European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(6):558-566; doi:10.1093/eurheartj/ehi051
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Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation
Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland
Received 5 July 2004; revised 19 October 2004; accepted 21 October 2004; online publish-ahead-of-print 30 November 2004.
* Corresponding author. Tel: +41 31 632 36 93; fax: 41 31 632 42 99. E-mail address: christian.seiler.cardio{at}insel.ch
Aims The aim of our study in patients with coronary artery disease (CAD) and present, or absent, myocardial ischaemia during coronary occlusion was to test whether (i) left ventricular (LV) filling pressure is influenced by the collateral circulation and, on the other hand, that (ii) its resistance to flow is directly associated with LV filling pressure.
Methods and results In 50 patients with CAD, the following parameters were obtained before and during a 60 s balloon occlusion: LV, aortic (Pao) and coronary pressure (Poccl), flow velocity (Voccl), central venous pressure (CVP), and coronary flow velocity after coronary angioplasty (VØ-occl). The following variables were determined and analysed at 10 s intervals during occlusion, and at 60 s of occlusion: LV end-diastolic pressure (LVEDP), velocity-derived (CFIv) and pressure-derived collateral flow index (CFIp), coronary collateral (Rcoll), and peripheral resistance index to flow (Rperiph). Patients with ECG signs of ischaemia during coronary occlusion (insufficient collaterals, n=33) had higher values of LVEDP over the entire course of occlusion than those without ECG signs of ischaemia during occlusion (sufficient collaterals, n=17). Despite no ischaemia in the latter, there was an increase in LVEDP from 20 to 60 s of occlusion. In patients with insufficient collaterals, CFIv decreased and CFIp increased during occlusion. Beyond an occlusive LVEDP>27 mmHg, Rcoll and Rperiph increased as a function of LVEDP.
Conclusion Recruitable collaterals are reciprocally tied to LV filling pressure during occlusion. If poorly developed, they affect it via myocardial ischaemia; if well grown, LV filling pressure still increases gradually during occlusion despite the absence of ischaemia indicating transmission of collateral perfusion pressure to the LV. With low, but not high, collateral flow, resistance to collateral as well as coronary peripheral flow is related to LV filling pressure in the high range.
Key Words: Coronary circulation • Collateral circulation • Ventricular function • Coronary imaging
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