Long-term physical exercise and quantitatively assessed human coronary collateral circulation
Susanna Senti, MDa,
Martin Fleisch, MDa,
Michael Billinger, MDa,
Bernhard Meier, MD, FACCa and
Christian Seiler, MD, FACCa
a Section of Cardiology, University Hospital, Bern, Switzerland
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Figure 1 Schematic diagram of the heart showing the left anterior descending (LAD) and the left circumflex coronary arteries. The Doppler guide wire is positioned in the left circumflex coronary artery distal to the stenosis (occluder symbol) to be dilated. The IC (i.c.) ECG lead is obtained from the Doppler guide wire. During balloon occlusion of the stenosis, an instantaneous flow velocity signal (cm/s) and a flow velocity trend over 90 s (both shown on the black panel to the right) can be recorded. Compared with the status shortly before occlusion (white arrow), there are almost no flow velocity signals. The velocity-derived collateral flow index (no unit) is calculated as distal flow velocity time integral during (Vioccl or peak velocity integral [PVi] [cm]; in this case, 2.3 cm) divided by that after occlusion and after cessation of reactive hyperemia (Viø-occl [cm]; in this case, 23 cm). During stenosis occlusion, marked ST segment elevation on the IC ECG lead is present (arrowheads) (i.e., this patient has insufficient collateral channels. The difference between distal IC pressure and mean aortic pressure further illustrates the period of stenosis occlusion and also the low collateral flow index present in this case. APV = average peak velocity (cm/s; BAPV = basal average peak velocity (cm/s); DPVi = diastolic peak velocity time integral (cm); PAPV = peak average peak velocity; SPVi = systolic peak velocity time integral (cm).
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Figure 2 Linear regression trend (y = 100 – 10x, r = 0.36, p = 0.0008) of stenosis severity (percent diameter stenosis) of the lesion to be dilated between patients with sufficient and insufficient collateral channels. Stenosis severity was significantly higher in patients with sufficient collateral channels than in those with insufficient collateral channels. Triangles = mean value; vertical lines = ±SD.
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Figure 3 Plot of individual LTPA data in patients with sufficient versus those with insufficient coronary collateral channels. There was a significant difference in LTPA score during leisure time between the two groups. Symbols as in Figure 2.
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Figure 4 Linear regression trends between individual collateral flow index data (no unit) and physical activity scores during working hours (left) and leisure time (right). There was a statistically significant trend between collateral flow index and leisure time physical activity score; p values between different activity scores were obtained by analysis of variance.
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