Effect of Coronary Collateral Circulation on Exercise Stress Test

Abstract

In this study, patients who have recovery-only ST segment depression in exercise stress test were chosen. It is proposed that coronary collateral circulation could improve with stress-increased coronary perfusion, and accordingly, patients with recovery-only ST segment depression were evaluated by coronary angiography for grading the coronary collateral circulation. Twenty-one men and five women were assigned to the study group. Sixteen men and two women who had exercise-induced ST segment depression were assigned to the control group. Age and gender of both groups were not statistically different (p > 0.05) . The reason for terminating the exercise stress test was chest pain in two of 26 patients in the study group versus 15 of 18 in the control group (p < 0.001 ) . In both groups coronary collateral frequency and grade were directly correlated with the severity of the coronary artery disease (p < 0.001 in the study group, and p < 0.05 in the control group). When both groups were compared for the frequency of significant coronary collateral circulation, 14 of 26 patients in the study group versus 4 of 18 patients in the control group had significant coronary collateral circulation (p=0.035). The authors conclude that recovery-only ST segment depression correlates well with the frequency of significant coronary collateral circulation, and coronary collaterals may prevent myocardial ischemia during exercise.

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References

Chaitman B. : Exercise stress testing In: Heart Disease, a Textbook of Cardiovascular Medicine, ed. 4, ed. by Braunwald E. Philadelphia: WB Saunders Co, 1992, pp 161-179.

Lachterman B. , Lehmann KG , Abrahamson D., et al : 'Recovery only' ST segment depression and the predictive accuracy of the exercise test Ann Intern Med 112:11-16, 1990.

Karnegis JN , Matts J. , Tuna N., et al : Comparison of exercise positive with recovery positive treadmill graded exercise tests Am J Cardiol 60:544-547, 1987.

Savage MP , Squires LS , Hopkins JT, et al : Usefulness of ST segment depression as a sign of coronary artery disease when confined to postexercise recovery period Am J Cardiol 60:1405-1406, 1987.

Cohen M. , Rentrop KP : Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: A prospective study Circulation 74:469-476, 1986.

Levin DC , Gardiner GA : Coronary arteriography In: Heart Disease, a Textbook of Cardiovascular Medicine, ed. 4, ed. by Braunwald E. Philadelphia: WB Saunders Co, 1992 , pp 235-275.

Newman PE : The coronary collateral circulation: Determinants and functional significance in ischemic heart disease Am Heart J 102:431-445, 1981.

Goldberg HL , Goldstein J. , Borer JS, et al : Functional importance of coronary collateral vessels Am J Cardiol 53:694-699, 1984.

Gregg DE , Patterson RE : Functional importance of the coronary collaterals N Engl J Med 303:1404-1406, 1980.

10.

Hansen JF : Coronary collateral circulation: Clinical significance and influence on survival in patients with coronary artery occlusion Am Heart J 117:290-295, 1989.

11.

Hecht HS , Aroesty JM , Morkin E., et al : Role of the coronary collateral circulation in the preservation of left ventricular function Radiology 114:305-313, 1975.

12.

Fuster V. , Robert LF , Kennedy MA, et al : The role of collateral circulation in the various coronary syndromes Circulation 59:1137-1144, 1979.

13.

Schwarz F. , Flameng W. , Ensslen R., et al : Effect of coronary collaterals on left ventricular function at rest and during stress Am Heart J 95:570-577, 1978.

14.

Schaper W. , Günter G. , Winkler B., et al : The collateral circulation of the heart Prog Cardiovasc Dis 31: 57-77, 1988.

15.

Kolibash AJ , Bush CA , Wepsic RA, et al : 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 Am J Cardiol 50:230-238, 1982.

16.

Sasayama S. : Effect of coronary collateral circulation on myocardial ischemia and ventricular dysfunction Cardiovasc Drugs Ther 8:327-334, 1994.

17.

Goldberg S. , Grossman W. , Markis JE, et al : Total occlusion of the left main coronary artery, a clinical, hemodynamic and angiographic profile Am J Med 64:3-8, 1978.

18.

Helfant RH , Kemp HG , Gorlin R. : Coronary atherosclerosis, coronary collaterals, and their relation to cardiac function Ann Intern Med 73:189-193, 1970.

19.

Eng C. , Patterson RE , Horowitz SF, et al : Coronary collateral function during exercise Circulation 66: 309-315, 1982.

20.

Bonetti F. , Margonato A. , Mailhac A., et al : Coronary collaterals reduce the duration of exercise-induced ischemia by allowing a faster recovery Am Heart J 124:48-55, 1992.

21.

Tubau JF , Chaitman BR , Bourassa MG, et al : Importance of coronary collateral circulation in interpreting exercise test results Am J Cardiol 47:27-32, 1981.

22.

Freedman B. , Dunn RF , Bernstein L., et al : Influence of coronary collateral blood flow on the development of exertional ischemia and Q wave infarction in patients with severe single vessel disease Circulation 71:681-686, 1985.