Relationship Between Coronary Collateral Circulation and The Presence of Bendopnea in Patients with Ischemic Low Ejection Fraction Heart Failure

Abstract

Background: Coronary collateral circulation(CCC) is a physiological protective mechanism that deve-lops as a result of critical coronary artery stenosis and ischemia. Bendopnea, shortness of breath upon bending forward, is linked to poor cardiac index, increased pulmonary capillary wedge pressure, and coronary artery disease. This study aims to investigate the relationship between coronary collateral circulation and the presence of bendopnea in patients with ischemic low ejection fraction heart failure. Materials and Methods: The cross-sectional study screened 1024 patients diagnosed with heart failure with low ejection fraction after coronary angiography between January 2023 and January 2024, and 259 met the inclusion criteria. Inclusion criteria for the study were defined as having stable coronary artery disease and low ejection fraction heart failure (LVEF<40%) Patients were categorized into ben-dopnea+ and bendopnea- groups. Rentrop classification was used as a basis for the evaluation of CCC Results: There were 158 patients (mean age: 74.1±12.9 years, % 66.4 male) in the bendopnea+ group, while there were 101 patients (mean age: 67.2±14.2 years, %70.2 male) in the bendopnea- group. Bendopnea+ patients were older and had a higher number of NYHA class 3-4 individuals(p<0.001). NT-proBNP(p=0.001) and uric acid levels(p=0.001) were significantly higher in the bendopnea+ group. The Gensini score(p=0.001) and poor collateral circulation(p=0.001) were significantly higher in the bendopnea+ group. Systolic pulmonary artery pressure (sPAP) was notably higher in the bendopnea+ group (p=0.001). Regression analyses identified age(OR: 1.355 %95 CI:1.212-1.517 p=0.001), NT-proBNP(OR: 1.252 %95 CI:1.195-1.412 p=0.001), NYHA class 3-4(OR: 1.245 %95 CI:1.195-1.412 p=0.001),, Gensini score(OR: 1.328 %95 CI:1.213-1.515 p=0.001), and poor collateral circulation(OR: 1.318 %95 CI:1.162-1.441 p=0.001) as independent risk factors for bendopnea. Conclusions: The study concludes that insufficient coronary collateral circulation is an independent risk factor for bendopnea in ischemic heart failure patients.

Keywords

• coronary collateral circulation
• bendopnea
• low ejection fraction heart failure

İskemik Düşük Ejeksiyon Fraksiyonlu Kalp Yetmezliği Olan Hastalarda Koro-ner Kollateral Dolaşım ile Bendopne Varlığı Arasındaki İlişki

Abstract

Amaç: Koroner kollateral dolaşım (KKK), kritik koroner arter stenozu ve iskemisi sonucu gelişen fizyolo-jik bir koruyucu mekanizmadır. Öne eğilince nefes darlığı olan bendopne, kötü kardiyak indeks, artmış pulmoner kapiller kama basıncı ve koroner arter hastalığı ile bağlantılıdır. Bu çalışma iskemik düşük ejeksiyon fraksiyonlu kalp yetmezliği olan hastalarda KKK ve bendopne varlığı arasındaki ilişkiyi araş-tırmayı amaçlamaktadır. Materyal ve Metod: Kesitsel çalışmaya Ocak 2023 ile Ocak 2024 arasında koroner anjiyografi sonrası düşük ejeksiyon fraksiyonlu kalp yetersizliği tanısı konulan 1024 hasta tarandı ve 259'u dahil etme kriterlerini karşıladı. Çalışmaya dahil edilme kriterleri stabil koroner arter hastalığı ve düşük ejeksiyon fraksiyonlu kalp yetmezliği (LVEF<%40) olması olarak tanımlandı. Hastalar bendopne+ ve bendopne- gruplarına ayrıldı. KKK değerlendirmesi için Rentrop sınıflandırması kullanıldı Bulgular: Bendopne+ grubunda 158 hasta (ortalama yaş: 74,1±12,9 yıl, % 66.4 erkek) varken, bendop-ne- grubunda 101 hasta (ortalama yaş: 67,2±14,2 yıl, %70.2 erkek) vardı. Bendopne+ hastalar daha yaşlı ve daha fazla sayıda NYHA sınıf 3-4 birey vardı (p<0.001). NT-proBNP (p=0.001) ve ürik asit(p=0.001) düzeyleri bendopne+ grubunda anlamlı olarak daha yüksekti. Gensini skoru(p=0.001) ve zayıf kollateral dolaşım(p=0.001) bendopne+ grubunda anlamlı olarak daha yüksekti. Sistolik pulmoner arter basıncı (sPAP) bendopne+ grubunda belirgin olarak daha yüksekti (p=0,001). Regresyon analizleri, bendopne için bağımsız risk faktörleri olarak yaş(OR: 1.355 %95 CI:1.212-1.517 p=0.001), NT-proBNP(OR: 1.252 %95 CI:1.195-1.412 p=0.001), NYHA sınıf 3-4 (OR: 1.245 %95 CI:1.195-1.412 p=0.001), Gensini skoru(OR: 1.328 %95 CI:1.213-1.515 p=0.001), ve zayıf kollateral dolaşımı(OR: 1.318 %95 CI:1.162-1.441 p=0.001) saptadı. Sonuç: Çalışmada, yetersiz koroner kollateral dolaşımın iskemik kalp yetmezliği hastalarında bendopne için bağımsız bir risk faktörü olduğu sonucuna varılmıştır.

Keywords

• Koroner kollateral dolaşım
• bendopne
• Düşük Ejeksiyon Fraksiyonlu Kalp Yetmezliği

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