| Project/Area Number |
63570389
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| Research Category |
Grant-in-Aid for General Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Research Field |
Circulatory organs internal medicine
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| Research Institution | Toyama Medical and Pharmaceutical University |
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Principal Investigator |
FUJITA Masatoshi Toyama Med. & Pharm. Univ. Hospital Assistant Professor, 附属病院, 講師 (50190046)
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| Co-Investigator(Kenkyū-buntansha) |
ASANOI Hidetsugu Toyama Med. & Pharm. Univ. Hospital Assistant, 附属病院, 助手 (00150128)
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| Project Period (FY) |
1988 – 1990
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| Project Status |
Completed (Fiscal Year 1990)
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| Budget Amount *help |
¥2,000,000 (Direct Cost: ¥2,000,000)
Fiscal Year 1990: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 1989: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 1988: ¥900,000 (Direct Cost: ¥900,000)
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| Keywords | Angina / Thrombolysis / Collateral circulation / Ventricular aneurysm / Heparin / Collateral recruitment / Collateral development / 冠側副血行循環 / Walkーthrough現象 / ヘパリン療法 / 心筋虚血 / 頻回冠動脈閉塞 / TIー201心筋シンチグラフィ / トレッドミル運動負荷試験 / 冠動脈造影 / 急性心筋硬塞 / ST低下 / 自転車エルゴメ-タ / 冠閉塞 / 狭心症 / ヘパリン運動療法 / 左心室瘤 / 冠動脈内血栓溶解療法 / ドレッドミル運動負荷試験 |
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| Research Abstract |
Clinical significance of Coronary Collateral Circulation
We found that there is a significant difference in the proportion of patients with post-infarction angina between those with pre-infarction angina but unsuccessful thrombolysis (67%) and those who had neither pre-infarction angina nor recanalization (13%). This suggests that the developed collateral circulation accompanying pre-infarction angina renders myocardial tissue viable in the perfusion territory of the infarct-related coronary artery and causes post-infarction angina because of its limited flow reserve. We also demonstrated that in 10 patients with acute myocardial infarction who had a significant collateral circulation to the infarct-related coronary artery and unsuccessful reperfusion, the left ventricular aneurysm was observed in only one patient (10%), while in 12 patients with unsuccessful recanalization in the absence of a significant collateral perfusion, there was a significantly higher incidence (7/12, 58%) of le
… More
ft ventricular aneurysm formation. These findings indicate that the well-developed collateral circulation can prevent the left ventricular aneurysm formation probably because of a salutary functional effect of viable islands of residual subepicardial cells in the infarct zone on infarct expansion. In patients with stable effort angina, exercise with heparin pretreatment definitely improved the exercise capability associated with an increase in the extent of opacification of collaterals to the jeopardized myocardium. The development of such a therapeutic modality may attenuate the deleterious sequelae due to coronary artery disease.
Effects of Myocardial Ischemia Coronary Collateral Circulation
We reported the importance of myocardial ischemia for the recruitment of a native collateral circulation. The collateral flow after 5 1 min or a 5 min coronary occlusion was significantly qreater than after 30 10 sec coronary occlusions, where the total occlusion time was identical. We compared the effects of repeated 1 min or 2 min coronary occlusions on the development of collateral circulation. The relative contribution of the first and second 1 min of coronary occlusion to the collateral development was mathematically evaluated. The second 1 min of coronary occlusion was 4.43 fold more effective than the first 1 min of occlusion. Because the extent of myocardial ischemia is more severe during the second 1 min of coronary occlusion, it was concluded that severe ischemia is crucial for the collateral development. Our data indicated the importance of myocardial ischemia for both recruitment and development of coronary collateral circulation. Less
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