Dai Yuxiang, Chang Shufu, Wang Shen, Shen Yi, Li Chenguang, Huang Zheyong, Lu Hao, Qian Juying, Ge Lei, Wang Qibing, Zhang Feng, Ge Junbo
Department of Cardiology, Fudan University Affiliated Zhongshan Hospital, Shanghai, China.
Department of Cardiology, Xinhua Hospital of Zhejiang Province, the Second Affiliated Hospital of Zhejiang Chinese Medical University, China.
Adv Clin Exp Med. 2020 Apr;29(4):493-497. doi: 10.17219/acem/104535.
Patients with coronary chronic total occlusion (CTO) typically have collateralization of the distal vessel, and these collaterals can contribute to the relief of ischemia and anginal symptoms and to the preservation of ventricular function.
To investigate the preservation effect of coronary collateral circulation on left ventricular (LV) function in coronary CTO, and to explore the potential mechanism behind the development of coronary collateral circulation.
A total of 102 consecutive patients with coronary CTO were divided into 2 groups: the left ventricular ejection fraction (LVEF)-preserved group (LVEF ≥ 50%; n = 46) and the LVEF-decreased group (LVEF < 50%; n = 56). Clinical, angiographic and laboratory data was collected for all patients. The association between LVEF and coronary collateral circulation in coronary CTO patients was analyzed with multivariate logistic regression analysis, and the serum levels of VEGF-A and the mRNA expression levels of the VEGF-A gene were compared between different grades of coronary collateral circulation.
Multivariate analysis revealed that Rentrop grades 2-3 and coexisting collateral pathways were independent predictors of LVEF preservation in coronary CTO patients. Patients with Rentrop grades 2-3 had smaller left ventricular end diastolic diameters (LVDd) and left ventricular end systolic diameters (LVSd), and they had larger LVEFs than the patients with Rentrop grades 0-1. Patients with Rentrop grades 2-3 also had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in their peripheral blood mononuclear cells (PBMCs) than patients with Rentrop grades 0-1. Patients with coexisting collateral pathways had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in PBMCs than patients without coexisting collateral pathways.
Coronary collateral circulation is significantly associated with LVEF preservation, and VEGF-A might promote the formation of coronary collateral circulation.
冠状动脉慢性完全闭塞（CTO）患者的远端血管通常存在侧支循环，这些侧支循环有助于缓解缺血和心绞痛症状，并维持心室功能。
研究冠状动脉CTO中冠状动脉侧支循环对左心室（LV）功能的保护作用，并探讨冠状动脉侧支循环形成背后的潜在机制。
连续纳入102例冠状动脉CTO患者，分为两组：左心室射血分数（LVEF）保留组（LVEF≥50%；n = 46）和LVEF降低组（LVEF<50%；n = 56）。收集所有患者的临床、血管造影和实验室数据。采用多因素logistic回归分析冠状动脉CTO患者LVEF与冠状动脉侧支循环的关系，并比较不同等级冠状动脉侧支循环患者血清VEGF-A水平及VEGF-A基因mRNA表达水平。
多因素分析显示，Rentrop分级2-3级和并存侧支循环途径是冠状动脉CTO患者LVEF保留的独立预测因素。Rentrop分级2-3级的患者左心室舒张末期内径（LVDd）和左心室收缩末期内径（LVSd）较小，LVEF高于Rentrop分级0-1级的患者。Rentrop分级2-3级的患者外周血单个核细胞（PBMC）中血清VEGF-A水平及VEGF-A基因mRNA表达水平也高于Rentrop分级0-1级的患者。并存侧支循环途径的患者PBMC中血清VEGF-A水平及VEGF-A基因mRNA表达水平高于无并存侧支循环途径的患者。
冠状动脉侧支循环与LVEF保留显著相关，VEGF-A可能促进冠状动脉侧支循环的形成。
