P90Improved myocardial function following coronary sinus reducer implantation in a patient with refractory angina and heart failure with reduced ejection fraction
Bibliographic record
Abstract
Funding Acknowledgements: Francesco Giannini is a consultant for Neovasc Inc. None of the other authors have conflicts of interest to declare. Introduction The coronary sinus (CS) Reducer is a percutaneous device improving symptoms in refractory angina (RA), possibly by enhanced perfusion to myocardial ischemic territories. We report a case describing changes in myocardial function and left ventricle (LV) dimensions following Reducer implant, as assessed by cardiac magnetic resonance (CMR). Case presentation A 82-year old man with a history of coronary artery bypass grafting, presented with Canadian Cardiovascular Society (CCS) class III angina, despite maximally tolerated anti-ischemic therapy, and chronic heart failure (New York Heart Association (NYHA) functional class II, NT-proBNP 2932 pg/mL). Coronary angiography documented two-vessel disease with open grafts, totally occluded right coronary artery and critical circumflex artery occlusion. Dipyridamole stress perfusion CMR, performed to assess myocardial ischemia and viability, revealed diffuse ischemia at visual analysis, impaired myocardial perfusion reserve at semi-quantitative analysis and infero-septal medio-apical subendocardial fibrosis, with mildly impaired systolic function (Table 1). The Heart Team deemed the patient to be high risk for either surgical or percutaneous revascularization procedures. Thus, a decision was made to undertake Reducer implant, which was successfully performed. At 4-month follow-up, stress CMR showed improved perfusion parameters with increased LV ejection fraction and reduced LV mass and volumes. The patient was asymptomatic for angina, in NYHA class I with improved six-minute walk test performance (380 vs. 270 mts at baseline) and Seattle Angina Questionnaire (from 45 to 72 points). Conclusions Reducer is postulated to alleviate symptoms by improving perfusion to myocardial ischemic territories. This case provides insight on how the improved perfusion might translate into improved myocardial function and remodeling, suggesting a physiological rationale to test Reducer in the setting of ischemic cardiomyopathy with reduced ejection fraction and adverse remodeling. Table 1 Changes in perfusion and structural parameters following CS Reducer implantation. EDV, end-diastolic volume; EDWM, end-diastolic wall mass; EF, ejection fraction; ESV, end-systolic volume; LV, left ventricle; MPRI, myocardial perfusion reserve index.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".