Importance of collateral circulation in coronary heart disease

Berry, Colin
Balachandran, Kanarath P.
L'Allier, Philippe L.
Lespérance, Jacques
Bonan, Raoul
Oldroyd, Keith G.

¹Department of Medicine, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
²Department of Cardiology, Bristol Royal Infirmary, Bristol, UK
³Department of Cardiology, Western Infirmary, Glasgow, UK

Received 14 June 2006; revised 27 November 2006; accepted 30 November 2006; online publish-ahead-of-print 11 January 2007

^*Corresponding author: Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G128TA, UK. Tel: +44 15143763330; fax: +44 141 211 1906. E-mail address: [email protected]

European Heart Journal 28(3):p 278-291, February 2007.

Aims

Collateral arteries are a common but inconsistent finding in coronary heart disease (CHD). We endeavoured to review the methods for coronary artery collateral assessment, the predictors and clinical importance of collateral blood flow, and the potential for therapeutic augmentation of collateral anastomoses.

Methods and results

While many methods have been used to assess collateral blood flow only a few have been formally validated. Collateral flow index, as determined by measurement of intra-coronary pressure or flow velocity, is the most robust measure of collateral flow. These techniques have led to important advances in our understanding of collateral artery function. Coronary collateral arteries may prevent myocardial ischaemia in healthy subjects and in patients with CHD. A functional collateral circulation may lead to reduced ischaemia, preservation of ventricular function, and an improved prognosis. Recent trials have demonstrated that vascular progenitor cell therapies may improve ventricular function following acute myocardial infarction, raising the possibility of effective biological treatments to improve myocardial blood flow and prognosis in CHD.

Conclusions

Coronary collateral anastomoses represent a prognostically important adaptive response in patients with CHD. Therapeutic augmentation of collaterals with emerging biological therapies represents a desirable goal for treating CHD patients.