The Human Coronary Collateral Circulation, Its Extracardiac Anastomoses and Their Therapeutic Promotion

Bigler, Marius Reto; Seiler, Christian

doi:10.3390/ijms20153726

Cited by 27 publications

(8 citation statements)

References 124 publications

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“…Taken together, accumulating evidence suggests that well-developed collateral circulation contributes positively to the course of coronary artery disease. Recently, a large body of evidence has indicated that the presence of an extensive collateral circulation has been associated with the decrease of myocardial infarction in patients with stable CAD [9]. The most widely used invasive method for assessing coronary collateral circulation is contrast angiography.…”

Section: Discussionmentioning

confidence: 99%

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Hellmann

Piotrowski

Kaszubowski³

et al. 2020

JCM

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Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation.

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Section: Discussionmentioning

confidence: 99%

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Hellmann

Piotrowski

Kaszubowski³

et al. 2020

JCM

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“…Coronary collateral circulation (CCC) was evaluated by the Rentrop classification method. 11 The criterias of this method are as follows: grade 0, no filling of contrast; grade one, filling of side branches of collateral with no epicardial perfusion; grade two, partial filling of epicardial artery by collateral; grade three, fully filling of epicardial artery. 11 Good coronary collateral circulation (CCC) was delineated as grade two or grade three collateral, poor CCC was delineated as grade 0 or grade one collateral.…”

Section: Methodsmentioning

confidence: 99%

Hyperinsulinemia Impaired Coronary Collateral Circulation in Patients with Chronic Total Coronary Occlusion

Zou¹,

Sun²,

Tan³

2023

DMSO

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Background and Objectives Hyperinsulinemia impaired cardiovascular system and endothelial function in the population. The purpose of this study was to explore the relationship between hyperinsulinemia and coronary collateral circulation in patients with chronic total coronary occlusion. Methods Patients with stable angina and at least one total coronary occlusion were enrolled in this study. Collateral grade was determined according to Rentrop’s classification. Patients were divided into a good coronary collateral circulation (CCC) group (grade 2 or 3 collateral vessels, n = 223) and a poor CCC group (grade 0 or 1 collateral vessels, n = 115). Fasting insulin level (FINS) and fasting glucose level (FBS) were measured. Endothelial function evaluated by flow-mediated dilation (FMD). Results Serum FINS level was significantly increased in the poor CCC group ( P < 0.01). Patients in the poor CCC group had higher levels of FBS, HbA1C, and homeostasis model assessment for insulin resistance (HOMA-IR) than patients in the good CCC group. The poor CCC group also had lower levels of FMD, lower LVEF and higher syntax scores than the good CCC group. Hyperinsulinemia (T3, FINS ≥15.22 μIU/mL) increased OR for the incidence of the poor CCC group (OR 2.419, 95% CI 1.780–3.287) in multivariate analysis. Multivariate logistic regression also revealed that diabetes, HbA1c, HOMA-IR, HDL-C and Syntax score were independent predictors of poor CCC (all P < 0.05). Conclusion Hyperinsulinemia is a valuable predictor of poor collateral formation in patients with chronic total coronary occlusion.

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“…The formation of CCC is affected by various factors, including chronic myocardial ischemia, changes in blood flow pressure gradient, and the effect of inflammatory factors 3 . In addition, comorbidities such as hypertension and diabetes, as well as physical exercise training and growth factors, have also been reported to influence CCC development 4,5 . C‐reactive protein (CRP) and red cell distribution width (RDW) have recently been reported to have a close relationship with CCC formation 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non‐ST segment elevation myocardial infarction

Yin,

Ye,

You

et al. 2024

Clinical Cardiology

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BackgroundUric acid/albumin ratio (UAR) is a novel composite biomarker with superior predictive value for cardiovascular disease.ObjectiveTo investigate the relationship between UAR and coronary collateral circulation (CCC) in patients with non‐ST segment elevation myocardial infarction (NSTEMI).MethodsA total of 205 NSTEMI patients who underwent coronary arteriography with at least one major coronary stenosis, 95% were included. Patients were divided into two groups according to CCC development: poorly‐developed CCC group (Rentrop 0–1) and well‐developed CCC (Rentrop 2–3). Univariate analysis and logistic regression analysis were utilized to investigate the factors influencing adverse CCC formation in NSTEMI patients. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of UAR, C‐reactive protein (CRP), uric acid, and albumin for patients with poorly developed CCC, and the area under the curve (AUC) was compared.ResultsThe UAR values of NSTEMI patients were significantly higher in the poorly developed CCC group than those in the well‐developed CCC group (10.19 [8.80–11.74] vs. 7.79 [6.28–9.55], p < .001). In the multiple logistic regression tests, UAR (odds ratio [OR]: 1.365, 95% confidence interval [CI]: 1.195–1.560, p < .001), CRP (OR: 1.149, 95% CI: 1.072–1.231, p < .001), and diabetes (OR: 2.924, 95% CI: 1.444–5.920, p = .003) were independent predictors of poorly developed CCC. The ROC curve analysis showed that the optimal cut‐off value of UAR was 8.78 in predicting poorly developed CCC with a sensitivity of 76.8% and specificity of 62.4%, with the AUC of 0.737 (95% Cl: 0.668–0.805, p < .001).ConclusionElevated UAR may be an independent and effective biomarker for predicting poorly‐developed CCC development in NSTEMI patients.

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The Human Coronary Collateral Circulation, Its Extracardiac Anastomoses and Their Therapeutic Promotion

Cited by 27 publications

References 124 publications

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Hyperinsulinemia Impaired Coronary Collateral Circulation in Patients with Chronic Total Coronary Occlusion

Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non‐ST segment elevation myocardial infarction

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