Bradycardia is associated with development of coronary collateral vessels in humans

Sanjay R. Patel, Jeffrey A. Breall, Daniel J. Diver, Bernard J. Gersh, Andrew P. Levy

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: The development of mature coronary collateral vessels in patients with obstructive coronary artery disease (CAD) decreases the ischemic myocardial burden. Chronic bradycardia has been shown to stimulate formation of collateral vessels in experimental models. Objective: To test our hypothesis that CAD patients with bradycardia would have better developed collateral circulation than would members of a control group. Design A retrospective study examining the relationship between bradycardia and the development of coronary collateral vessels in patients with obstructive CAD. Methods: Admission electrocardiograms and rhythm tracings obtained during angiography of all patients presenting to the cardiac catheterization laboratory were screened from January to October 1997. Angiograms for patients with heart rates ≤ 50 beats/min were reviewed. An equivalent number of consecutive patients with heart rates ≥ 60 beats/min served as controls. Patients with acute myocardial infarction, with rhythms other than sinus, and without high grade obstructive CAD (< 70% stenosis) were excluded from the study. Results: The study population consisted of 61 patients, 30 having heart rates ≤ 50 beats/min (group A), and 31 controls with heart rates ≥ 60 beats/min (group B). A significantly greater proportion of patients in group A than of matched controls was demonstrated to have developed collaterals (97 versus 55% in group B, P < 0.005). The mean collateral grades were 1.66 and 0.95 for subjects in groups A and B, respectively (P < 0.001). CAD patients with bradycardia are more likely (odds ratio 24, 95% confidence interval 5-146) to have angiographic coronary collaterals than are those with higher heart rates. Conclusion: Results of this study demonstrate that there is an association between bradycardia and growth of collateral vessels in patients with obstructive CAD, Bradycardic agents may be useful for promoting development of coronary collaterals in patients with atherosclerotic disease. (C) 2000 Lippincott Williams and Wilkins.

Original languageEnglish (US)
Pages (from-to)467-472
Number of pages6
JournalCoronary Artery Disease
Volume11
Issue number6
DOIs
StatePublished - Sep 12 2000

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Bradycardia
Coronary Vessels
Coronary Artery Disease
Heart Rate
Angiography
Collateral Circulation
Cardiac Catheterization
Electrocardiography
Pathologic Constriction
Research Design
Theoretical Models
Retrospective Studies
Odds Ratio
Myocardial Infarction
Confidence Intervals

Keywords

  • Collateral circulation
  • Coronary disease
  • Heart rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bradycardia is associated with development of coronary collateral vessels in humans. / Patel, Sanjay R.; Breall, Jeffrey A.; Diver, Daniel J.; Gersh, Bernard J.; Levy, Andrew P.

In: Coronary Artery Disease, Vol. 11, No. 6, 12.09.2000, p. 467-472.

Research output: Contribution to journalArticle

Patel, Sanjay R. ; Breall, Jeffrey A. ; Diver, Daniel J. ; Gersh, Bernard J. ; Levy, Andrew P. / Bradycardia is associated with development of coronary collateral vessels in humans. In: Coronary Artery Disease. 2000 ; Vol. 11, No. 6. pp. 467-472.
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abstract = "Background: The development of mature coronary collateral vessels in patients with obstructive coronary artery disease (CAD) decreases the ischemic myocardial burden. Chronic bradycardia has been shown to stimulate formation of collateral vessels in experimental models. Objective: To test our hypothesis that CAD patients with bradycardia would have better developed collateral circulation than would members of a control group. Design A retrospective study examining the relationship between bradycardia and the development of coronary collateral vessels in patients with obstructive CAD. Methods: Admission electrocardiograms and rhythm tracings obtained during angiography of all patients presenting to the cardiac catheterization laboratory were screened from January to October 1997. Angiograms for patients with heart rates ≤ 50 beats/min were reviewed. An equivalent number of consecutive patients with heart rates ≥ 60 beats/min served as controls. Patients with acute myocardial infarction, with rhythms other than sinus, and without high grade obstructive CAD (< 70{\%} stenosis) were excluded from the study. Results: The study population consisted of 61 patients, 30 having heart rates ≤ 50 beats/min (group A), and 31 controls with heart rates ≥ 60 beats/min (group B). A significantly greater proportion of patients in group A than of matched controls was demonstrated to have developed collaterals (97 versus 55{\%} in group B, P < 0.005). The mean collateral grades were 1.66 and 0.95 for subjects in groups A and B, respectively (P < 0.001). CAD patients with bradycardia are more likely (odds ratio 24, 95{\%} confidence interval 5-146) to have angiographic coronary collaterals than are those with higher heart rates. Conclusion: Results of this study demonstrate that there is an association between bradycardia and growth of collateral vessels in patients with obstructive CAD, Bradycardic agents may be useful for promoting development of coronary collaterals in patients with atherosclerotic disease. (C) 2000 Lippincott Williams and Wilkins.",
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