title: The relationship between diastolic pressure and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion.
abstract: BACKGROUND
  The most important biomechanical source of activation of the coronary collateral circulation (CCC) is increased tangential fluid shear stress at the arterial endothelial surface. The coronary circulation is unique in that most coronary blood flow occurs in diastole. Consequently, the diastolic blood pressure (DBP) may influence the tangential fluid shear stress on the arterial endothelial surface in diastole, therebyaffecting development of the CCC.
  
  
  METHODS
  To investigate this, we conducted a study of 222 patients with stable angina pectoris and chronic total occlusion of coronary arteries. All of the patients had no history of coronary artery interventional therapy, coronary artery bypass surgery, cardiomyopathy, or congenital heart disease. The extent of the collateral vasculature of the area perfused by the artery affected by chronic total occlusion was graded as poor or well-developed according to Rentrop's classification.
  
  
  RESULTS
  Univariate analysis showed a significant difference between the study subgroup with poorly developed collaterals and that with well-developed collaterals in terms of high diastolic blood pressure (DBP) and mean DBP. Multivariate analysis revealed high DBP as the only independent positive predictor of a well-developed collateral circulation.
  
  
  CONCLUSIONS
  High DBP is positively related to a well-developed CCC. Differences in development of the CCC may be one of the pathophysiologic mechanisms responsible for the J-curve phenomenon in the relationship between DBP and cardiovascular risk.
authors: The Cardiovascular Medical Department of the General Hospital of the Chinese People's Liberation Army, Beijing, China.
authors: Wang
authors: W
authors: Shu
authors: Jing
authors: J
authors: jing
authors: Liu Chang
authors: LC
authors: Fu
authors: Jiang Tie
authors: JT
authors: Min
authors: Yang Xiao
authors: YX
authors: Bo
authors: Zhou
authors: Z
authors: Ying
authors: Chen Yun
authors: CY
authors: Dai
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic / Q000503:physiopathology; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013314:Stress, Mechanical