Impact of collateral circulation in a patient with chronic coronary occlusion

It is widely accepted that, during acute coronary occlusion, ischemic cell death progresses from the subendocardium to the subepicardium in a wavefront fashion. This concept, which implies that the subendocardium is the most susceptible myocardial region to ischemic injury, was established using a canine model with an extensive system of subepicardial coronary collaterals. In humans, particularly in those with coronary artery disease, there is a wide range in the distribution and functional capacity of the collateral circulation, which may affect the pattern of infarct evolution. Using an ovine model with a limited system of preformed subendocardial coronary collaterals, we characterized the effect of increasing lengths of ischemia on regional blood flow and infarct size in three regions of the ventricular wall: subendocardium, midmyocardium, and subepicardium. Our results demonstrate that the myocardium and microvasculature in these three regions are equally susceptible to injury after 45 min of ischemia. When ischemic time is increased to 1 h, infarct size in the midmyocardium (90 ± 2%) is greater than in the subendocardium (76 ± 4%, P = 0.004) and subepicardium (84 ± 3%, P = 0.13). Microvascular dysfunction as assessed as a percentage of baseline flow is also greater in the midmyocardium (14 ± 5%) compared with the subendocardium (20 ± 3%, P = 0.23) and subepicardium (51 ± 9%, P = 0.007). These findings suggest that, in subjects with a limited system of coronary collateral circulation, the midmyocardium is the most susceptible myocardial region to ischemia and the subendocardium is the most resistant. Myocardial viability during coronary occlusion appears to be primarily determined by the distribution and functional capacity of the collateral circulation.

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Functional Significance of Collateral Circulation in Patients with Total Coronary Occlusion

Korean Circulation Journal ◽

10.4070/kcj.1993.23.4.522 ◽

1993 ◽

Vol 23 (4) ◽

pp. 522

Author(s):

Jong Won Ha ◽

Seung Yun Cho ◽

Yang Soo Jang ◽

Nam Sik Chung ◽

Won Heum Shim ◽

...

Keyword(s):

Functional Significance ◽

Collateral Circulation ◽

Coronary Occlusion

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Prediction-Determining Outcomes and Their Predictors in Atrial Fibrillation Patients Receiving Multicomponent Antithrombotic Therapy in Real Clinical Practice

Kardiologiia ◽

10.18087/cardio.2020.8.n1123 ◽

2020 ◽

Vol 60 (8) ◽

pp. 33-45

Author(s):

E. N. Krivosheeva ◽

E. P. Panchenko ◽

E. S. Kropacheva ◽

A. B. Dobrovolsky ◽

E. V. Titaeva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Antithrombotic Therapy ◽

Coronary Occlusion ◽

Oral Anticoagulants ◽

Coronary Syndrome ◽

Reduced Dose ◽

Chronic Coronary Occlusion ◽

Coronary Events ◽

Pai 1

Aim Searching for clinical, angiographic, and biochemical predictors of cardiovascular complications (CVC) and hemorrhagic complications in patients with atrial fibrillation (AF) receiving a multicomponent antithrombotic therapy (MAT) for an elective percutaneous coronary intervention (PCI). Patients with ischemic heart disease (IHD) and AF who require MAT for PCI are at a high risk of thrombotic complications (stroke, systemic embolism, coronary events) and hemorrhage. This warrants searching for new risk factors determining prediction of the outcome.Materials and methods This study included 207 patients (146 males aged 70.1±8.3 years) with IHD and AF who received direct oral anticoagulants (DOAC) as a part of their MAT therapy. Median duration of the follow-up was 12 [8.0; 12.0] months. The efficacy endpoint was a sum of CVCs combining cardiovascular death, ischemic stroke, venous thromboembolic complications, acute coronary syndrome (ACS), and requirement for an unscheduled PCI. “Coronary events”, including ACS and requirement for an unscheduled PCI were analyzed separately. The safety endpoint was BARC type 2-5 bleeding. Upon admission, biomarkers (growth-differentiation factor 15 (GDF-15), D-dimer, thrombin-activated fibrinolysis inhibitor (TAFI), and plasminogen activator inhibitor-1 (PAI-1)) were measured for all patients. Searching for prognostically significant indexes was performed with the Cox proportional hazards regression.Results Incidence of all CVCs was 16.4 %. Independent predictors of CVC included the DOAC treatment at a reduced dose (odds ratio (OR) 2.5 at 95 % confidence interval (CI) 1.02-6.15; p=0.0454), GDF-15 >1191 pg /ml (OR 3.76 at 95 % CI, 1.26-11.18; p=0.0172), PAI-1 >13.2 U/ml (OR 2.67 at 95 % CI, 1.13-6,26; p=0.0245). Incidence of coronary complications was 9.2 %. Independent predictors of coronary complications included a SYNTAX index >26.5 (OR 4.5 at 95 % CI, 1.45-13.60; p=0.0090), PCI for chronic coronary occlusion (OR 3.21 at 95 % CI, 1.10-9.33; p=0.0326), a GDF-15 >1191 pg/ml (ОR 4.70 at 95 % CI, 1.32-16.81; p=0.0172). Incidence of BARC type 2-5 bleeding was 26.1 %. The only independent predictor for hemorrhage complications was the total PRECISE-DAPT score >30 (ОR 3.22; 95 % CI, 1.89-5.51; р<0.0001).Conclusion Three independent predictors of CVC were identified for patients with IHD and AF treated with MAT following an elective PCI: treatment with a reduced dose of DOAC, GDF-15 >1191 pg /ml, and PAI-1>13.2 U/ml. Independent predictors of coronary complications included a SYNTAX index >26.5, PCI for chronic coronary occlusion, and GDF-15 >1191 pg/ml. The factor associated with a risk of bleeding was the total PRECISE-DAPT score >30.

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SINGLE INTRAVENOUS ADMINISTRATION OF COENZYME Q10 FOLLOWING CHRONIC CORONARY OCCLUSION LIMITS POSTINFARCT MYOCARDIAL REMODELLING IN RATS

Journal of Hypertension ◽

10.1097/00004872-201106001-01403 ◽

2011 ◽

Vol 29 ◽

pp. e466-e467

Author(s):

E. Gorodetskaya ◽

E. Kalenikova ◽

A. Ivanov ◽

O. Medvedev

Keyword(s):

Intravenous Administration ◽

Coenzyme Q10 ◽

Coronary Occlusion ◽

Chronic Coronary Occlusion ◽

Myocardial Remodelling ◽

Single Intravenous Administration

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Effect of nitroglycerin on myocardial collateral conductance in awake dogs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1988.254.4.h751 ◽

1988 ◽

Vol 254 (4) ◽

pp. H751-H755

Author(s):

S. Brazzamano ◽

J. C. Rembert ◽

J. C. Greenfield

Keyword(s):

Blood Flow ◽

Pressure Gradient ◽

Collateral Circulation ◽

Coronary Occlusion ◽

Mean Value ◽

Coronary Collateral Circulation ◽

Control Value ◽

Coronary Pressure ◽

The Mean ◽

Collateral Vessels

Conductance of the coronary collateral circulation during the course of two abrupt circumflex coronary occlusions (pre- and posttreatment with nitroglycerin) was measured in awake dogs approximately 2 wk after collateral vessels were stimulated to develop. The pressure gradient from the central aorta to the distal circumflex coronary artery was measured, and myocardial blood flow was determined by 9-microns radioactive microspheres at 30 s and 4 min after coronary occlusions. Collateral conductance was calculated as mean collateral blood flow divided by the mean aorta-coronary pressure gradient. Before nitroglycerin, collateral conductance increased in all eight dogs from 30 s to 4 min by a mean value of 0.006 +/- 0.003 ml.min-1.g-1.mmHg-1. After nitroglycerin administration, the conductance at 30 s increased from the prenitroglycerin control value of 0.009 +/- 0.008 to 0.014 +/- 0.012 ml.min-1.g-1.mmHg-1, P less than 0.03. The mean change in conductance from 30 s to 4 min postnitroglycerin 0.003 +/- 0.003 ml.min-1.g-1.mmHg-1 was significantly less than during prenitroglycerin (P = 0.01). These data indicate that an increase in conductance during coronary occlusion occurs even in the immature collateral circulation. This effect presumably takes place in the arterial smooth muscle at the origin of the collateral vasculature.

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Clinical and angiographic outcome after stent placement for chronic coronary occlusion

The American Journal of Cardiology ◽

10.1016/s0002-9149(98)00440-8 ◽

1998 ◽

Vol 82 (6) ◽

pp. 803-806 ◽

Cited By ~ 15

Author(s):

Shpend Elezi ◽

Adnan Kastrati ◽

Anne Wehinger ◽

Hanna Walter ◽

Helmut Schühlen ◽

...

Keyword(s):

Stent Placement ◽

Coronary Occlusion ◽

Chronic Coronary Occlusion

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Weak magnetic field is cardio protective following chronic coronary occlusion but not following reperfusion

Journal of Molecular and Cellular Cardiology ◽

10.1016/j.yjmcc.2008.02.125 ◽

2008 ◽

Vol 44 (4) ◽

pp. 763

Author(s):

S. Barzelai ◽

S. Laniado ◽

M. Scheinowitz

Keyword(s):

Magnetic Field ◽

Weak Magnetic Field ◽

Coronary Occlusion ◽

Chronic Coronary Occlusion

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Exercise training restores adenosine-induced relaxation in coronary arteries distal to chronic occlusion

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.2000.278.6.h1984 ◽

2000 ◽

Vol 278 (6) ◽

pp. H1984-H1992 ◽

Cited By ~ 28

Author(s):

Cristine L. Heaps ◽

Michael Sturek ◽

Julie A. Rapps ◽

M. Harold Laughlin ◽

Janet L. Parker

Keyword(s):

Coronary Artery ◽

Exercise Training ◽

Sodium Nitroprusside ◽

Coronary Arteries ◽

Coronary Occlusion ◽

Circumflex Coronary Artery ◽

Miniature Swine ◽

Chronic Occlusion ◽

Chronic Coronary Occlusion ◽

Camp And Cgmp

We previously reported that canine collateral-dependent coronary arteries exhibit impaired relaxation to adenosine but not sodium nitroprusside. In contrast, exercise training enhances adenosine sensitivity of normal porcine coronary arteries. These results stimulated the hypothesis that chronic coronary occlusion and exercise training produce differential effects on cAMP- versus cGMP-mediated relaxation. To test this hypothesis, Ameroid occluders were surgically placed around the proximal left circumflex coronary artery (LCx) of female Yucatan miniature swine 8 wk before initiating sedentary or exercise training (treadmill run, 16 wk) protocols. Relaxation to the cAMP-dependent vasodilators adenosine (10− 7 to 10− 3 M) and isoproterenol (3 × 10− 8 to 3 × 10− 5 M) were impaired in collateral-dependent LCx versus nonoccluded left anterior descending (LAD) arterial rings isolated from sedentary but not exercise-trained pigs. Furthermore, adenosine-mediated reductions in simultaneous tension and myoplasmic free Ca2+ were impaired in LCx versus LAD arteries isolated from sedentary but not exercise-trained pigs. In contrast, relaxation in response to the cAMP-dependent vasodilator forskolin (10− 9 to 10− 5 M) and the cGMP-dependent vasodilator sodium nitroprusside (10− 9 to 10− 4 M) was not different in LCx versus LAD arteries of sedentary or exercise-trained animals. These data suggest that chronic occlusion impairs receptor-dependent, cAMP-mediated relaxation; receptor-independent cAMP- and cGMP-mediated relaxation were unimpaired. Importantly, exercise training restores cAMP-mediated relaxation of collateral-dependent coronary arteries.

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