Copyright © 2004 by the European Society of Cardiology.
Clinical research
Coronary collateral perfusion in patients with coronary artery disease: effect of metoprolol
Cardiology, Swiss Cardiovascular Centre, University Hospital, CH-3010 Bern, Switzerland
* Corresponding author. Tel.: +41-31-632-9652/3693; fax: +41-31-632-4771
E-mail address: otto.martin.hess{at}insel.ch
Received 17 April 2003; revised 30 January 2004; accepted 5 February 2004 See page 537 for the editorial comment on this article1
Abstract
Background The use of ultrathin Doppler angioplasty guidewires has made it possible to measure collateral flow quantitatively. Pharmacologic interventions have been shown to influence collateral flow and, thus, to affect myocardial ischaemia.
Methods Twenty-five patients with coronary artery disease undergoing PTCA were included in the present analysis. Coronary flow velocities were measured in the ipsilateral (
) and contralateral (
; two Doppler wires) vessels during PTCA with and without i.v. adenosine (140 µg/kg.min) before and 3 min after 5 mg metoprolol i.v., respectively. The ipsilateral Doppler wire was positioned distal to the stenosis, whereas the distal end of the contralateral wire was in an angiographically normal vessel. The flow signals of the ipsilateral wire were used to calculate the collateral flow index (CFI). CFI was defined as the ratio of flow velocity during balloon inflation divided by resting flow.
Results Heart rate and mean aortic pressure decreased slightly (ns) after i.v. metoprolol. The collateral flow index was 0.25±0.12 (one fourth of the resting coronary flow) during the first PTCA and 0.27±0.14 (ns versus first PTCA) during the second PTCA, but decreased with metoprolol to 0.16±0.08 (
vs. baseline) during the third PTCA.
Conclusions Coronary collateral flow increased slightly but not significantly during maximal vasodilatation with adenosine but decreased in 23 of 25 patients after i.v. metoprolol. Thus, there is a reduction in coronary collateral flow with metoprolol, probably due to an increase in coronary collateral resistance or a reduction in oxygen demand.
Key Words: Coronary collateral flow • Coronary artery disease • Doppler flow velocity • Coronary angiography • PTCA
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- ß-blockers, myocardial ischaemia and collateral circulation
- M Sato, S.E Harding, and P.A Poole-Wilson
EHJ 2004 25: 537-539.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  C. Berry, K. P. Balachandran, P. L. L'Allier, J. Lesperance, R. Bonan, and K. G. Oldroyd Importance of collateral circulation in coronary heart disease Eur. Heart J., February 1, 2007; 28(3): 278 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B.-q. Zhu, U. Simonis, G. Cecchini, H.-z. Zhou, L. Li, J. R. Teerlink, and J. S. Karliner Comparison of Pyrroloquinoline Quinone and/or Metoprolol on Myocardial Infarct Size and Mitochondrial Damage in a Rat Model of Ischemia/Reperfusion Injury Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2006; 11(2): 119 - 128. [Abstract] [PDF]
|
|
|
|
|
|
I. Atar, M. E. Korkmaz, I. A. Atar, O. Gulmez, B. Ozin, H. Bozbas, T. Erol, A. Aydinalp, A. Yildirir, M. Yucel, et al. Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions Eur. Heart J., March 1, 2006; 27(5): 547 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Aazami Metoprolol reduces the coronary collateral flow index: alternative explanations Eur. Heart J., November 1, 2004; 25(21): 1966 - 1966. [Full Text] [PDF]
|
|
|
|
|
|
M Sato, S.E Harding, and P.A Poole-Wilson {beta}-blockers, myocardial ischaemia and collateral circulation Eur. Heart J., April 1, 2004; 25(7): 537 - 539. [Full Text] [PDF]
|
|