The Evaluation Of The Coronary Collateral Circulation Of The Patients With Coronary Artery Disease And The Analysis Of Its Relational Factors

In recent years,scholars of certain subjects hold positive opinions about whether there existing possibility of coronary collateral circulation. To know the coronary collateral degree of the patients with CAD is helpful to selecting the treatment ways and judging the prognosis. To explore the relational factors of the construction of the coronary collateral circulation is very important to the cure of CAD.OBJECTIVES:1.To study the premised condition and distribution of coronary collaterals and explore the relational factors of the foundation.2. To evaluate the effects of coronary collateral circulation on the left ventricular function of patients with CAD.3. To appraise the role of X ray- coronary angiography in study of the coronary collateral circulation.MATERIALS AND METHODS:Retrospective analysis were taken on 78 patients with CAD . The selection criteria were at least one major branch arteriostenosis of coronary artery reduced more than 75% diameter confirmed by coronary angiography. We observed coronary angiography (CAG) and left ventricular cardiography of them,knew the amount of jeopardized vessels and the location and degree of the ischemia-related vessel,analyzed the common communication ways and the degree of the coronary collateral,and evaluated the left ventricular function with left ventricular ejection fraction (LVEF) and regional wall-motion fraction gained by digital subtracted left ventricular cardiography,then compared their left ventricular function in different groups divided with the grade of coronary collateral. Contrasted the results of pre-operation CAG and post-operation PET imaging of 13 patients,who underwent myocardial PET Perfusion-Metabolism imaging after PTCA,toappraise the significance of the coronary collateral to the myocardial viability of patients with CAD.RESULTS:There were 27 patients had single-vessel disease and 51 had multi-vessels disease confirmed by CAG. 28 patients had no visual coronary collateral circulation,12 of the others were classified grade I,23 grade II and 15 grade III. Total 50 patients had coronary collateral circulation including 7 single-vessel disease and 43 multi-vessels disease. The degrees of arteriostenosis of the 50 were 11 seriously-reduced,11 almost-blocked and 28 blocked. The higher degrees of arteriostenosis,the higher grades of the coronary collateral circulation,P<0.001. We defined the non-collateral and grade I as poor-developed,however,higher than Il(included) as well-developed,each is 40 and 38. The present rate of the coronary collateral circulation on patients who had left or right coronary artery as the ischemia-related vessels was 57.8%(26/45) and 72.7%(24/33),rate of well-developed coronary collateral circulation was 35.6%(16/45) and 66.7(22/33) respectively,the location of the lesion was significantly relative to prevalence and the degree of the coronary collateral circulation. The present rate and degree of coronary collateral circulation about the arteriostenosis on right coronary artery were higher than those on the left coronary artery. The poor-developed collateral circulation group had significantly lower mean LVEF than the well-developed group (p<0.05,41.21+9.02 and 65.79+8.52),and had significantly higher present rate of regional wall-motion fraction and ventricular aneurysm than those of the well-developed group(p<0.05,3.23 +2.08 and 2.05+1.44,32.5% and 7.9%). Compared the PET image after PTCA with the CAG image before it,5 patients with well-developed coronary collateral circulation were considered to have viable myocardium,whereas 8 patients with poor-developed coronary collateral,only 2 of them were considered have viable myocardium. The rate of myocardial viability with well-developed coronary collateral was significantly higher than cases without it (p<0.05).CONCLUSIONS:The open of coronary collateral circulation is depended on thealmost-blocked or blocked lesions of the coronary artery and related with the locations of the arteriostenosis,the presence rate of well-develop...