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CLINICAL STUDIES

Quantification of collateral flow in humans: a comparison of angiographic, electrocardiographic and hemodynamic variables

^a Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands

Manuscript received May 29, 1998; revised manuscript received September 17, 1998, accepted October 30, 1998.

Reprint requests and correspondence: Dr. Jan J. Piek, Department of Cardiology, B2-108, Academic Medical Center, P.O. Box 22700, 1100 DE, Amsterdam, the Netherlands
j.j.piek{at}amc.uva.nl

OBJECTIVES

Evaluation of collateral vascular circulation according to hemodynamic variables and its relation to myocardial ischemia.

BACKGROUND

There is limited information regarding the hemodynamic quantification of recruitable collateral vessels.

METHODS

Angiography of the donor coronary artery was performed before and during balloon coronary occlusion in 63 patients with one vessel disease. Patients were divided into groups of those with an absence of collateral vessels (group 1, n = 10), those with recruitable collateral vessels (group 2, n = 23) and those with spontaneously visible collateral vessels (group 3, n = 30). During balloon inflation the coronary wedge/aortic pressure ratio (Pw/Pao) was determined as were collateral blood flow velocity variables, using a 0.014'' Doppler guide wire. Myocardial ischemia was defined as 0.1 mV ST-shift on a 12 lead electrocardiogram at 1 min coronary occlusion.

RESULTS

Myocardial ischemia was present in all patients of group 1, in 14 patients of group 2 and in 3 patients of group 3. Recruitable collateral flow without ischemia showed similar hemodynamic values as in group 3 while these values were similar to group 1 in regard to the presence of recruitable collateral vessels showing ischemia. Logistic regression analysis revealed both Pw/Pao and Vi_col as independent predictors for the function of collateral vessels.

CONCLUSIONS

Hemodynamic variables of collateral vascular circulation are better markers of the functional significance of collateral vessels than is coronary angiography. The total collateral blood flow velocity integral and coronary wedge/aortic pressure ratio are good and independent predictors of the function of collateral vessels producing complementary information.

Abbreviations and Acronyms   Rcoll = collateral vascular resistance   Pw = coronary occlusion wedge pressure   Pw/Pao = coronary wedge/aortic pressure ratio   dVicol = diastolic collateral blood flow velocity integral   Rrec = peripheral vascular resistance of the recipient coronary artery   ROC = receiver operating characteristics   sVicol = systolic collateral blood flow velocity integral   Vicol = total collateral blood flow velocity integral

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