The preservation effect of coronary collateral circulation on left ventricular function in chronic total occlusion and its association with the expression of vascular endothelial growth factor A

Yuxiang Dai; Shufu Chang; Shen Wang; Yi Shen; Chenguang Li; Zheyong Huang; Hao Lu; Juying Qian; Lei Ge; Qibing Wang; Feng Zhang; Junbo Ge

doi:10.17219/acem/104535

The preservation effect of coronary collateral circulation on left ventricular function in chronic total occlusion and its association with the expression of vascular endothelial growth factor A

Adv Clin Exp Med. 2020 Apr;29(4):493-497. doi: 10.17219/acem/104535.

Authors

Yuxiang Dai¹, Shufu Chang¹, Shen Wang², Yi Shen³, Chenguang Li¹, Zheyong Huang¹, Hao Lu¹, Juying Qian¹, Lei Ge¹, Qibing Wang¹, Feng Zhang¹, Junbo Ge¹

Affiliations

¹ Department of Cardiology, Fudan University Affiliated Zhongshan Hospital, Shanghai, China.
² Department of Cardiology, Xinhua Hospital of Zhejiang Province, the Second Affiliated Hospital of Zhejiang Chinese Medical University, China.
³ Department of Geratology, Fudan University Affiliated Zhongshan Hospital, Shanghai, China.

PMID: 32338833
DOI: 10.17219/acem/104535

Abstract

Background: Patients with coronary chronic total occlusion (CTO) typically have collateralization of the distal vessel, and these collaterals can contribute to the relief of ischemia and anginal symptoms and to the preservation of ventricular function.

Objectives: To investigate the preservation effect of coronary collateral circulation on left ventricular (LV) function in coronary CTO, and to explore the potential mechanism behind the development of coronary collateral circulation.

Material and methods: A total of 102 consecutive patients with coronary CTO were divided into 2 groups: the left ventricular ejection fraction (LVEF)-preserved group (LVEF ≥ 50%; n = 46) and the LVEF-decreased group (LVEF < 50%; n = 56). Clinical, angiographic and laboratory data was collected for all patients. The association between LVEF and coronary collateral circulation in coronary CTO patients was analyzed with multivariate logistic regression analysis, and the serum levels of VEGF-A and the mRNA expression levels of the VEGF-A gene were compared between different grades of coronary collateral circulation.

Results: Multivariate analysis revealed that Rentrop grades 2-3 and coexisting collateral pathways were independent predictors of LVEF preservation in coronary CTO patients. Patients with Rentrop grades 2-3 had smaller left ventricular end diastolic diameters (LVDd) and left ventricular end systolic diameters (LVSd), and they had larger LVEFs than the patients with Rentrop grades 0-1. Patients with Rentrop grades 2-3 also had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in their peripheral blood mononuclear cells (PBMCs) than patients with Rentrop grades 0-1. Patients with coexisting collateral pathways had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in PBMCs than patients without coexisting collateral pathways.

Conclusions: Coronary collateral circulation is significantly associated with LVEF preservation, and VEGF-A might promote the formation of coronary collateral circulation.

Keywords: chronic total occlusion; coronary collateral circulation; left ventricular ejection fraction; vascular endothelial growth factor A.

MeSH terms

Collateral Circulation*
Coronary Angiography
Coronary Circulation*
Coronary Occlusion*
Humans
Leukocytes, Mononuclear*
Percutaneous Coronary Intervention
Stroke Volume
Vascular Endothelial Growth Factor A / blood*
Vascular Endothelial Growth Factor A / genetics
Ventricular Function, Left / physiology*

Substances

Vascular Endothelial Growth Factor A