title: Coronary collaterals reduce the duration of exercise-induced ischemia by allowing a faster recovery.
abstract: The role of collaterals in influencing postischemic recovery after exercise testing has not been investigated previously. We studied 54 patients (mean age 59 +/- 6 years) with effort-induced angina and documented coronary disease who underwent exercise testing and thallium-201 myocardial scintigraphy. On angiography, 30 patients (group A) exhibited visible collaterals (grade 2 to 3, Cohen and Rentrop classification) perfusing the ischemic zone, whereas the other 24 (group B) did not. Patients with collaterals had more severe coronary artery disease (Gensini score 46.9 +/- 16 vs 28.6 +/- 18; p less than 0.001) and more severe impairment of coronary flow reserve (time and rate-pressure product to 1 mm ST segment depression 3.5 +/- 0.8 vs 4.8 +/- 0.6 minutes, p less than 0.01; 14,189 +/- 2451 vs 16,081 +/- 2215 beats/min x mm Hg, p less than 0.04, respectively). However, in these patients the ECG returned to baseline more rapidly after exercise (5.5 +/- 1.6 vs 11.7 +/- 3.3 minutes; p less than 0.001). Therefore, although collaterals do not apparently prevent or delay the development of exercise-induced ischemia, they can limit its duration by allowing a faster recovery.
authors.affiliation: Department of Cardiology, Istituto Scientifico Ospedale San Rafaele, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bonetti
authors.forename: A
authors.initials: A
authors.lastname: Margonato
authors.forename: A
authors.initials: A
authors.lastname: Mailhac
authors.forename: O
authors.initials: O
authors.lastname: Carandente
authors.forename: A
authors.initials: A
authors.lastname: Cappelletti
authors.forename: C
authors.initials: C
authors.lastname: Ballarotto
authors.forename: S L
authors.initials: SL
authors.lastname: Chierchia
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology*; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000502:physiology*; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes; D013997:Time Factors
chemical_list: D013794:Thallium Radioisotopes