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Spadaccio C, Nenna A, Rose D, Piccirillo F, Nusca A, Grigioni F, Chello M, Vlahakes GJ. The Role of Angiogenesis and Arteriogenesisin Myocardial Infarction and Coronary Revascularization. J Cardiovasc Transl Res 2022; 15:1024-1048. [PMID: 35357670 DOI: 10.1007/s12265-022-10241-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
Surgical myocardial revascularization is associated with long-term survival benefit in patients with multivessel coronary artery disease. However, the exact biological mechanisms underlying the clinical benefits of myocardial revascularization have not been elucidated yet. Angiogenesis and arteriogenesis biologically leading to vascular collateralization are considered one of the endogenous mechanisms to preserve myocardial viability during ischemia, and the presence of coronary collateralization has been regarded as one of the predictors of long-term survival in patients with coronary artery disease (CAD). Some experimental studies and indirect clinical evidence on chronic CAD confirmed an angiogenetic response induced by myocardial revascularization and suggested that revascularization procedures could constitute an angiogenetic trigger per se. In this review, the clinical and basic science evidence regarding arteriogenesis and angiogenesis in both CAD and coronary revascularization is analyzed with the aim to better elucidate their significance in the clinical arena and potential therapeutic use.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiac Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, USA. .,Cardiac Surgery, Golden Jubilee National Hospital & University of Glasgow, Glasgow, UK.
| | - Antonio Nenna
- Cardiac Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - David Rose
- Cardiac Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | | | | | | | - Massimo Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gus J Vlahakes
- Cardiac Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, USA
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Sharma K, Champaneri B, Patel I, Thangasami S, Tated S, Jha SN. Do collaterals visualized on coronary angiography impact left ventricle ejection fraction among Asian Indians presenting with acute coronary syndrome?-The Deucalion Study. Asian Cardiovasc Thorac Ann 2021; 30:567-572. [PMID: 34730014 DOI: 10.1177/02184923211038463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The coronary collaterals have been ascribed as a potential alternative source of myocardial perfusion to the extent that some suggest it as a "natural bypass"! We proposed to evaluate the impact of the extent of collaterals on left ventricle ejection fraction among Asian Indians presenting with acute coronary syndrome. METHODS This was a retrospective, all-comers study performed on consecutive 3614 patients presenting with the acute coronary syndrome. Angiograms were evaluated for collaterals graded according to Rentrop's classification among group A (grades 0 and 1) and group B (grades 2 and 3) collaterals. RESULTS Patients were matched for traditional cardiovascular risk factors in groups A and B as well as for ST elevation myocardial infarction and non-ST elevation myocardial infarction subgroups in both the groups. Grades 2 and 3 collaterals were significantly (P = 0.04) higher in patients with non-ST elevation myocardial infarction-266/1319 (20.17%), as compared to ST elevation myocardial infarction-group 400/2295 (17.43%). Left ventricle ejection fraction on presentation was better preserved in group A as compared to group B in those with double-vessel disease and triple-vessel disease patients with non-ST elevation myocardial infarction, whereas it was better in single-vessel disease and triple-vessel disease patients with ST elevation myocardial infarction. The inverse correlation (r = -0.111, P = 0.000) existed between left ventricle ejection fraction and grades of collaterals. CONCLUSION Patients with the single-vessel disease were more likely to have poor coronary collateral as compared to double-vessel disease/triple-vessel disease. Despite higher grade coronary collateral among Asian Indians presenting with acute coronary syndrome, both non-ST elevation myocardial infarction and ST elevation myocardial infarction patients with triple-vessel disease had significantly lower left ventricle ejection fraction. This paradoxically brings out worse left ventricle ejection fraction on presentation in those with double-vessel disease and triple-vessel disease with ST elevation myocardial infarction and single-vessel disease and triple-vessel disease with ST elevation myocardial infarction despite higher grade of coronary collateral representing as "Asian Indian Paradox" in our cohort.
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Affiliation(s)
- Kamal Sharma
- Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Bhavik Champaneri
- Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Iva Patel
- Department of Research, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Senthilraj Thangasami
- Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Suyash Tated
- Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Shobha Nand Jha
- Department of Cardiology, 161213UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Güngör H, Sivri F, Yıldırım BO, Çayırlı S, Demiroğlu Ö, Yeşilkaya CU, Zencir C. The Effects of Preoperative Coronary Collateral Circulation on Cardiac-Related Events after Coronary Artery Bypass Graft Surgery. Braz J Cardiovasc Surg 2021; 36:25-31. [PMID: 33112585 PMCID: PMC7918396 DOI: 10.21470/1678-9741-2019-0375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction This study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG). Methods A total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF. Results Sixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011). Conclusion Stroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.
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Affiliation(s)
- Hasan Güngör
- Department of Cardiology, Adnan Menderes University, Aydin, Turkey
| | - Fatih Sivri
- Department of Cardiology, Adnan Menderes University, Aydin, Turkey
| | | | - Sercan Çayırlı
- Department of Cardiology, Adnan Menderes University, Aydin, Turkey
| | - Özgün Demiroğlu
- Department of Cardiology, Adnan Menderes University, Aydin, Turkey
| | | | - Cemil Zencir
- Department of Cardiology, Adnan Menderes University, Aydin, Turkey
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Quantification of late gadolinium enhancement cardiovascular MRI in patients with coronary artery chronic total occlusion. Clin Radiol 2020; 75:643.e19-643.e26. [PMID: 32418670 DOI: 10.1016/j.crad.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/19/2020] [Indexed: 01/25/2023]
Abstract
AIM To determine the most accurate and reproducible semi-automated greyscale thresholding technique for quantifying late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMRI), by using positron-emission tomography (PET) as the reference standard in patients with coronary artery chronic total occlusion (CTO). MATERIALS AND METHODS LGE in CMRI, single-photon-emission computed tomography (SPECT), and PET were performed within 1 week in each of 63 patients with known CTO. The presence and quantity of LGE were determined with greyscale thresholds of 2, 4, 5, 6, and 8 standard deviations (SDs) above the mean signal intensity for normal remote myocardium and full width at half maximum (FWHM). The infarcted myocardium was delineated by PET. RESULTS Sixty-three patients and 1,008 segments were analysed. Based on patient analysis, with PET as the reference standard, the 5 SD method yielded the strongest correlation (r=0.85, p<0.0001) compared with the 2 SDs (r=0.42), 4 SDs (r=0.73), 6 SDs (r=0.81), 8 SDs (r=0.71), and FWHM (r=0.69; p<0.001 for all comparisons). The 5 SDs threshold quantification showed high interobserver and intra-observer agreement (intraclass correlation coefficient [ICC]=0.90, p<0.0001; ICC=0.93, p<0.0001, respectively). CONCLUSIONS Semi-automated LGE CMRI greyscale thresholding with 5 SDs above the mean signal intensity for normal remote myocardium yields the strongest correlation to the extent of LGE identified using PET and is highly reproducible in patients with CTO.
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Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand. Gen Thorac Cardiovasc Surg 2019; 67:655-660. [DOI: 10.1007/s11748-019-01077-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
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Yang ZK, Shen Y, Hu J, Zhang Q, Ding FH, Zhang RY, Lu L, Shen WF. Impact of coronary collateral circulation on angiographic in-stent restenosis in patients with stable coronary artery disease and chronic total occlusion. Int J Cardiol 2017; 227:485-489. [PMID: 27836292 DOI: 10.1016/j.ijcard.2016.10.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between coronary collateralization and in-stent restenosis (ISR) in stable coronary artery disease patients with chronic total occlusion (CTO) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. METHODS The degree of coronary collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded according to Rentrop classification in 216 patients with stable angina undergoing successful DES based PCI for CTO. Univariable and multivariable logistic regression analyses were performed to assess the potential factors related to angiographic ISR during follow-up. RESULTS Despite similar number of diseased coronary arteries, good collateralization (Rentrop score 2 or 3) was more frequently associated with right coronary artery occlusion (60%), whereas poor collaterals (Rentrop score 0 or 1) occurred more often in left anterior descending artery occlusion (40%). Despite similar number of CTO intervened, stent length was longer in patients with good collateralization (59±27mm vs 47±23mm, p=0.001). At mean 18months, the rate of ISR did not significantly differ between patients with good collateralization and those with poor collateralization (12.7% vs 20.2%, p=0.148). At multivariable analysis, age (OR 1.058, 95%CI 1.015-1.104, p=0.008), history of diabetes mellitus (OR 2.382, 95%CI 1.109-5.116, p=0.026) and reference CTO vessel diameter (OR 0.219, 95% CI 0.051-0.951, p=0.043) were independent risk factors for ISR while Rentrop collateral grade (OR 0.795, 95% CI 0.365-1.732, p=0.414) was not associated with ISR. CONCLUSIONS The occurrence of ISR after successful DES based PCI for CTO may be not influenced by coronary collateralization.
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Affiliation(s)
- Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Qi Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China; Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China; Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.
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Harmouche M, Maasrani M, Verhoye JP, Corbineau H, Drochon A. Coronary three-vessel disease with occlusion of the right coronary artery: What are the most important factors that determine the right territory perfusion? Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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SCHUTT ROBERTC, YOUNG SHIUM, LIU LING, LIPSON LEWISC, KEELEY ELLENC. The Association of Angiographic Collaterals with Long-Term Clinical Outcomes in Patients with Chronic Stable Angina. J Interv Cardiol 2014; 27:225-32. [DOI: 10.1111/joic.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- ROBERT C. SCHUTT
- Department of Medicine; University of Virginia; Charlottesville Virginia
| | - SHIU M. YOUNG
- Department of Medicine; University of Virginia; Charlottesville Virginia
| | - LING LIU
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
| | - LEWIS C. LIPSON
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
| | - ELLEN C. KEELEY
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
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Kaku D, Nakahira A, Hirai H, Sasaki Y, Hosono M, Bito Y, Suehiro Y, Suehiro S. Does rich coronary collateral circulation distal to chronically occluded left anterior descending artery compete with graft flow? Interact Cardiovasc Thorac Surg 2013; 17:944-9. [PMID: 23959772 DOI: 10.1093/icvts/ivt337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In coronary artery bypass grafting (CABG), graft flow distal to a mild stenosis can compete with relatively preserved native flow through the stenosis and the competition can result in graft stenosis. In chronic total occlusion (CTO), coronary collateral circulation, which is essential to maintain myocardial viability distal to CTO, varies in extent among patients and the extent can be scored by Rentrop grade in coronary angiography. We investigated whether rich collateral circulation distal to CTO competes with distally anastomosed graft flow in association with Rentrop grade. METHODS Of 666 patients who underwent CABG from January 2001 to December 2012, 70 patients whose left internal thoracic artery (ITA) was grafted distal to CTO in the left anterior descending artery (LAD) were divided into three groups: Poor collaterals (Rentrop grades 0 and 1, Group P, n = 22), Moderate collaterals (grade 2, Group M, n = 23) and Rich collaterals (grade 3, Group R, n = 25). The intraoperative measurements of mean graft flow (MGF) and pulsatility index (PI) of left ITA grafts, early graft patency and long-term clinical outcomes were compared. RESULTS The MGF and PI of left ITA grafts differed significantly among the three groups (P = 0.025 and P = 0.046, respectively). Lower Rentrop grade was associated with preferable results of higher MGF and lower PI. The graft flow pattern in Group P showed a significantly higher MGF (P = 0.020) and lower PI (P = 0.041) than those in Group R. All early postoperative coronary angiograms showed patent left ITA grafts. Serial echocardiographic evaluations, survival rates and cardiac event-free rates were comparable with the follow-up of 5.00 ± 3.11 years. CONCLUSIONS Rich collateral circulation distal to CTO in LADs can potentially compete with graft flow, although the competition seems not to affect clinical outcomes probably due to the regression of collaterals surmounted by the graft flow. Rentrop grade is shown to certainly reflect the degree of collateral haemodynamic circulation distal to CTO and especially important to evaluate intraoperative graft flow appropriately, considering the possible phenomenon of graft flow competition.
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Affiliation(s)
- Daisuke Kaku
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
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A more sensitive pressure-based index to estimate collateral blood supply in case of coronary three-vessel disease. Med Hypotheses 2012; 79:261-3. [PMID: 22633139 DOI: 10.1016/j.mehy.2012.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/29/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
Abstract
With progressive occlusion of a coronary main artery, some anastomotic vessels are recruited in order to supply blood to the ischemic region. This collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it alters the blood flow distribution in the coronary network and can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index based on pressure measurements. It is named Collateral Flow Index (CFI) and defined as: (P(w)-P(v))/(P(ao)-P(v)), where P(w) is the pressure distal to the thrombosis, P(ao) the aortic pressure and P(v) the central venous pressure. We propose here another index, that is more sensitive to the P(w) value and could thus describe the role of collateral flow with more precision. We illustrate this idea using some clinical pressure measurements in patients with severe coronary disease (stenoses on the left branches and total occlusion of the right coronary artery).
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Maasrani M, Drochon A, Harmouche M, Corbineau H, Verhoye JP. Theoretical study of the flow rate toward the right heart territory in case of total occlusion of the right coronary artery. Med Eng Phys 2012; 35:103-7. [PMID: 22584016 DOI: 10.1016/j.medengphy.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 02/15/2012] [Accepted: 04/22/2012] [Indexed: 11/30/2022]
Abstract
In this work, patients with severe coronary disease and chronic occlusion of the right coronary artery (RCA) are studied. In this clinical situation, the collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index (CFI, Collateral Flow Index) based on pressure measurements. Using a model of the coronary circulation based on hydraulic/electric analogy, we demonstrate, through theoretical simulations, that a wide range of fractional collateral flow values can be obtained for any given distal pressure difference depending on the values of the capillary and collateral resistances.
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McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, Norris CM, Graham MM. The Clinical Profile and Outcomes Associated With Coronary Collaterals in Patients With Coronary Artery Disease. Can J Cardiol 2011; 27:581-8. [DOI: 10.1016/j.cjca.2011.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 01/04/2023] Open
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Keeley EC, Moorman JR, Liu L, Gimple LW, Lipson LC, Ragosta M, Taylor AM, Lake DE, Burdick MD, Mehrad B, Strieter RM. Plasma chemokine levels are associated with the presence and extent of angiographic coronary collaterals in chronic ischemic heart disease. PLoS One 2011; 6:e21174. [PMID: 21731663 PMCID: PMC3120847 DOI: 10.1371/journal.pone.0021174] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/21/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with chronic ischemic heart disease (IHD), the presence and extent of spontaneously visible coronary collaterals are powerful determinants of clinical outcome. There is marked heterogeneity in the recruitment of coronary collaterals amongst patients with similar degrees of coronary artery stenoses, but the biological basis of this heterogeneity is not known. Chemokines are potent mediators of vascular remodeling in diverse biological settings. Their role in coronary collateralization has not been investigated. We sought to determine whether plasma levels of angiogenic and angiostatic chemokines are associated with of the presence and extent of coronary collaterals in patients with chronic IHD. METHODOLOGY/PRINCIPAL FINDINGS We measured plasma concentrations of angiogenic and angiostatic chemokine ligands in 156 consecutive subjects undergoing coronary angiography with at least one ≥90% coronary stenosis and determined the presence and extent of spontaneously visible coronary collaterals using the Rentrop scoring system. Eighty-eight subjects (56%) had evidence of coronary collaterals. In a multivariable regression model, the concentration of the angiogenic ligands CXCL5, CXCL8 and CXCL12, hyperlipidemia, and an occluded artery were associated with the presence of collaterals; conversely, the concentration of the angiostatic ligand CXCL11, interferon-γ, hypertension and diabetes were associated with the absence of collaterals (ROC area 0.91). When analyzed according to extent of collateralization, higher Rentrop scores were significantly associated with increased concentration of the angiogenic ligand CXCL1 (p<0.0001), and decreased concentrations of angiostatic ligands CXCL9 (p<0.0001), CXCL10 (p = 0.002), and CXCL11 (p = 0.0002), and interferon-γ (p = 0.0004). CONCLUSIONS/SIGNIFICANCE Plasma chemokine concentrations are associated with the presence and extent of spontaneously visible coronary artery collaterals and may be mechanistically involved in their recruitment.
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Affiliation(s)
- Ellen C Keeley
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, United States of America.
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