Feature tracking and mapping analysis of myocardial response to improved perfusion reserve in patients with refractory a
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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 Anna Palmisano1,2 · Francesco Giannini3,4 · Paola Rancoita5 · Guglielmo Gallone3,6 · Giulia Benedetti1,7 · Luca Baldetti3 · Georgios Tzanis3 · Davide Vignale1,2 · Caterina Monti8 · Francesco Ponticelli4 · Marco Ancona3 · Matteo Montorfano3 · Alessandro Del Maschio1 · Francesco De Cobelli1,2 · Antonio Colombo4 · Antonio Esposito1,2 Received: 8 May 2020 / Accepted: 6 August 2020 © Springer Nature B.V. 2020
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. Keywords Refractory angina · Reducer · Cardiac magnetic resonance · Stress imaging · ECV · T1 mapping
* Antonio Esposito [email protected] 1
5
Department University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
6
Division of Cardiology, Department of Medical Sciences, Città della Scienza e della Salute Hospital, University of Turin, Turin, Italy
Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
School of Medicine, Vita-Salute San Raffaele University,
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