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CLINICAL STUDIES

Simultaneous intracoronary velocity- and pressure-derived assessment of adenosine-induced collateral hemodynamics in patients with one- to two-vessel coronary artery disease

^a Division of Cardiology, University Hospital, Swiss Cardiovascular Center Bern, Bern, Switzerland

Manuscript received September 10, 1998; revised manuscript received August 16, 1999, accepted September 1, 1999.

Reprint requests and correspondence: Dr. Christian Seiler, Division of Cardiology, Swiss Cardiovascular Center Bern, Inselspital, CH-3010 Bern, Switzerland.
christian.seiler.cardio{at}insel.ch

OBJECTIVES

The purpose of this investigation in patients with poorly and well developed coronary collaterals was to assess the influence of collateral and collateral adjacent vascular resistances and, in part, a stenotic lesion of the collateral supplying vessel on the hemodynamic collateral responses to adenosine.

BACKGROUND

In humans, little is known about the functional behavior of the coronary collateral circulation.

METHODS

In 50 patients with one- and two-vessel coronary artery disease (CAD) undergoing percutaneous transluminal coronary angioplasty (PTCA), collateral flow index (CFI, no unit) changes and vascular resistance index (R, cm/mm Hg) changes of the collateral (R_coll) and the distal collateral receiving (R₄) vessel in response to adenosine (140 µg/min/kg IV) were measured by intracoronary (i.c.) Doppler and pressure guidewires. The variables were determined at baseline and during adenosine in patients with poor (angiographic collateral degree before PTCA <2 of 0 to 3) and good coronary collaterals.

RESULTS

Pressure-derived CFI (CFI_p) decreased under adenosine in patients with poor collaterals, and it increased in the group with good collaterals. There were inverse correlations between the adenosine-induced change in CFI_p and the change in R_coll (r = 0.61, p = 0.0001). In the group with good, but not with poor collaterals, there was also a significant correlation between CFI_p increase and the decrease in R₄, between the severity of the contralateral stenosis and CFI_p augmentation and among the left versus right coronary artery as ipsilateral vessel and CFI_p change.

CONCLUSIONS

Overall, patients with well, versus poorly developed coronary collaterals do better regarding the capacity to increase collateral flow in response to adenosine. In patients with good, but not poor, collaterals, an adenosine-induced collateral flow increase depends on the ipsilateral distal vascular resistance decrease, but is also directly influenced by the severity of a contralateral stenosis and probably by the size of the collateralized vascular bed.

Abbreviations and Acronyms   ANOVA = analysis of variance   CAD = coronary artery disease   CFI = collateral flow index   CFIp = pressure-derived collateral flow index   CFIv = velocity-derived collateral flow index   CFVR = coronary flow velocity reserve   CVP = central venous pressure   ECG = electrocardiogram   FFR = fractional flow reserve   i.c. = intracoronary   LAD = left anterior descending artery   LCX = left circumflex artery   Pao = mean aortic pressure   Poccl = distal coronary occlusive (wedge) pressure   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery   Rcoll = collateral resistance index   R1 = epicardial vascular resistance   R3 = contralateral resistance index   R4 = ipsilateral resistance index   Vioccl = distal velocity time integral during vessel occlusion   Viø-occl = distal velocity time integral during vessel patency

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