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Coronary sinus size and ischemia improvement after reducer implantation; "one size to fit them all?"
Georgios Tzanis1,2, Arif A Khokhar3, Francesco Ponticelli1,3
1Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
Coronary sinus (CS) reducer implantation is effective for refractory angina. Smaller coronary sinus sizes (<5.8 mm) correlate with greater improvements in myocardial perfusion reserve index (MPRI), indicating better treatment response.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Physiology
Background:
- Coronary sinus (CS) reducer implantation offers symptomatic relief for refractory angina.
- A significant portion of patients (15-30%) do not respond to CS reducer therapy.
Purpose of the Study:
- To investigate the impact of coronary sinus size on the effectiveness of CS reducer implantation.
- To identify potential predictors of non-responsiveness to CS reducer therapy.
Main Methods:
- Cardiac magnetic resonance imaging (CMR) was used to assess resting ventricular function and myocardial perfusion reserve index (MPRI).
- Assessments were performed before and 4 months after successful CS Reducer implantation in 15 patients.
- Coronary sinus size was measured and correlated with changes in MPRI and ventricular volumes.
Main Results:
- Patients with smaller CS sizes (<5.8 mm) showed a significantly greater increase in MPRI (63% ± 51% vs 9% ± 30%, P = .03).
- Smaller CS size was also associated with a greater reduction in left ventricle end-diastolic volumes.
- All patients experienced improvements in angina class and exercise tolerance post-implantation.
Conclusions:
- Smaller coronary sinus dimensions are associated with enhanced ischemia improvement following CS Reducer implantation.
- Coronary sinus size may be a key factor influencing patient response and non-responsiveness to CS reducer therapy.
Aim:
Coronary sinus (CS) reducer implantation is associated with symptomatic relief of patients with refractory angina. However, 15% to 30% of the patients do not respond to this treatment. Aim if this study was to evaluate the effect of CS size in the effectiveness of the device.
Methods:
Prior to device implantation and at 4-month resting ventricular function was assessed by stress cardiac magnetic resonance. Ischemia was assessed by the myocardial perfusion reserve index (MPRI).
Results:
Fifteen patients (66 ± 10 years) underwent successful CS Reducer implantation, with improvements in angina class and exercise tolerance. Patients with a smaller CS size (<5.8 mm) presented a significantly higher percentage increase in MPRI (63 ± 51 vs 9 ± 30%, P = .03) and a higher reduction in left ventricle end-diastolic volumes.
Conclusions:
Greater benefits, in terms of ischemia improvement, after CS Reducer implantation were seen in patients with smaller CS sizes, suggesting a potential mechanism underlying the observed rates of reducer non-responsiveness.
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