完全闭塞的冠状动脉侧支循环建立对左室功能的影响

The influence of collateral circulation on left ventricular function in patient with total coronary Occlution

冠状动脉侧支血管是指直径为20～30μm潜在的血流通道，通常处于关闭状态，当冠脉显著狭窄或闭塞时开放而发展成为有功能意义的侧支循环。本研究通过对完全闭塞的冠状动脉侧支循环建立程度的观察，研究其对左室功能的影响及与心绞痛发生率的关系。

Objective To assesses the effect of collateral circulation developed on left ventricular function and the relationship between the development of collateral and angina pectoris in patient with total coronary occlusion. Methods 156 patients were confrimed that at least one vessel was totally occluded by coronary arteriography. 156 patients were divided into 2 groups in according to the rentrop class. Group A （79） had either poor or no collateral circulation（ Rentrop Grade 0 or 1 ）. Group B had good collateral circulation（Rentrop Grade 2 - 3）. The occlusion of LAD or RCA may also be further respectively classified into Group C/D （n = 32/37 ） and Group E/F （n = 30/42）. Group C and E had good collateral circulation. However Group D and F had poor collateral circulation. Results The LVEF of sufficient collateral circulation（group A） is 0. 55 ±0. 12,of insufficient collaterals（Group B） is 0. 64 ±0. 09. The LVEF of Group B is higher than that of Group A. There are significant difference between two groups （P 〈 0. 05 ）. The contina score of poor collateral circulation（ group B） is （4. 89 ± 1.99 ）, of good collateral circulation （ Group B） is 2. 62 ±1.37 ： Contina score was lower in group B than Group A. The frequency of angina pectoris was significandy higher in Group B （86. 2% ） than in Group A （66. 7% ） （ P 〈 0.05 ）. Group C and D with total obstruction of the LAD had a significant difference in LVEF and Contina Score. Whereas, there were no statistically significant differences between Group E and F with total obstruction of the right coronary artery. Conclusion Collateral circulation has a protective role on the left ventricular systolic function in total occlusion of coronary artery. The history of Angina pectoris is a reliable item to estimate the formation of collateral circulation in total occlusion of coronary artery.