Ejiri M, Fujita M, Miwa K, Nozawa T, Asanoi H, Sasayama S
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
Int J Cardiol. 1993 Apr;39(1):5-11. doi: 10.1016/0167-5273(93)90291-n.
To elucidate whether the presence of significant stenoses in donor coronary arteries compromises collateral flow reserve, coronary arteriography was performed in 22 patients with stable effort angina who had a complete obstruction in one of the major coronary arteries. The patients were divided into two groups according to the absence (group I: n = 11) or presence (group II: n = 11) of significant stenoses (> or = 75% stenosis of the luminal diameter) in donor arteries. After conventional cardiac catheterization, coronary arteriography was repeated before and during rapid atrial pacing. Coronary collateral circulation was evaluated by means of angiographic contrast appearance time (CAT) which was defined as the time (s) until the epicardial segments distal to the site of complete occlusion were opacified after the injection of contrast medium into the donor artery. The pressure gradient across the collateral circulation (mean aortic pressure minus left ventricular end-diastolic pressure) remained unchanged before and during rapid atrial pacing (group I: 95 +/- 14 vs. 99 +/- 15 mmHg; group II: 91 +/- 18 vs. 94 +/- 16 mmHg). Rapid atrial pacing decreased the contrast appearance time in group I from 1.73 +/- 0.34 to 1.47 +/- 0.37 s (P < 0.01), but was not changed in group II from 1.68 +/- 0.36 to 1.73 +/- 0.51 s (P = n.s.). It was concluded that coronary collateral circulation is further augmented in response to an increase in myocardial oxygen demand in patients with non-stenosed donor coronary arteries and significant stenoses in donor arteries compromise an increase in collateral blood flow.
