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Coronary Collateral Circulation And Humans Are Often More Controversial

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Studies looking at coronary collateral circulation in humans are typically more controversial. Skeptics have stated that collateral development is probably due to the progression of coronary artery disease rather than an effect of exercise training. In addition, direct measurement of collateral growth, typically through coronary angiographic techniques, is difficult and may have severe limitations due to low levels of resolution of vessels (Heaps et al., 2011). Small vessels involved in the coronary collateral system (<100μm) are incredibly difficult to view angiographically, so the full magnitude of collateralization may not be assessed or may be drastically underestimated (Heaps et al., 2011; Belardinelli et al., 1998).
An additional approach that studies have used to measure collateral circulation development is to measure the rate-pressure product in patients with coronary artery disease (CAD). Increases in rate-pressure product at the beginning of myocardial ischemia have been found and is potentially related to increased myocardial oxygen supply from collateral growth stimulation (Senti et al., 1998). After exercise training, coronary patients have also seen a 29% increase in coronary flow reserve in response to adenosine (Hambrecht et al., 1993). Patients with chronic CAD and impaired LV systolic function who exercised at 60% of peak oxygen uptake 3 times a week for 8 weeks saw a significant increase in mean collateral circulation score and improvements in wall

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