chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Faculty of Medicine, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Faculty of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC
- Faculty of Medicine, Kaohsiung, Taiwan
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Teunissen PF, Horrevoets AJ, van Royen N. The coronary collateral circulation: Genetic and environmental determinants in experimental models and humans. J Mol Cell Cardiol 2012; 52:897-904. [DOI: 10.1016/j.yjmcc.2011.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/25/2011] [Accepted: 09/12/2011] [Indexed: 12/27/2022]
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Ng S, Soerianata S, Andriantoro H, Ottervanger JP, Grobbee DE. Timing of coronary collateral appearance during ST-elevation myocardial infarction. Interv Cardiol 2012. [DOI: 10.2217/ica.11.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, Norris CM, Graham MM. The Clinical Profile and Outcomes Associated With Coronary Collaterals in Patients With Coronary Artery Disease. Can J Cardiol 2011; 27:581-8. [DOI: 10.1016/j.cjca.2011.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 01/04/2023] Open
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de Marchi SF, Gloekler S, Meier P, Traupe T, Steck H, Cook S, Vogel R, Seiler C. Determinants of Preformed Collateral Vessels in the Human Heart without Coronary Artery Disease. Cardiology 2011; 118:198-206. [DOI: 10.1159/000328648] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/16/2011] [Indexed: 11/19/2022]
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Lavie L, Lavie P. Coronary collateral circulation in sleep apnea: a cardioprotective mechanism? Chest 2010; 137:511-2. [PMID: 20202945 DOI: 10.1378/chest.09-2657] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tongers J, Roncalli JG, Losordo DW. Role of endothelial progenitor cells during ischemia-induced vasculogenesis and collateral formation. Microvasc Res 2010; 79:200-6. [PMID: 20144623 DOI: 10.1016/j.mvr.2010.01.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 01/30/2010] [Indexed: 12/22/2022]
Abstract
Cell-based therapy has emerged as a promising therapeutic tool for treatment of ischemic cardiovascular disease. Both unselected bone marrow-derived mononuclear cells (BMNCs), which include stem/progenitor cells and several other cell types, and endothelial progenitor cells (EPCs), a subpopulation of BMNCs, display regenerative potential in ischemic tissue. Abundant evidence supports the involvement of EPCs in capillary growth, and EPCs also appear to participate in the formation of collateral vessels. Collectively, these effects have led to improved perfusion and functional recovery in animal models of myocardial and peripheral ischemia, and in early clinical trials, the therapeutic administration of EPCs to patients with myocardial infarction or chronic angina has been associated with positive trends in perfusion. EPCs also contribute to endothelial repair and may, consequently, impede the development or progression of arteriosclerosis. This review provides a brief summary of the preclinical and clinical evidence for the role of EPCs in blood-vessel formation and repair during ischemic cardiovascular disease.
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Affiliation(s)
- Jörn Tongers
- Feinberg Cardiovascular Research Institute, Northwestern University, Tarry 12-703, 303 East Chicago Avenue, Chicago, IL 60611, USA
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Abstract
Arterial lumen narrowing and vascular occlusion is the actual cause of morbidity and mortality in atherosclerotic disease. Collateral artery formation (arteriogenesis) refers to an active remodelling of non-functional vascular anastomoses to functional collateral arteries, capable to bypass the site of obstruction and preserve the tissue that is jeopardized by ischaemia. Hemodynamic forces such as shear stress and wall stress play a pivotal role in collateral artery formation, accompanied by the expression of various cytokines and invasion of circulating leucocytes. Arteriogenesis hence represents an important compensatory mechanism for atherosclerotic vessel occlusion. As arteriogenesis mostly occurs when lumen narrowing by atherosclerotic plaques takes place, presence of cardiovascular risk factors (e.g. hypertension, hypercholesterolaemia and diabetes) is highly likely. Risk factors for atherosclerotic disease affect collateral artery growth directly and indirectly by altering hemodynamic forces or influencing cellular function and proliferation. Adequate collateralization varies significantly among atherosclerotic patients, some profit from the presence of extensive collateral networks, whereas others do not. Cardiovascular risk factors could increase the risk of adverse cardiovascular events in certain patients because of the reduced protection through an alternative vascular network. Likewise, drugs primarily thought to control cardiovascular risk factors might contribute or counteract collateral artery growth. This review summarizes current knowledge on the influence of cardiovascular risk factors and the effects of cardiovascular medication on the development of collateral vessels in experimental and clinical studies.
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Affiliation(s)
- D de Groot
- Laboratory of Experimental Cardiology, UMC Utrecht, the Netherlands
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Mouquet F, Cuilleret F, Susen S, Sautière K, Marboeuf P, Ennezat PV, McFadden E, Pigny P, Richard F, Hennache B, Vantyghem MC, Bertrand M, Dallongeville J, Jude B, Van Belle E. Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1. Eur Heart J 2009; 30:840-9. [PMID: 19164335 PMCID: PMC2663725 DOI: 10.1093/eurheartj/ehn569] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aims The metabolic syndrome (MS) is associated with an increased cardiovascular risk. Patients with the MS have endothelial dysfunction, decreased circulating adiponectin, and a high expression of angiogenic inhibitors such as plasminogen activator inhibitor-1 (PAI-1). We hypothesized that such patients, in the event of a coronary occlusion, might exhibit a less developed collateral circulation. Methods and results Three hundred and eighty-seven consecutive patients with at least one coronary occlusion of a major coronary vessel at diagnostic angiography were prospectively enrolled. Collateral development was graded with validated angiographic methods. The MS was defined according to the ATP-III definition. Fasting glucose, adiponectin, insulin concentrations, and PAI-1 were measured at the time of angiography. MS was associated with less developed collateral vessels (P = 0.005). In multivariable analysis adjusting for potential confounding factors including the duration of coronary occlusion (P = 0.0001), fasting glycaemia (P = 0.0007), low adiponectin concentration (P = 0.01), insulin-resistance (HOMA-IR; P = 0.01), high circulating PAI-1 concentration (P = 0.01), and hypertension (P = 0.008) were independently associated with poor coronary collateral vessel development. Conclusion This study shows that in patients with coronary occlusion, collateral circulation is impaired in patients with the MS. This association is partly related to fasting glycaemia and to key parameters linked to insulin resistance.
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Affiliation(s)
- Frédéric Mouquet
- Departments of Cardiology, Centre Hospitalier Régional Universitaire, Lille, France
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Karadas F, Yalta K, Turgut OO, Yilmaz MB, Yilmaz A, Dogan K, Tandogan I. The effect of collateral circulation on left ventricular systolic function. Coron Artery Dis 2007; 18:169-73. [PMID: 17429289 DOI: 10.1097/mca.0b013e3280814d91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conflicting reports exist on the influence of coronary collateral circulation on preservation of left ventricular systolic function. The aim of this study was to assess the effect of coronary collateral circulation on left ventricular systolic function in coronary artery disease. METHODS Seventy-one consecutive patients having left anterior descending arteries with proximal or near-proximal stenosis of at least 95% (excluding 100%) were included in the study. The coronary collateral circulation to left anterior descending artery was evaluated with regard to its effects on left ventricular systolic function. RESULTS Among the 71 patients, 46 patients were found to have a coronary collateral circulation grade of >or=1 (group 1), whereas the remaining 25 patients had coronary collateral circulation grade of 0 (group 2). The mean value of left ventricular function score in group 1 was higher than that of group 2 (3.69+/-2.34 vs. 2.00+/-1.55, P=0.002), whereas the mean value of left ventricular ejection fraction in group 1 was lower than that of group 2 (44.67+/-12.05 vs. 54.32+/-10.22, P=0.001). The value of coronary collateral circulation grade was found to be positively correlated with the value of left ventricular function score (P=0.01, r=0.3), and negatively correlated with the value of left ventricular ejection fraction (P=0.01, r=-0.3). CONCLUSION Coronary collateral circulation to the severely stenotic left anterior descending artery was not found to have an improving effect on left ventricular systolic function. In contrast with the previous studies demonstrating the coronary collateral circulation-associated preservation of left ventricular systolic function, presence of coronary collateral circulation was found to accompany or be associated with impairment of left ventricular systolic function. The grade of coronary collateral circulation was also found to be positively correlated with the severity of left ventricular systolic dysfunction. Further research on larger patient populations based on a long-term follow-up is warranted to investigate this issue.
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Affiliation(s)
- Filiz Karadas
- Department of Cardiology, Cumhuriyet University, Sivas, Turkey
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21
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Mourad JJ, Laville M. Is hypertension a tissue perfusion disorder? Implications for renal and myocardial perfusion. J Hypertens 2006; 24:S10-6. [PMID: 16936530 DOI: 10.1097/01.hjh.0000240041.43214.8a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Structural alterations in the microcirculation form a major link between hypertension and target organ damage. More than 60% of the overall peripheral resistance of the circulatory system arises at the level of the microcirculation. The primary function of the microcirculation is to supply oxygen and nutrients to tissues. In hypertension, remodelling of the microvascular vessels occurs, leading to an early, functional then anatomical reduction in the number of arterioles or capillaries in a given vascular bed. Such changes have been seen in the structure and density of the microvasculature of different target organs such as the myocardium and the kidneys. In hypertension, capillary rarefaction induces an increase in blood pressure, a relative decrease in tissue perfusion and an increased cardiovascular risk. Recent in-vivo non-invasive techniques for exploring the human microcirculation have allowed the detection of myocardial and renal microvascular impairment in hypertensive patients. In comparative therapeutic studies, antihypertensive drugs have been shown to have different capacities for preventing or reversing changes to the microvasculature of affected organs.
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Koerselman J, de Jaegere PPT, Verhaar MC, Grobbee DE, van der Graaf Y. Coronary collateral circulation: the effects of smoking and alcohol. Atherosclerosis 2006; 191:191-8. [PMID: 16696984 DOI: 10.1016/j.atherosclerosis.2006.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 02/10/2006] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The presence or absence of coronary collaterals is of vital importance during acute ischemia. Smoking and alcohol have been suggested to play a role, but data are scarce. We examined the extent to which smoking and alcohol use affect the presence of coronary collateral circulation. METHODS Cross-sectional study in 242 patients, admitted for elective PTCA. Smoking was defined as past or current. Pack years were calculated and categorized into never-smokers (reference-category): <10, 10-19, 20-29, and >or=30 pack years. Alcohol consumption was defined as past or current, and categorized into never-users (reference-category): <1, 1-10, 11-20, and >or=21 units per week (UPW). Collaterals were graded with Rentrop's classification. Coronary collateral presence was defined as Rentrop-grade >or=1. RESULTS Current smoking (odds ratio (OR) 4.17; 95% confidence interval (CI) 1.79-9.71) was positively associated, while pack years of smoking was not related. Current alcohol intake showed a J-shaped tendency with coronary collateral presence, while past moderate alcohol consumption was inversely associated (OR 0.19; 95% CI 0.04-0.98). CONCLUSIONS Smoking and (to some extent) alcohol use are associated with collateral presence. The results support the view that life-style factors may affect the formation of coronary collaterals in patients with ischemic cardiac disease.
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Affiliation(s)
- Jeroen Koerselman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht), HP Str. 6.131, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Tayebjee MH, Lip GYH, Macfadyen RJ. Is there an association between hypertension and the development of coronary collateral flow? J Hum Hypertens 2005; 19:757-9. [PMID: 15988537 DOI: 10.1038/sj.jhh.1001906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M H Tayebjee
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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