Assessment of Myocardial Perfusion Status through the Angiographically Visible Collaterals in the Ischemic Heart Disease

Background:It is well known that collateral circulation has important roles in ischemic heart diseases. The method most commonly used at present to evaluate collateral flow is coronary angiography. However, there are debates about the functional significance of angiographically visible collaterals because angiography visualizes only vessels that are larger than 100um in diameter. Recent studies suggest that myocardial contrast echocardiography(MCE) is a useful method in assessing collateral flow because it uses small microvascular tracers(4-12um) as a contrast agent. By using MCE, this study evaluates the role of angiographically visible collaterals in patients with acute myocardial infarction(AMI) and chronic ischemic heart disease. Method:Forty-one patients who underwent coronary angiography and MCE were included in this study(22 patients with acute myocardial infarction and 19 patients with chronic ischemic heart disease). Antegrade coronary flow was less than TIMI 3 flow in all patients. Myocardial perfusion through collaterals with MCE was evaluated by injecting sonicated Hexabrix into nonobstructing coronary arteries. Angiographically visualized collateral vessels were analysed as four grades and compared with the degree of myocardial opacification by MCE through collateral vessels. Result:Angiographic collaterals were frequently observed in patients with AMI and chronic ischemic heart disease with≤ TIMI 2 flow. There was poor correlation between TIMI grade and the grade of collaterals by angiography in AMI(r=-0.29, p=0.20) and chronic ischemic heart disease (r=-0.31, p=0.19). There was no correlation between collateral grades and myocardial opacification by MCE through collateral vessels in AMI(r=-0.07, p=NS) and chronic ischemic heart disease(r