title: Quantitative evaluation of collateral circulation in patients with previous myocardial infarction: relation to myocardial ischemia, angiographic appearance and functional improvement of myocardium.
abstract: Evaluation of coronary pressures during angioplasty may functionally quantify collateral circulation. The aim of the study was to evaluate the relation between the amount of collateral circulation and development of myocardial ischemia during balloon occlusion, anatomic degree of collaterals, and functional improvement of myocardium. Study population consisted of 31 pts (mean age 53 +/- 7 years; 25 male) with previous myocardial infarction and significant one-vessel stenosis undergoing angioplasty. Collateral circulation was calculated as the ratio between distal coronary pressure during balloon occlusion (P(w)) and aortic pressure (P(a)). Angiographic appearance of collaterals was evaluated by Rentrop classification. Patients were evaluated by echo for functional improvement of myocardium in the follow-up period. Mean P(w)/P(a) was 0.24 +/- 0.10 (range of 0.07-0.51). Rentrop grade 0 of collaterals was present in 16 patients (52%), grade 1 in11 patients (35%), and grade 2 in 4 patients (13%). A mild correlation between angio and hemodynamic evaluation of collaterals was observed (r = 0.38, P = 0.035). In patients without ECG changes during angioplasty (21 pts, 68%), P(w)/P(a) was significantly higher in comparison to patients with ECG changes (0.28 +/- 0.09 vs. 0.15 +/- 0.06, P < 0.001; area under the curve 0.93). In patients with myocardial functional improvement during follow-up (21 pts, 68%), P(w)/P(a) was significantly higher than in the patients without echo improvement (0.26 +/- 0.10 vs. 0.18 +/- 0.08, P = 0.035). The amount of recruitable collaterals is not negligible even in the patients with no angio visible collaterals. Low values of P(w)/P(a) are associated with ECG changes during balloon occlusion. Higher P(w)/P(a) was associated with better functional improvement of myocardium.
authors.affiliation: Department for Diagnostic and Catheterization Laboratories, Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Vladan
authors.initials: V
authors.lastname: Vukcevic
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
authors.forename: Sinisa
authors.initials: S
authors.lastname: Stojkovic
authors.forename: Goran
authors.initials: G
authors.lastname: Stankovic
authors.forename: Milan
authors.initials: M
authors.lastname: Nedeljkovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Orlic
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.forename: Jelena
authors.initials: J
authors.lastname: Stepanovic
authors.forename: Vojislav
authors.initials: V
authors.lastname: Giga
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Arandjelovic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Dikic
authors.forename: Jelena
authors.initials: J
authors.lastname: Kostic
authors.forename: Ivana
authors.initials: I
authors.lastname: Nedeljkovic
authors.forename: Biljana
authors.initials: B
authors.lastname: Nedeljkovic-Beleslin
authors.forename: Jovica
authors.initials: J
authors.lastname: Saponjski
mesh_terms: D021721:Balloon Occlusion; D016009:Chi-Square Distribution; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D012372:ROC Curve