scholarly journals Exercise Training as a Mediator for Enhancing Coronary Collateral Circulation: A Review of the Evidence

2020 ◽  
Vol 16 (3) ◽  
pp. 212-220
Author(s):  
Thomas Nickolay ◽  
Simon Nichols ◽  
Lee Ingle ◽  
Angela Hoye
Keyword(s):  
Pressure Gradient ◽  
Stable Coronary Artery Disease ◽  
Arterial Occlusion ◽  
Current Evidence ◽  
Future Research ◽  
Myocardial Oxygen Demand ◽  
Collateral Flow ◽  
Maximal Conductance ◽  
Collateral Development ◽  
Coronary Collateral

: Coronary collateral vessels supply blood to areas of myocardium at risk after arterial occlusion. Flow through these channels is driven by a pressure gradient between the donor and the occluded artery. Concomitant with increased collateral flow is an increase in shear force, a potent stimulus for collateral development (arteriogenesis). Arteriogenesis is self-limiting, often ceasing prematurely when the pressure gradient is reduced by the expanding lumen of the collateral vessel. After the collateral has reached its self-limited maximal conductance, the only way to drive further increases is to re-establish the pressure gradient. During exercise, the myocardial oxygen demand is increased, subsequently increasing coronary flow. Therefore, exercise may represent a means of driving augmented arteriogenesis in patients with stable coronary artery disease. Studies investigating the ability of exercise to drive collateral development in humans are inconsistent. However, these inconsistencies may be due to the heterogeneity of assessment methods used to quantify change. This article summarises current evidence pertaining to the role of exercise in the development of coronary collaterals, highlighting areas of future research.

scholarly journals Impact of Admission Blood Glucose on Coronary Collateral Flow in Patients with ST-Elevation Myocardial Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ozge Kurmus ◽  
Turgay Aslan ◽  
Berkay Ekici ◽  
Sezen Baglan Uzunget ◽  
Sukru Karaarslan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Glucose Level ◽  
St Elevation Myocardial Infarction ◽  
Collateral Flow ◽  
Collateral Development ◽  
Coronary Collateral ◽  
Diabetes Status ◽  
St Elevation ◽  
Admission Glucose

In patients with acute myocardial infarction, glucose metabolism is altered and acute hyperglycemia on admission is common regardless of diabetes status. The development of coronary collateral is heterogeneous among individuals with coronary artery disease. In this study, we aimed to investigate whether glucose value on admission is associated with collateral flow in ST-elevation myocardial infarction (STEMI) patients. We retrospectively evaluated 190 consecutive patients with a diagnosis of first STEMI within 12 hours of onset of chest pain. Coronary collateral development was graded according to Rentrop classification. Rentrop 0-1 was graded as poor collateral development, and Rentrop 2-3 was graded as good collateral development. Admission glucose was measured and compared between two groups. Mean admission glucose level was 173.0 ± 80.1 mg/dl in study population. Forty-five (23.7%) patients had good collateral development, and 145 (76.3%) patients had poor collateral development. There were no statistically significant differences in demographic characteristics between two groups. Three-vessel disease was more common in patients with good collateral development (p=0.026). Mean admission glucose level was higher in patients with poor collateral than good collateral (180.6 ± 84.9 mg/dl versus 148.7 ± 56.6 mg/dl, resp., p=0.008). In univariate analysis, higher admission glucose was associated with poor collateral development, but multivariate logistic regression analysis revealed a borderline result (odds ratio 0.994, 95% CI 0.989–1.000, p=0.049). Our results suggest that elevated glucose on admission may have a role in the attenuation of coronary collateral blood flow in acute myocardial infarction. Further studies are needed to validate our results.

Effect of serum YKL-40 on coronary collateral development and SYNTAX score in stable coronary artery disease

2016 ◽  
Vol 224 ◽  
pp. 323-327 ◽  
Author(s):  
Mehmet Kadri Akboga ◽  
Ridvan Yalcin ◽  
Asife Sahinarslan ◽  
Canan Yilmaz Demirtas ◽  
Adnan Abaci
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Syntax Score ◽  
Collateral Development ◽  
Coronary Collateral ◽  
Artery Disease

Coronary collateral stimulation by exercise in dogs with stenotic coronary arteries

1982 ◽  
Vol 52 (3) ◽  
pp. 664-671 ◽  
Author(s):  
M. V. Cohen ◽  
T. Yipintsoi ◽  
J. Scheuer
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Left Atrial ◽  
Reactive Hyperemia ◽  
Left Ventricular ◽  
Treadmill Running ◽  
Collateral Flow ◽  
Flow Measurements ◽  
Collateral Development ◽  
Coronary Collateral

To determine the effects of an exercise-training program on coronary collateral development, we instrumented 13 1-yr-old beagles with left circumflex (LCf) coronary artery flow probes and balloon occluders and left atrial and aortic catheters. The LCf artery was constricted resulting in a 58 +/- 4% reduction of the peak reactive hyperemia response following release of a 154-s LCf occlusion. All dogs were studied during the first week of the study protocol. Resting heart rate, cardiac output, and left atrial and aortic pressures were evaluated before and during a 1-min LCf occlusion. Myocardial blood flow was also measured with radioactively-labeled microspheres injected into the left atrium during the LCf occlusion. Subsequently the dogs were exercised at 6.4 km/h and 12% grade, and all hemodynamic and blood flow measurements were repeated. The animals were then randomized to either a sedentary or exercising group. The six sedentary animals were confined to their cages, while the seven training beagles did sprint and endurance running for 75 min/day, 5 days/wk. After 12 wk the hemodynamic and blood flow studies were repeated at rest and during treadmill running. There were no statistically significant differences in resting or exercise hemodynamics, response to LCf occlusion, or myocardial blood flow in the two groups in wk 1. Hemodynamics and blood flow data were virtually unchanged in the sedentary animals after 12 wk. However, the trained dogs demonstrated less evidence of left ventricular failure following LCf occlusion while running and had significantly higher myocardial blood flows. Their resting collateral flow increased from 0.52 +/- 0.16 ml . min-1 . g-1 at wk 1 to 0.90 +/- 0.28 ml . min-1 . g-1 at wk 12 (P less than 0.05), while the ratio of collateral to normal myocardial blood flow increased from 0.46 +/- 0.12 to 0.64 +/- 0.16 (P less than 0.05). Thus chronic exercise can stimulate coronary collateral development, and the enhanced collateral flow has a salutary functional effect.

The application of virtual reality in health professions� digital education: a narrative review (Preprint)

2018 ◽  
Author(s):  
Lorraine Tudor Car ◽  
Bhone Myint Kyaw ◽  
Josip Car
Keyword(s):  
Virtual Reality ◽  
Professional Education ◽  
Health Professions ◽  
Health Professions Education ◽  
Narrative Review ◽  
Current Evidence ◽  
Future Research ◽  
Educational Content ◽  
Potential Applications

BACKGROUND Digital technology called Virtual Reality (VR) is increasingly employed in health professions’ education. Yet, based on the current evidence, its use is narrowed around a few most applications and disciplines. There is a lack of an overview that would capture the diversity of different VR applications in health professions’ education and inform its use and research. OBJECTIVE This narrative review aims to explore different potential applications of VR in health professions’ education. METHODS The narrative synthesis approach to literature review was used to analyse the existing evidence. RESULTS We outline the role of VR features such as immersion, interactivity and feedback and explain the role of VR devices. Based on the type and scope of educational content VR can represent space, individuals, objects, structures or their combination. Application of VR in medical education encompasses environmental, organ and micro level. Environmental VR focuses on training in relation to health professionals’ environment and human interactions. Organ VR educational content targets primarily human body anatomy; and micro VR microscopic structures at the level of cells, molecules and atoms. We examine how different VR features and health professional education areas match these three VR types. CONCLUSIONS We conclude by highlighting the gaps in the literature and providing suggestions for future research.

Sign in / Sign up

Export Citation Format

Share Document