Coronary collateral vessels: spectrum of physiologic capabilities with respect to providing rest and stress myocardial perfusion, maintenance of left ventricular function and protection against infarction
| Autor: | Richard A. Wepsic, David Schroeder, Charles A. Bush, Albert J. Kolibash, Marc R. Tetalman, Richard P. Lewis |
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| Rok vydání: | 1982 |
| Předmět: |
medicine.medical_specialty
Rest Physical Exertion Myocardial Infarction Infarction Collateral Circulation Coronary Angiography Coronary artery disease Coronary circulation Internal medicine Coronary Circulation Medicine Humans Myocardial infarction Radionuclide Imaging business.industry Heart Collateral circulation medicine.disease Coronary Vessels Myocardial Contraction Cardiovascular physiology Coronary arteries medicine.anatomical_structure cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Perfusion |
| Zdroj: | The American journal of cardiology. 50(2) |
| ISSN: | 0002-9149 |
| Popis: | The physiologic significance of coronary collateral vessels was evaluated in 91 patients with stable coronary artery disease. Four physiologic variables were assessed in the distribution areas of 101 totally occluded coronary arteries associated with angiographically defined collateral vessels. These variables included myocardial perfusion at rest and during stress, left ventricular wall motion and the presence or absence of myocardial infarction. These 101 collateralized areas of myocardium were classified into two major groups on the basis of normal (43 areas) or abnormal (58 areas) myocardial perfusion at rest. Among the 43 areas with normal perfusion at rest, three or more variables were normal in 37 instances (86 percent) and all variables were normal in 17. Of 58 areas with abnormal perfusion at rest, three or more variables were abnormal in 47 (81 percent), and all four variables were abnormal in 32. Although the results were generally concordant when all variables were assessed as a group, significant discrepancies existed if each variable was compared individually with resting perfusion. Of the 43 areas with normal resting perfusion 14 (33 percent) had stress defects, 15 (35 percent) had wall motion abnormalities and 5 (12 percent) showed electrocardiographic evidence of myocardial infarction. Of the 58 areas with abnormal resting perfusion 5 (9 percent) had normal stress perfusion, 16 (28 percent) had normal wall motion and 22 (38 percent) lacked electrocardiographic evidence of infarction. The presence or absence of significant coronary artery disease distal to the origin of a collateral vessel, the extent of coronary artery disease in all coronary vessels and the angiographic appearance of collateral vessels were not helpful in defining the significance of a collateral vessel. These results indicate that the functional significance of collateral vessels varies considerably. Collateral vessels in many patients may be highly effective in maintaining myocardial perfusion and left ventricular function and preventing infarction; in others, collateralization may be of no significance. The use of multiple variables as a group rather than individually provides meaningful information regarding the physiologic significance of a collateral vessel and complements the coronary angiogram, which is not uniformly helpful in making this assessment. |
| Databáze: | OpenAIRE |
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