CORONARY COLLATERAL CIRCULATION AND DISTAL CORONARY RUNOFF: THE KEY FACTORS IN PRESERVING MYOCARDIAL CONTRACTILITY IN PATIENTS WITH CORONARY ARTERY DISEASE

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Abstract
The effects of obstructing coronary artery lesions upon regional left ventricular contractility were studied angiographically in 200 patients with significant coronary artery disease. The arteries were graded according to degree of obstruction and adequacy of distal runoff flow beyond the lesion. The corresponding regional myocardial contractility was evaluated by ventriculography. Left ventricular contractility was found to be determined not primarily by the degree of arterial obstruction but rather by the adequacy of runoff flow in the distal segment of the diseased vessel. In cases of complete occlusion, the adequacy of distal runoff flow is determined directly by the degree of development of collateral circulation. Normal or mildly impaired contractility was present in most instances where distal runoff was adequate; regional akinesia or dyskinesia occurred in most instances where distal runoff was inadequate. Collateral circulation and distal coronary runoff are thus felt to be the key factors in preserving myocardial contractility in patients with coronary artery disease.

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