Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance
ABSTRACT: Background: The coronary sinus reducer (CSR) is a novel percutaneous treatment for patients with refractory angina. Increasing evidence supports its clinical efficacy in patients with advanced epicardial coronary artery disease. However, its mechanism of action and its effects on myocardi...
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Elsevier
2025-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664725000304 |
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| author | Kevin Cheng Francisco Alpendurada Chiara Bucciarelli-Ducci Jose Almeida Peter Kellman Jonathan M. Hill Dudley J. Pennell Ranil de Silva |
| author_facet | Kevin Cheng Francisco Alpendurada Chiara Bucciarelli-Ducci Jose Almeida Peter Kellman Jonathan M. Hill Dudley J. Pennell Ranil de Silva |
| author_sort | Kevin Cheng |
| collection | DOAJ |
| description | ABSTRACT: Background: The coronary sinus reducer (CSR) is a novel percutaneous treatment for patients with refractory angina. Increasing evidence supports its clinical efficacy in patients with advanced epicardial coronary artery disease. However, its mechanism of action and its effects on myocardial perfusion remain undefined. Using quantitative stress perfusion cardiovascular magnetic resonance (CMR), this study assessed changes in myocardial perfusion in patients with refractory angina undergoing CSR implantation. Methods: This single-center retrospective observational cohort study included 16 patients. Rest and adenosine stress perfusion CMR was performed before and at median 5 months after CSR implantation. Perfusion images were acquired using a dual-sequence quantitative protocol with automated generation of myocardial blood flow (MBF; mL/min/g). In addition to visual assessment of ischemic segments, changes in absolute MBF across myocardial segments and between myocardial layers were analyzed. Results: A high proportion of myocardial segments had visually adjudicated ischemia at baseline (208 out of 254: 81.9%), which significantly reduced after CSR implantation (175 out of 254: 68.9%; P = 0.001). There were no changes in global MBF or strain values. Changes in myocardial perfusion reserve (MPR) correlated with baseline MPR with more ischemic segments at baseline improving to a greater extent at follow-up. Similar patterns were observed in both the left and right coronary artery territories. Changes in endocardial/epicardial MBF ratio at stress were similarly dependent on baseline values. Conclusion: In patients with refractory angina undergoing CSR implantation, quantitative stress perfusion CMR demonstrated redistribution of myocardial perfusion across segments, from less ischemic to more ischemic myocardium, and across myocardial layers with greatest improvements in endocardial perfusion observed in the most ischemic myocardium. Further studies are needed to validate the different patterns of MBF redistribution that may occur after CSR implantation and correlate with clinical outcomes. |
| format | Article |
| id | doaj-art-cfd54fc2744848bd86b8335ee9afd69d |
| institution | Kabale University |
| issn | 1097-6647 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-cfd54fc2744848bd86b8335ee9afd69d2025-08-20T03:45:59ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127110186810.1016/j.jocmr.2025.101868Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonanceKevin Cheng0Francisco Alpendurada1Chiara Bucciarelli-Ducci2Jose Almeida3Peter Kellman4Jonathan M. Hill5Dudley J. Pennell6Ranil de Silva7National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UKNational Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UKRoyal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College University, London, UKRoyal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDivision of Intramural Research, National Heart Lung and Blood Institute, Bethesda, Maryland, USARoyal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UKNational Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UKNational Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; Corresponding author.ABSTRACT: Background: The coronary sinus reducer (CSR) is a novel percutaneous treatment for patients with refractory angina. Increasing evidence supports its clinical efficacy in patients with advanced epicardial coronary artery disease. However, its mechanism of action and its effects on myocardial perfusion remain undefined. Using quantitative stress perfusion cardiovascular magnetic resonance (CMR), this study assessed changes in myocardial perfusion in patients with refractory angina undergoing CSR implantation. Methods: This single-center retrospective observational cohort study included 16 patients. Rest and adenosine stress perfusion CMR was performed before and at median 5 months after CSR implantation. Perfusion images were acquired using a dual-sequence quantitative protocol with automated generation of myocardial blood flow (MBF; mL/min/g). In addition to visual assessment of ischemic segments, changes in absolute MBF across myocardial segments and between myocardial layers were analyzed. Results: A high proportion of myocardial segments had visually adjudicated ischemia at baseline (208 out of 254: 81.9%), which significantly reduced after CSR implantation (175 out of 254: 68.9%; P = 0.001). There were no changes in global MBF or strain values. Changes in myocardial perfusion reserve (MPR) correlated with baseline MPR with more ischemic segments at baseline improving to a greater extent at follow-up. Similar patterns were observed in both the left and right coronary artery territories. Changes in endocardial/epicardial MBF ratio at stress were similarly dependent on baseline values. Conclusion: In patients with refractory angina undergoing CSR implantation, quantitative stress perfusion CMR demonstrated redistribution of myocardial perfusion across segments, from less ischemic to more ischemic myocardium, and across myocardial layers with greatest improvements in endocardial perfusion observed in the most ischemic myocardium. Further studies are needed to validate the different patterns of MBF redistribution that may occur after CSR implantation and correlate with clinical outcomes.http://www.sciencedirect.com/science/article/pii/S1097664725000304Refractory anginaAngina pectorisCoronary sinus reducerCardiovascular magnetic resonance imagingQuantitative perfusionMyocardial blood flow |
| spellingShingle | Kevin Cheng Francisco Alpendurada Chiara Bucciarelli-Ducci Jose Almeida Peter Kellman Jonathan M. Hill Dudley J. Pennell Ranil de Silva Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance Journal of Cardiovascular Magnetic Resonance Refractory angina Angina pectoris Coronary sinus reducer Cardiovascular magnetic resonance imaging Quantitative perfusion Myocardial blood flow |
| title | Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| title_full | Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| title_fullStr | Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| title_full_unstemmed | Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| title_short | Segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| title_sort | segmental redistribution of myocardial blood flow after coronary sinus reducer implantation demonstrated by quantitative perfusion cardiovascular magnetic resonance |
| topic | Refractory angina Angina pectoris Coronary sinus reducer Cardiovascular magnetic resonance imaging Quantitative perfusion Myocardial blood flow |
| url | http://www.sciencedirect.com/science/article/pii/S1097664725000304 |
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