Adequate collateral circulation in total arterial occlusion preserved normal regional left ventricular contraction better than inadequate collaterals (43% vs 11%, P=0.01).
Observational (n=200)
Does adequate coronary collateral circulation preserve regional left ventricular contractility in patients with total arterial occlusion?
Adequate coronary collateral circulation plays a significant role in preserving regional myocardial contractility in patients with severe coronary artery disease and total arterial occlusion.
Absolute Event Rate: 43% vs 11%
p-value: p=0.01
Two hundred coronary arteriograms and left ventriculograms of patients having significant coronary artery disease were reviewed. Collateral circulation was seen only when the degree of arterial narrowing exceeded 90%. Ten different collateral pathways were noted in patients having right coronary obstruction; seven different pathways were noted in left anterior descending obstruction; five different pathways were noted in left circumflex obstruction. The role of collateral circulation in preserving myocardial function was assessed by comparing regional left ventricular contractility in 86 instances of total arterial occlusion and adequate collateral circulation with that in 80 instances of total arterial occlusion and inadequate collateral circulation. Among the group with adequate collaterals, regional left ventricular contraction was normal in 43%, mildly impaired (hypokinetic) in 52% and severely impaired (akinetic or dyskinetic) in only 5%. Among the group lacking adequate collaterals, regional contraction was normal in 11%, mildly impaired in 16% and severely impaired in 73%. Chi square analysis reveals that the difference between the two groups is significant at the .01 level. These data indicate that collateral circulation plays an important role in preserving myocardial contractility in patients with coronary artery disease.
“In 1974, Levin reported observations of collaterals in 200 coronary angiograms and left ventriculograms of patients with significant coronary disease. He noted that collateral circulation was seen only when the degree of coronary artery narrowing exceeded 90%. In a group of patients with 'adequate' collaterals, regional left ventricular contraction was normal in 43%, mildly hypokinetic in 52%, and akinetic or dyskinetic in 5%. In the group lacking 'adequate' collaterals, regional contraction was normal in only 11%, mildly impaired in 16%, and severely impaired in 73%. No assessment of the presence or absence of myocardial ischemia was done (other than regional wall motion). The conclusion from this observational study was that collateral circulation plays an important role in preserving myocardial contraction in patients with coronary disease.”
David C. Levin (1974) conducted an observational in Significant coronary artery disease (n=200). Adequate collateral circulation vs. Inadequate collateral circulation was evaluated on Normal regional left ventricular contraction (p=0.01). Adequate collateral circulation in total arterial occlusion preserved normal regional left ventricular contraction better than inadequate collaterals (43% vs 11%, P=0.01).
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