Top

The International Journal of Cardiovascular Imaging

Published in:

01-01-2021 | Original Paper

Feature tracking and mapping analysis of myocardial response to improved perfusion reserve in patients with refractory angina treated by coronary sinus Reducer implantation: a CMR study

Authors: Anna Palmisano, Francesco Giannini, Paola Rancoita, Guglielmo Gallone, Giulia Benedetti, Luca Baldetti, Georgios Tzanis, Davide Vignale, Caterina Monti, Francesco Ponticelli, Marco Ancona, Matteo Montorfano, Alessandro Del Maschio, Francesco De Cobelli, Antonio Colombo, Antonio Esposito

Published in: The International Journal of Cardiovascular Imaging | Issue 1/2021

Abstract

Coronary sinus (CS) Reducer implantation improves myocardial perfusion and symptoms in patients with debilitating refractory angina. Its impact on myocardial remodeling remain uncertain. Aim of the present study was to assess possible impact of CS Reducer on myocardial systolic-diastolic deformation and microstructural remodeling, as assessed through cardiac magnetic resonance (CMR) feature tracking and mapping analysis. Twenty-eight consecutive patients with refractory angina underwent multiparametric stress CMR before and 4 months after CS Reducer implantation. Eight patients were excluded (6 for absence of inducible ischemia, 2 for artifacts). Modifications in 3D systo-diastolic myocardial deformation were evaluated using feature tracking analysis on rest cine images. Myocardial microstructural remodeling was assessed by native T1 mapping, cellular and matrix volume and extracellular volume fraction (ECV). Collaterally, the percentage of ischemic myocardium (ischemic burden %) and the myocardial perfusion reserve index (MPRI) were measured. After CS Reducer implantation, myocardial contractility improved (ejection fraction rose from 61 to 67%; p = 0.0079), along with longitudinal (from − 16 to − 19%; p = 0.0192) and circumferential strain (from − 18 to − 21%; p = 0.0017). Peak diastolic radial, circumferential and longitudinal strain rate did not change (p > 0.05), and no changes in native T1, ECV, cellular and matrix volume were observed. Myocardial perfusion improved, with a reduction of ischemic burden (13–11%; p = 0.0135), and recovery of intramural perfusion balance in segments with baseline ischemia (MPRi endocardial/epicardial ratio from 0.67 to 0.96; p = 0.0107). CS Reducer improves myocardial longitudinal and circumferential strain, without microstructural remodeling and no impact on diastolic proprieties.

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, Group ESCSD (2019) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz425CrossRef

Gallone G, Baldetti L, Tzanis G, Gramegna M, Latib A, Colombo A, Henry TD, Giannini F (2020) Refractory angina. From pathophysiology to new therapeutic nonpharmacological technologies. JACC: Cardiovasc Interv 13(1):1–19. https://doi.org/10.1016/j.jcin.2019.08.055CrossRef

Giannini F, Tzanis G, Ponticelli F, Baldetti L, Demir OM, Mitomo S, Gallone G, Banai S, Colombo A (2019) Technical aspects in coronary sinus Reducer implantation. EuroIntervention. https://doi.org/10.4244/EIJ-D-18-01180CrossRefPubMed

ElMallah W (2016) Coronary sinus stent: could it help in refractory chronic stable angina? Curr Cardiol Rep 18(4):35. https://doi.org/10.1007/s11886-016-0710-4CrossRefPubMed

Ido A, Hasebe N, Matsuhashi H, Kikuchi K (2001) Coronary sinus occlusion enhances coronary collateral flow and reduces subendocardial ischemia. Am J Physiol Heart Circ Physiol 280(3):H1361–1367. https://doi.org/10.1152/ajpheart.2001.280.3.H1361CrossRefPubMed

Banai S, Ben Muvhar S, Parikh KH, Medina A, Sievert H, Seth A, Tsehori J, Paz Y, Sheinfeld A, Keren G (2007) Coronary sinus Reducer stent for the treatment of chronic refractory angina pectoris: a prospective, open-label, multicenter, safety feasibility first-in-man study. J Am Coll Cardiol 49(17):1783–1789. https://doi.org/10.1016/j.jacc.2007.01.061CrossRefPubMed

Konigstein M, Meyten N, Verheye S, Schwartz M, Banai S (2014) Transcatheter treatment for refractory angina with the coronary sinus Reducer. EuroIntervention 9(10):1158–1164. https://doi.org/10.4244/EIJV9I10A196CrossRefPubMed

Tzanis G, Palmisano A, Gallone G, Ponticelli F, Baldetti L, Esposito A, Colombo A, Giannini F (2019) The impact of the coronary sinus Reducer upon left ventricular function in patients with refractory angina pectoris. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.28408CrossRefPubMed

Giannini F, Palmisano A, Baldetti L, Benedetti G, Ponticelli F, Rancoita PMV, Ruparelia N, Gallone G, Ancona M, Mangieri A, Tzanis G, De Cobelli F, Del Maschio A, Colombo A, Esposito A (2019) Patterns of regional myocardial perfusion following coronary sinus Reducer implantation. Circ Cardiovasc Imaging 12(9):e009148. https://doi.org/10.1161/CIRCIMAGING.119.009148CrossRefPubMedPubMedCentral

10.

Gallone G, Palmisano A, Baldetti L, Monti CB, Ponticelli F, Tzanis G, Colombo A, Esposito A, Giannini F (2020) Improved myocardial function with coronary sinus Reducer in a patient with refractory angina and heart failure with reduced ejection fraction. Can J Cardiol 36(4):589 e581–589 e584. https://doi.org/10.1016/j.cjca.2019.10.030CrossRef

11.

Danad I, Szymonifka J, Twisk JWR, Norgaard BL, Zarins CK, Knaapen P, Min JK (2017) Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. Eur Heart J 38(13):991–998. https://doi.org/10.1093/eurheartj/ehw095CrossRefPubMed

12.

Konigstein M, Bazan S, Revivo M, Banai S (2018) Coronary sinus Reducer implantation improves symptoms, ischaemia and physical capacity in patients with refractory angina unsuitable for myocardial revascularisation: a single-centre experience. EuroIntervention 14(4):e452–e458. https://doi.org/10.4244/EIJ-D-18-00102CrossRefPubMed

13.

Verheye S, Jolicoeur EM, Behan MW, Pettersson T, Sainsbury P, Hill J, Vrolix M, Agostoni P, Engstrom T, Labinaz M, de Silva R, Schwartz M, Meyten N, Uren NG, Doucet S, Tanguay JF, Lindsay S, Henry TD, White CJ, Edelman ER, Banai S (2015) Efficacy of a device to narrow the coronary sinus in refractory angina. N Engl J Med 372(6):519–527. https://doi.org/10.1056/NEJMoa1402556CrossRefPubMedPubMedCentral

14.

Fent GJ, Garg P, Foley JRJ, Dobson LE, Musa TA, Erhayiem B, Greenwood JP, Plein S, Swoboda PP (2017) The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 33(10):1561–1569. https://doi.org/10.1007/s10554-017-1138-7CrossRefPubMedPubMedCentral

15.

Dongaonkar RM, Stewart RH, Quick CM, Uray KL, Cox CS Jr, Laine GA (2012) Award article: Microcirculatory Society Award for Excellence in Lymphatic Research: time course of myocardial interstitial edema resolution and associated left ventricular dysfunction. Microcirculation 19(8):714–722. https://doi.org/10.1111/j.1549-8719.2012.00204.xCrossRefPubMedPubMedCentral

16.

Szekely Y, Topilsky Y, Bazan S, Revivo M, Banai S, Konigstein M (2019) The impact of coronary sinus narrowing on diastolic function in patients with refractory angina. Int J Cardiol 291:8–12. https://doi.org/10.1016/j.ijcard.2019.03.041CrossRefPubMed

17.

Rademakers F, Nagel E (2018) Is global longitudinal strain a superior parameter for predicting outcome after myocardial infarction? JACC Cardiovasc Imaging 11(10):1458–1460. https://doi.org/10.1016/j.jcmg.2017.11.005CrossRefPubMed

18.

Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, Sheikh A, Lopez B, Gonzalez A, Manisty C, Lloyd G, Kellman P, Diez J, Moon JC (2018) Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol 71(8):860–871. https://doi.org/10.1016/j.jacc.2017.12.035CrossRefPubMedPubMedCentral

19.

Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E, Society for Cardiovascular Magnetic Resonance Board of Trustees Task Force on Standardized P (2008) Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35. https://doi.org/10.1186/1532-429X-10-35CrossRef

20.

Al-Saadi N, Nagel E, Gross M, Bornstedt A, Schnackenburg B, Klein C, Klimek W, Oswald H, Fleck E (2000) Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation 101(12):1379–1383. https://doi.org/10.1161/01.cir.101.12.1379CrossRefPubMed

21.

Jolicoeur EM, Banai S, Henry TD, Schwartz M, Doucet S, White CJ, Edelman E, Verheye S (2013) A phase II, sham-controlled, double-blinded study testing the safety and efficacy of the coronary sinus reducer in patients with refractory angina: study protocol for a randomized controlled trial. Trials 14:46. https://doi.org/10.1186/1745-6215-14-46CrossRefPubMedPubMedCentral

22.

Liu B, Dardeer AM, Moody WE, Hayer MK, Baig S, Price AM, Leyva F, Edwards NC, Steeds RP (2018) Reference ranges for three-dimensional feature tracking cardiac magnetic resonance: comparison with two-dimensional methodology and relevance of age and gender. Int J Cardiovasc Imaging 34(5):761–775. https://doi.org/10.1007/s10554-017-1277-xCrossRefPubMed

23.

Gatti M, Palmisano A, Faletti R, Benedetti G, Bergamasco L, Bioletto F, Peretto G, Sala S, De Cobelli F, Fonio P, Esposito A (2019) Two-dimensional and three-dimensional cardiac magnetic resonance feature-tracking myocardial strain analysis in acute myocarditis patients with preserved ejection fraction. Int J Cardiovasc Imaging 35(6):1101–1109. https://doi.org/10.1007/s10554-019-01588-8CrossRefPubMed

24.

Kempny A, Fernandez-Jimenez R, Orwat S, Schuler P, Bunck AC, Maintz D, Baumgartner H, Diller GP (2012) Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 14:32. https://doi.org/10.1186/1532-429X-14-32CrossRefPubMedPubMedCentral

25.

van Dijk R, Kuijpers D, Kaandorp TAM, van Dijkman PRM, Vliegenthart R, van der Harst P, Oudkerk M (2017) Effects of caffeine intake prior to stress cardiac magnetic resonance perfusion imaging on regadenoson- versus adenosine-induced hyperemia as measured by T1 mapping. Int J Cardiovasc Imaging 33(11):1753–1759. https://doi.org/10.1007/s10554-017-1157-4CrossRefPubMedPubMedCentral

26.

Ben-Shoshan J, Banai S (2020) Coronary sinus Reducer and left ventricular function. Can J Cardiol 36(4):474–475. https://doi.org/10.1016/j.cjca.2019.12.026CrossRefPubMed

27.

Moreo A, Ambrosio G, De Chiara B, Pu M, Tran T, Mauri F, Raman SV (2009) Influence of myocardial fibrosis on left ventricular diastolic function: noninvasive assessment by cardiac magnetic resonance and echo. Circ Cardiovasc Imaging 2(6):437–443. https://doi.org/10.1161/CIRCIMAGING.108.838367CrossRefPubMedPubMedCentral

28.

Pries AR, Badimon L, Bugiardini R, Camici PG, Dorobantu M, Duncker DJ, Escaned J, Koller A, Piek JJ, de Wit C (2015) Coronary vascular regulation, remodelling, and collateralization: mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation. Eur Heart J 36(45):3134–3146. https://doi.org/10.1093/eurheartj/ehv100CrossRefPubMed

29.

Garcia-Cardena G, Comander J, Anderson KR, Blackman BR, Gimbrone MA Jr (2001) Biomechanical activation of vascular endothelium as a determinant of its functional phenotype. Proc Natl Acad Sci USA 98(8):4478–4485. https://doi.org/10.1073/pnas.071052598CrossRefPubMed

30.

Andre F, Steen H, Matheis P, Westkott M, Breuninger K, Sander Y, Kammerer R, Galuschky C, Giannitsis E, Korosoglou G, Katus HA, Buss SJ (2015) Age- and gender-related normal left ventricular deformation assessed by cardiovascular magnetic resonance feature tracking. J Cardiovasc Magn Reson 17:25. https://doi.org/10.1186/s12968-015-0123-3CrossRefPubMedPubMedCentral

Title: Feature tracking and mapping analysis of myocardial response to improved perfusion reserve in patients with refractory angina treated by coronary sinus Reducer implantation: a CMR study
Authors: Anna Palmisano
Francesco Giannini
Paola Rancoita
Guglielmo Gallone
Giulia Benedetti
Luca Baldetti
Georgios Tzanis
Davide Vignale
Caterina Monti
Francesco Ponticelli
Marco Ancona
Matteo Montorfano
Alessandro Del Maschio
Francesco De Cobelli
Antonio Colombo
Antonio Esposito
Publication date: 01-01-2021
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 1/2021
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-020-01964-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Feature tracking and mapping analysis of myocardial response to improved perfusion reserve in patients with refractory angina treated by coronary sinus Reducer implantation: a CMR study

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2021

Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

Distribution of myocardial work in arterial hypertension: insights from non-invasive left ventricular pressure-strain relations

Value of echocardiography for mini-invasive per-atrial closure of perimembranous ventricular septal defect

Left atrial myocardial function and compliance in pre-eclampsia with preserved left ventricular systolic and diastolic function

Comparison of 3D and 2D late gadolinium enhancement magnetic resonance imaging in patients with acute and chronic myocarditis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page