Ha J W, Cho S Y, Jang Y S, Chung N, Shim W H, Kim S S
Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1994 Jun;35(2):132-41. doi: 10.3349/ymj.1994.35.2.132.
The functional significance of the collateral circulation was evaluated in 125 patients with total coronary occlusion. Patients were classified into two groups. Group 1:patients with angina pectoris (AP), Group 2:patients with a first transmural myocardial infarction (MI) within 3 months of the symptom onset. Clinical variables, resting and exercise electrocardiogram (EKG) were analyzed with angiographic findings. Collateral fillings were graded from 0 to 3: 0 = none; 1 = filling of side branches only; 2 = partial filling of the epicardial segment; 3 = complete filling of epicardial segment. The wall motion of each segment was scored from 1 to 5: 1 = normal; 2 = mild to moderate hypokinesia; 3 = severe hypokinesia; 4 = akinesia; 5 = dyskinesia. The scores of the 5 segments were added to yield a total LV score. There was a higher prevalence of good collaterals and multi-vessel disease in patients with AP than in those with MI (83% vs 53%, 54% vs 30%, respectively, p < 0.005). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic pressure (LVEDP) and segmental wall motion score were significantly better in patients with AP than in those with MI (68.9 +/- 13.4%, vs 50.5 +/- 12.6%, 15.0 +/- 7.3 mmHg vs 20.3 +/- 8.8 mmHg, 6.5 +/- 2.2 vs 9.6 +/- 2.3, respectively, p < 0.05). In spite of total coronary occlusion, 61% of AP patients had normal resting EKG but (96% of AP patients who underwent treadmill test proved positive. The proportions of well-developed collaterals in 3 groups divided according to the interval between onset of MI and angiography (within 1 day, 2 to 14 days, 15 days to 3 months) were 13%, 54% and 60%. There were no significant differences in LVEF, segmental wall motion score and LVEDP in MI patients with poorly-developed collaterals and well-developed collaterals (49.1 +/- 15.7% vs 46.4 +/- 10.1%, 11.1 +/- 2.2 vs 10.9 +/- 1.4 and 24.3 +/- 9.7 mmHg vs 20.3 +/- 7.0 mmHg, p = NS). The degree of collateral development was higher in MI with right coronary artery occlusion compared with that of left anterior descending artery occlusion (1.1 +/- 1.0 vs 2.0 +/- 1.0, p < 0.05). In conclusion, collateral circulation can prevent myocardial ischemia and preserve myocardial function in a significant number of patients with AP but do not provide protection against exercise-induced myocardial ischemia in the majority of patients with AP.(ABSTRACT TRUNCATED AT 400 WORDS)
对125例冠状动脉完全闭塞患者的侧支循环功能意义进行了评估。患者被分为两组。第1组：心绞痛（AP）患者；第2组：症状发作3个月内首次发生透壁性心肌梗死（MI）的患者。对临床变量、静息和运动心电图（EKG）与血管造影结果进行了分析。侧支充盈情况分为0至3级：0级 = 无；1级 = 仅侧支血管充盈；2级 = 心外膜段部分充盈；3级 = 心外膜段完全充盈。每个节段的壁运动评分为1至5分：1分 = 正常；2分 = 轻度至中度运动减弱；3分 = 重度运动减弱；4分 = 运动不能；5分 = 运动障碍。将5个节段的评分相加得出左心室总评分。AP患者中良好侧支循环和多支血管病变的患病率高于MI患者（分别为83%对53%，54%对30%，p < 0.005）。AP患者的左心室射血分数（LVEF）、左心室舒张末期压力（LVEDP）和节段性壁运动评分显著优于MI患者（分别为68.9±13.4%对50.5±12.6%，15.0±7.3 mmHg对20.3±8.8 mmHg，6.5±2.2对9.6±2.3，p < 0.05）。尽管冠状动脉完全闭塞，但61%的AP患者静息EKG正常，但（96%接受平板运动试验的AP患者结果呈阳性。根据MI发作与血管造影之间的间隔（1天内、2至14天、15天至3个月）分为3组，其中侧支循环良好的比例分别为13%、54%和60%。侧支循环发育不良和发育良好的MI患者在LVEF、节段性壁运动评分和LVEDP方面无显著差异（分别为49.1±15.7%对46.4±10.1%，11.1±2.2对10.9±1.4，24.3±9.7 mmHg对20.3±7.0 mmHg，p = 无显著性差异）。与左前降支闭塞的MI相比，右冠状动脉闭塞的MI侧支循环发育程度更高（1.1±1.0对2.0±I.0，p < 0.05）。总之，侧支循环可预防大量AP患者的心肌缺血并保留心肌功能，但在大多数AP患者中不能预防运动诱发的心肌缺血。（摘要截短至400字）
