Significance of myocardial ischemia as a factor of the development of coronary collateral vessels

1.梗死前心绞痛与急性心肌梗死后左心功能的关系梗死前心绞痛有利于急性心肌功能恢复后左心功能的维持，无论梗塞相关冠状动脉早期再通与否，其有益作用至少部分是由于侧支循环的发展。另一方面，梗塞前心绞痛的缺血预适应对于早期再灌注患者的左心功能的保护起着重要作用，而对于那些持续闭塞的梗塞相关冠脉的患者，缺血预适应对左心功能的保护作用不大。劳力性心绞痛或急性心肌梗死患者冠状动脉侧支循环的发展在心肌缺血刺激存在的情况下，所有患者的侧支循环都会发展。次要渠道的发展是评估…随着受体冠状动脉内径的增加，其数量也越多。侧支循环的功能状态由侧支血管的解剖存在和侧支网络上的压力梯度决定。肝素运动治疗稳定性劳力型心绞痛的远期疗效肝素预处理的重复运动有助于提高稳定性劳力型心绞痛患者的运动能力，并能在较长的随访期内保持良好效果。肝素运动治疗后较长时间内，相同负荷下运动Tl-201心肌显像的严重程度评分明显降低。供冠脉狭窄对侧支循环储备的意义冠状动脉侧支循环随着非狭窄供冠脉患者心肌耗氧量的增加而进一步增加，而供体动脉显著狭窄则影响侧支血流量的增加。较少

1. Relationship between preinfarction angina and left ventricular function after acute myocardial infarctionPreinfarction angina is useful for the preservation of left ventricular function after acute myocardial function regardless of the early reperfusion of the infarct-related coronary artery The beneficial effect is, at least in part, due to the development of collateral circulation. On the other hand, ischemic preconditioning by preinfarction angina plays an important role in the preservation of left ventricular function in patients with the early reperfusion, whereas ischemic preconditioning is not useful for the preservation of left ventricular function in those with the persistently occluded infarct-related coronary artery2. The development of coronary collateral circulation in patients with effort angina or acute myocardial infarctionIn the presence of myocardial ischemic stimuli, collateral vessels are developed in all patients. The development of collateral channels is assess … More ed quantitatively as an increase in the diameter of recipient coronary arteries. The functional state of collateral circulation is determined by the anatomical presence of collateral vessels and pressure gradient across the collateral network.3. Long-term efficacy of heparin exercise treatment for patients with stable effort anginaRepeated exercise with heparin pretreatment is useful for improving exercise capacity in patients with stable effort angina, and the beneficial effect of the treatment is maintained over a long follow-up period. The severity score of exercise thallium-201 myocardial scintigrams with the same work-load was significantly decreased long after heparin exercise treatnent.4. Significance of stenosis of donating coronary arteries for collateral flow reserveCoronary collateral circulation is further augmented in response to an increase in myocardial oxygen demand in patients with non-stenosed donating coronary arteries, whereas significant stenoses in donating arteries compromise an increase in collaterai blood flow. Less