A more sensitive pressure-based index to estimate collateral blood supply in case of coronary three-vessel disease
Department of Thoracic and Cardiovascular Surgery, Rennes Hospital Center, France. Medical Hypotheses
(Impact Factor: 1.07).
05/2012; 79(2):261-3. DOI: 10.1016/j.mehy.2012.05.004
With progressive occlusion of a coronary main artery, some anastomotic vessels are recruited in order to supply blood to the ischemic region. This collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it alters the blood flow distribution in the coronary network and can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index based on pressure measurements. It is named Collateral Flow Index (CFI) and defined as: (P(w)-P(v))/(P(ao)-P(v)), where P(w) is the pressure distal to the thrombosis, P(ao) the aortic pressure and P(v) the central venous pressure. We propose here another index, that is more sensitive to the P(w) value and could thus describe the role of collateral flow with more precision. We illustrate this idea using some clinical pressure measurements in patients with severe coronary disease (stenoses on the left branches and total occlusion of the right coronary artery).
Available from: Tobias Traupe
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ABSTRACT: Objective Well-developed collaterals provide survival benefit in patients with obstructive coronary artery disease (CAD). Therefore, in this study we sought to determine which clinical variables are associated with arteriogenesis.
Design Clinical and laboratory variables were collected before percutaneous coronary intervention. Multivariate analysis was performed to determine which variables are associated with the collateral flow index (CFI).
Patients Data from 295 chronic total occlusion (CTO) patients (Bern, Switzerland, Amsterdam, the Netherlands and Jena, Germany) were pooled. In earlier studies, patients had varying degrees of stenosis. Therefore, different stages of development of the collaterals were used. In our study, a unique group of patients with CTO was analysed.
Interventions Instead of angiography used earlier, we used a more accurate method to determine CFI using intracoronary pressure measurements. CFI was calculated from the occlusive pressure distal of the coronary lesion, the aortic pressure and central venous pressure.
Results The mean CFI was 0.39±0.14. After multivariate analysis, β blockers, hypertension and angina pectoris duration were positively associated with CFI (B: correlation coefficient β=0.07, SE=0.03, p=0.02, B=0.040, SE=0.02, p=0.042 and B=0.001, SE=0.000, p=0.02). Furthermore also after multivariate analysis, high serum leucocytes, prior myocardial infarction and high diastolic blood pressure were negatively associated with CFI (B=−0.01, SE=0.005, p=0.03, B=−0.04, SE=0.02, p=0.03 and B=−0.002, SE=0.001, p=0.011).
Conclusions In this unique cohort, high serum leucocytes and high diastolic blood pressure are associated with poorly developed collaterals. Interestingly, the use of β blockers is associated with well-developed collaterals, shedding new light on the potential action mode of this drug in patients with CAD.
Heart (British Cardiac Society) 05/2013; 99(15). DOI:10.1136/heartjnl-2013-304006 · 5.60 Impact Factor
Available from: hal-univ-rennes1.archives-ouvertes.fr
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ABSTRACT: Mathematical models of the coronary circulation have been shown to provide useful information for the analysis of intracoronary blood flow and pressure measurements acquired during coronary artery bypass graft (CABG) surgery. Although some efforts towards the patient-specific estimation of model parameters have been presented in this context, they are based on simplifying hypotheses about the collateral circulation and do not take advantage of the whole set of data acquired during CABG. In order to overcome these limitations, this paper presents an exhaustive parameter sensitivity analysis and a multiobjective patient-specific parameter estimation method, applied to a model of the coronary circulation of patients with triple vessel disease. The results of the sensitivity analysis highlighted the importance of capillary and collateral development. On the other hand, the estimation method was applied to intraoperative clinical data from ten patients obtained during CABG, which permitted to assess patient-specific collateral vessel situations. These approaches provide new insights regarding the heterogeneous configuration of the collateral circulation.
IEEE Transactions on Biomedical Engineering 04/2014; 61(4):1208-1219. DOI:10.1109/TBME.2013.2296971 · 2.35 Impact Factor
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ABSTRACT: With progressive occlusion of a coronary main artery, some anastomotic vessels are recruited in order to supply blood to the ischemic region. This collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it alters the blood flow distribution in the coronary network and can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index based on pressure measurements. It is named collateral flow index (CFI) and defined as: (Pw − Pv)/(Pao − Pv), where Pw is the pressure distal to the thrombosis, Pao the aortic pressure and Pv the central venous pressure. In the present work, we study patients with severe coronary disease (stenoses on the left branches and total occlusion of the right coronary artery). Using a mathematical model that describes the coronary hemodynamics in that situation, we demonstrate that the dependence of the collateral circulation to the pressure values is not as simple as it is commonly believed: using pressures alone as an index of collateral flow is likely to result in misinterpretation of the collateral flow contribution, because collateral flow depends on many other factors related to the status of the native stenosed arteries and to the microvascular resistances (capillary and collateral resistances, and the proportion between them).
IRBM 06/2014; 35(3). DOI:10.1016/j.irbm.2013.11.002 · 0.52 Impact Factor
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