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CLINICAL STUDIES

Long-term physical exercise and quantitatively assessed human coronary collateral circulation

^a Section of Cardiology, University Hospital, Bern, Switzerland

Manuscript received December 15, 1997; revised manuscript received March 19, 1998, accepted March 20, 1998.

Address for correspondence: Dr. Christian Seiler, University Hospital, Section of Cardiology, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland
christian.seiler{at}insel.ch

Objectives. This prospective, cross-sectional study sought to determine an association between the level of long-term physical activity as well as other clinical and angiographic variables and an index of collateral flow to the vascular region undergoing percutaneous transluminal coronary angioplasty (PTCA).

Background. There is limited and conflicting information about the effect of physical exercise on the coronary collateral circulation in humans, partly because previous studies lacked a quantitative means of assessing collateral channels.

Methods. In 79 patients (mean [±SD] age 58 ± 10 years) with coronary artery disease undergoing PTCA (no transmural myocardial infarction), a coronary collateral flow index was determined as the ratio between the intracoronary (IC) distal flow velocity time integral during (Vi_occl [cm]) and after (Vi_ø-occl [cm]) PTCA of the stenosis. Vi_occl/Vi_ø-occl was measured by a 0.014-in. Doppler guide wire, from which an IC electrocardiogram (ECG) was also recorded. Patients without ECG ST-T wave changes during PTCA were considered to have sufficient collateral channels (n = 29); those with ST-T wave changes were considered to have insufficient collateral channels (n = 50). The level of long-term physical activity was determined by a structured interview (score from 1 to 4). Univariate and multivariate analyses were used to find associations between physical activity as well as 30 other clinical and angiographic variables and the collateral flow index.

Results. Long-term physical activity during leisure time, but not during work hours, and the severity of the stenosis undergoing PTCA were found to be independently and directly associated with sufficient versus insufficient collateral channels and with Vi_occl/Vi_ø-occl (leisure time physical activity [LTPA] score 3.3 ± 0.9 vs. 2.4 ± 1.0, p = 0.0002; percent diameter stenosis 88 ± 12% vs. 80 ± 14%, p = 0.001; , p = 0.0002 for trend).

Conclusions. In patients with coronary artery disease, the level of long-term physical activity during leisure time and the severity of the stenosis undergoing PTCA are directly associated with the quantitative degree of collateral flow.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiogram, electrocardiographic   IC = intracoronary   LTPA = leisure time physical activity   PTCA = percutaneous transluminal coronary angioplasty   Vioccl = flow velocity–time integral obtained distal to occluded stenosis   Viø-occl = flow velocity–time integral obtained distal to dilated stenosis   WPA = work-related physical activity

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