Author + information
- 1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, Shanghai, China
- 2Zhongshan Hospital, Fudan Universtity, Shanghai, Shanghai, China
- 3Zhongshan Hospital, Shanghai, Shanghai, China
- 4Shanghai Zhongshan Hospital, Shanghai, Shanghai, China
- 5Zhongshan Hopital, Fudan University, Shanghai, Shanghai, China
- 6Chinese Meidical Association, Beijing, Shanghai, China
To study the relationship between coronary collaterals, expression of vascular endothelial growth factor A, and preservation of ventricular function in coronary chronic total occlusions.
Patients with at least one CTO detected on diagnostic coronary angiography were studied. Clinical data, echocardiographic and angiographic results were analyzed. Plasma level of VEGF-A was measured by ELISA. mRNA expression of VEGF-A in PBMCs was measured by Real-Time relative quantitative RT-PCR.
A total of 102 patients were included in this study, 56 cases with LVEF decreased and 46 cases with LVEF reserved. LVEF reserved group has lower rate of prior myocardial infarction, higher rate of well-developed collateral (Rentrop 2-3 grade), higher rate of multiple coexisting collateral pathways, and lower rate of collateral donor artery lesion. Logistic regression analysis showed that, after adjustment, Rentrop 2-3 grade, multiple coexisting collateral pathways and diabetes mellitus were independent predictors of LVEF reservation in CTOs. Compared with Rentrop 0-1 group, Rentrop 2-3 group had smaller LVDd and LVSd, larger LVEF, higher level of plasma VEGF and higher level of VEGF-A expression in PBMCs.
|OR (95% CI)||P value|
|Diabetes mellitus||0.302 (0.108∼0.841)||0.022|
|Cigarette smoking||0.721 (0.412∼1.550)||0.324|
|Prior myocardial infarction||0.377 (0.129∼1.085)||0.061|
|Creatinine (mg/dl)||0.523 (0.398∼1.263)||0.186|
|Collateral grading||3.95 (1.47∼10.62)||0.007|
|Multiple coexisting collateral pathways||1.83 (1.012∼4.08)||0.045|
|Lesion of the collateral donor artery||0.393 (0.135∼1.022)||0.055|
Coronary collateral is of great significance for myocardial salvaging effect in CTOs, while VEGF is essential for the establishment of collateral circulation. Thus, VEGF is an important potential therapeutic target for promotion of collateral growth in the treatment of CTOs with no suitable revascularization option.
CORONARY: Cell Therapy and Angiogenesis