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European Heart Journal Advance Access originally published online on January 11, 2007
European Heart Journal 2007 28(3):278-291; doi:10.1093/eurheartj/ehl446
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Importance of collateral circulation in coronary heart disease

Colin Berry1,3,*, Kanarath P. Balachandran2, Philippe L. L'Allier1, Jacques Lespérance1, Raoul Bonan1 and Keith G. Oldroyd3

1 Department of Medicine, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
2 Department of Cardiology, Bristol Royal Infirmary, Bristol, UK
3 Department of Cardiology, Western Infirmary, Glasgow, UK

Received 14 June 2006; revised 27 November 2006; accepted 30 November 2006; online publish-ahead-of-print 11 January 2007.

* Corresponding author: Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G128TA, UK. Tel: +44 15143763330; fax: +44 141 211 1906. E-mail address: colin.berry{at}clinmed.gla.ac.uk

Aims Collateral arteries are a common but inconsistent finding in coronary heart disease (CHD). We endeavoured to review the methods for coronary artery collateral assessment, the predictors and clinical importance of collateral blood flow, and the potential for therapeutic augmentation of collateral anastomoses.

Methods and results While many methods have been used to assess collateral blood flow only a few have been formally validated. Collateral flow index, as determined by measurement of intra-coronary pressure or flow velocity, is the most robust measure of collateral flow. These techniques have led to important advances in our understanding of collateral artery function. Coronary collateral arteries may prevent myocardial ischaemia in healthy subjects and in patients with CHD. A functional collateral circulation may lead to reduced ischaemia, preservation of ventricular function, and an improved prognosis. Recent trials have demonstrated that vascular progenitor cell therapies may improve ventricular function following acute myocardial infarction, raising the possibility of effective biological treatments to improve myocardial blood flow and prognosis in CHD.

Conclusions Coronary collateral anastomoses represent a prognostically important adaptive response in patients with CHD. Therapeutic augmentation of collaterals with emerging biological therapies represents a desirable goal for treating CHD patients.

Key Words: Angina • Angiogenesis • Collateral • Coronary artery • Myocardial infarction


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