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The impact of coronary sinus narrowing on diastolic function in patients with refractory angina

Yishay Szekely1, Yan Topilsky1, Samuel Bazan1

  • 1Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel.

International Journal of Cardiology
|April 14, 2019
PubMed

Insights

Coronary sinus (CS) narrowing, a new therapy for refractory angina, does not worsen diastolic function. This procedure may even improve diastolic function in patients with myocardial ischemia.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Interventional Cardiology

Background:

  • Coronary sinus (CS) narrowing is an emerging treatment for refractory angina pectoris, aimed at enhancing subendocardial perfusion and alleviating ischemic symptoms.
  • Concerns exist that elevated CS pressure post-intervention could lead to interstitial myocardial edema and diastolic dysfunction.

Purpose of the Study:

  • To prospectively evaluate the impact of Coronary sinus (CS) narrowing on diastolic function in patients with refractory angina.

Main Methods:

  • Prospective assessment of diastolic function using echocardiography in 24 patients with chronic refractory angina before and 6 months after CS Reducer implantation.
  • Key diastolic parameters evaluated included left atrial volume, transmitral flow velocities (E and A waves), E wave deceleration time (DT), and mitral annular velocities (e' septal and e' lateral).

Main Results:

  • No significant changes were observed in left atrial volume, E/A ratio, E wave deceleration time, or A wave velocity 6 months post-implantation.
  • A non-significant trend towards improved diastolic function was noted, with a decrease in E/e' ratio from 12.6 to 11.4 (p=0.24).
  • Mean diastolic function class significantly improved post-procedure (from 1.5 to 1.17, p=0.008).

Conclusions:

  • Coronary sinus narrowing via CS Reducer implantation does not adversely affect diastolic function in patients with myocardial ischemia and refractory angina.
  • The findings suggest that CS narrowing may potentially improve diastolic function, contrary to initial concerns about increased CS pressure.
Abstract

Keywords:
Coronary sinus ReducerCoronary sinus narrowingDiastolic functionRefractory angina

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