Coronary collateral vessels: spectrum of physiologic capabilities with respect to providing rest and stress myocardial perfusion, maintenance of left ventricular function and protection against infarction.
Coronary collateral vessels: spectrum of physiologic capabilities with respect to providing rest and stress myocardial perfusion, maintenance of left ventricular function and protection against infarction.
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冠状侧支血管：提供休息和应激心肌灌注、维持左心室功能和预防梗塞的生理能力范围。
DOI：
10.1016/0002-9149(82)90171-0
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Richard P. Lewis
中科院分区：
文献类型：
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作者：
A. J. Kolibash;C. Bush;Richard A. Wepsic;David Schroeder;M. Tetalman;Richard P. Lewis
对91例稳定性冠心病患者冠状动脉侧支血管的生理意义进行了探讨。四个生理变量进行了评估，在101个完全闭塞的冠状动脉与血管造影定义的侧支血管的分布区域。这些变量包括静息和应激时的心肌灌注、左室壁运动以及是否存在心肌梗死。根据静息心肌灌注正常（43个区域）或异常（58个区域），将这101个心肌侧支化区域分为两大组。在43个静息灌注正常的区域中，37例（86%）有3个或更多变量正常，17例所有变量正常。在58个静息灌注异常的区域中，47个（81%）有三个或更多变量异常，32个所有四个变量都异常。虽然当所有变量作为一组进行评估时，结果通常是一致的，但如果将每个变量单独与静息灌注进行比较，则存在显著差异。在43个静息灌注正常的区域中，14个（33%）有应激缺陷，15个（35%）有室壁运动异常，5个（12%）有心肌梗死的心电图证据。在58个静息灌注异常的区域中，5个（9%）负荷灌注正常，16个（28%）室壁运动正常，22个（38%）缺乏梗死的心电图证据。侧支血管起源远端有无明显冠状动脉病变、冠状动脉病变在所有冠状动脉血管中的程度以及侧支血管的造影表现对侧支血管的意义没有帮助，这些结果表明侧支血管的功能意义差异很大。在许多患者中，侧支血管在维持心肌灌注和左心室功能以及预防梗死方面可能非常有效;在其他患者中，侧支血管可能没有意义。将多个变量作为一个组而不是单独使用提供了关于侧支血管生理意义的有意义的信息，并补充了冠状动脉血管造影，这在进行该评估时并没有统一的帮助。
The physiologic significance of coronary collateral vessels was evaluated in 91 patients with stable coronary artery disease. Four physiologic variables were assessed in the distribution areas of 101 totally occluded coronary arteries associated with angiographically defined collateral vessels. These variables included myocardial perfusion at rest and during stress, left ventricular wall motion and the presence or absence of myocardial infarction. These 101 collateralized areas of myocardium were classified into two major groups on the basis of normal (43 areas) or abnormal (58 areas) myocardial perfusion at rest. Among the 43 areas with normal perfusion at rest, three or more variables were normal in 37 instances (86 percent) and all variables were normal in 17. Of 58 areas with abnormal perfusion at rest, three or more variables were abnormal in 47 (81 percent), and all four variables were abnormal in 32. Although the results were generally concordant when all variables were assessed as a group, significant discrepancies existed if each variable was compared individually with resting perfusion. Of the 43 areas with normal resting perfusion 14 (33 percent) had stress defects, 15 (35 percent) had wall motion abnormalities and 5 (12 percent) showed electrocardiographic evidence of myocardial infarction. Of the 58 areas with abnormal resting perfusion 5 (9 percent) had normal stress perfusion, 16 (28 percent) had normal wall motion and 22 (38 percent) lacked electrocardiographic evidence of infarction. The presence or absence of significant coronary artery disease distal to the origin of a collateral vessel, the extent of coronary artery disease in all coronary vessels and the angiographic appearance of collateral vessels were not helpful in defining the significance of a collateral vessel.These results indicate that the functional significance of collateral vessels varies considerably. Collateral vessels in many patients may be highly effective in maintaining myocardial perfusion and left ventricular function and preventing infarction; in others, collateralization may be of no significance. The use of multiple variables as a group rather than individually provides meaningful information regarding the physiologic significance of a collateral vessel and complements the coronary angiogram, which is not uniformly helpful in making this assessment.