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Angina and left ventricular dysfunction: can we 'reduce' it?

Simone Biscaglia1, Matteo Tebaldi1, Donato Mele1

  • 1Department of Medical Sciences Ferrara University, Ferrara, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|April 19, 2019
PubMed
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Refractory angina, a persistent issue despite medical and device advancements, can be effectively managed with coronary sinus Reducer implantation. This innovative treatment offers significant symptom relief for patients with difficult-to-treat angina.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Recurrent and persistent angina remains a significant clinical challenge despite advances in pharmacology and interventional cardiology.
  • Existing treatments, including beta-blockers and ivabradine, may not fully resolve symptoms in all patients, leading to refractory angina.
  • A history of complex cardiac interventions, including aortic valve replacement and percutaneous coronary intervention (PCI), can complicate angina management.

Purpose of the Study:

  • To evaluate the efficacy of coronary sinus Reducer implantation in a patient with refractory angina following multiple cardiac interventions.
  • To assess the impact of the Reducer device on Canadian Cardiovascular Society (CCS) angina class and overall symptom burden.

Main Methods:

  • A case report detailing the treatment of a 69-year-old female patient with a history of severe aortic stenosis, bioprosthetic valve degeneration, and coronary artery disease.
Keywords:
Coronary sinus reducerIvabradineStable anginaTranscatheter aortic valve implantation

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  • The patient underwent aortic valve-in-valve implantation and PCI for in-stent restenosis, but continued to experience refractory angina.
  • A coronary sinus Reducer device was implanted to address persistent angina symptoms.

    • Main Results:

    • Following Reducer implantation, the patient experienced a gradual improvement in angina symptoms.
    • The patient became angina-free within two months of the procedure, indicating successful symptom management.
    • This outcome suggests the potential of the coronary sinus Reducer as a therapeutic option for refractory angina.

    Conclusions:

    • Coronary sinus Reducer implantation can provide significant relief for patients suffering from refractory angina, even after extensive prior treatments.
    • The COSIRA trial findings support the use of the coronary sinus Reducer as a valuable addition to the therapeutic armamentarium for angina management.
    • This case highlights the potential of novel device-based therapies in addressing unmet needs in cardiovascular symptom control.