Influence of collaterals on the left ventricular end-diastolic pressure and serum NT-proBNP levels in patients with coronary chronic total occlusion

Abstract

ObjectiveAlthough numerous studies have shown the protective effects of the well-developed coronary collaterals on left ventricular functions, the relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are conflicting data on the effect of collaterals on NT-proBNP levels. The aim of our study was to evaluate the relationship between coronary collateral circulation and left ventricular end diastolic pressure and NT-proBNP levels in chronic total occlusion patients.MethodsStudy group was retrospectively selected from the patients who had undergone coronary angiography at our hospital between June 2011 and March 2013. Clinical, biochemical, angiographic and hemodynamic data of 199 consecutive patients having at least one totally occluded major epicardial coronary artery were evaluated. Coronary collateral circulation was graded according to Rentrop classification. While Rentrop grade 3 was defined as well-developed, all the remaining collateral grades were regarded as poor collaterals.ResultsOverall 87 patients were found to have good collaterals and 112 patients had poor collaterals. There was no significant difference between the patients with well- or poorly developed coronary collaterals with regard to left ventricular end diastolic pressure (16.84 ± 5.40 mmHg vs 16.10 ± 6.09, respectively, p = 0,632) and log NT-proBNP (2.46 ± 0.58 vs 2.59 ± 0.76, respectively, p = 0,335).ConclusionIn patients with coronary chronic total occlusion even well-developed coronary collaterals are not capable of protecting the rise of left ventricular end diastolic pressure and NT-proBNP levels which are reliable markers of the left ventricular dysfunction.

The Effects of Percutaneous Coronary Intervention on Biomarkers and Quality of Life in Patients With Chronic Total Coronary Artery Obstruction

“…One study investigating only CTO patients showed that poorly collateralized coronary arteries were associated with significantly higher serum NT-pro-BNP levels compared with well-developed collateral coronary arteries. It is caused by the protection against myocardial ischemia provided by developing collaterals; and increased levels of NT-pro-BNP may simply reflect the humoral status required for stimulation of angiogenesis in patients with poor collateral arteries [ 26 , 27 ]. Our study results showed that the mean level of NT-pro-BNP in patients undergoing PCI was lower than in patients who did not undergo PCI (0.24 ± 0.10 ng/mL vs. 0.56 ± 0.23 ng/mL, 95% CI: 0.20 - 0.4, P < 0.001).…”

Koronar arteriyaların xroniki total okklüziyası

“…Xroniki total okklüziya (XTO) əksər hallarda sağ koronar arteriyada (RCA) (47%), 20% hallarda sol ön enən arteriyada (LAD), 16% hallarda sirkumfleks arteriyada (Cx), 17% hallarda isə birdən artıq lokalizasiyada müşahidə edilmişdir (6). Tərəfimizdən aparılmış tədqiqatda əldə olunmuş nəticələr də bənzər olmuşdur (8). XTO kişilərdə daha çox müşahidə edilir.…”