Mechanisms of Coronary Sinus Reducer for Treatment of Myocardial Ischemia : In Silico Study
The coronary sinus reducer (CSR) is an emerging medical device for treating patients with refractory angina, often associated with myocardial ischemia. Patients implanted with CSR have shown positive outcomes, but the underlying mechanisms are unclear. This study sought to understand the mechanisms of CSR by investigating its effects on coronary microcirculation hemodynamics that may help explain the therapy's efficacy. We applied a validated computer model of the coronary microcirculation to investigate how CSR affects hemodynamics under different degrees of coronary artery stenosis. With moderate coronary stenosis, an increase in capillary transit time (CTT) (up to 69% with near-complete coronary sinus (CS) occlusion) is the key change associated with CSR. Because capillaries in the microcirculation can still receive oxygenated blood from the upstream artery with moderate stenosis, the increase in CTT allows more time for the exchange of gases and nutrients, aiding tissue oxygenation. With severe coronary stenosis, however, the redistribution of blood draining from the non-ischemic region to the ischemic region (up to 96% with near-complete CS occlusion) and the reduction in capillary flow heterogeneity are the key changes associated with CSR. Because blood draining from the non-ischemic region is not completely devoid of O2, the redistribution of blood to the capillaries in the ischemic region by CSR is beneficial especially when little or no oxygenated blood reaches these capillaries. This simulation study provides insights into the mechanisms of CSR in improving clinical symptoms. The mechanisms differ with the severity of the upstream stenosis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of applied physiology (Bethesda, Md. : 1985) - (2024) vom: 21. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wang, Haifeng [VerfasserIn] |
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| Links: |
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| Themen: |
Capillary transit time |
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| Anmerkungen: |
Date Revised 21.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1152/japplphysiol.00910.2023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370007921 |
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| 520 | |a The coronary sinus reducer (CSR) is an emerging medical device for treating patients with refractory angina, often associated with myocardial ischemia. Patients implanted with CSR have shown positive outcomes, but the underlying mechanisms are unclear. This study sought to understand the mechanisms of CSR by investigating its effects on coronary microcirculation hemodynamics that may help explain the therapy's efficacy. We applied a validated computer model of the coronary microcirculation to investigate how CSR affects hemodynamics under different degrees of coronary artery stenosis. With moderate coronary stenosis, an increase in capillary transit time (CTT) (up to 69% with near-complete coronary sinus (CS) occlusion) is the key change associated with CSR. Because capillaries in the microcirculation can still receive oxygenated blood from the upstream artery with moderate stenosis, the increase in CTT allows more time for the exchange of gases and nutrients, aiding tissue oxygenation. With severe coronary stenosis, however, the redistribution of blood draining from the non-ischemic region to the ischemic region (up to 96% with near-complete CS occlusion) and the reduction in capillary flow heterogeneity are the key changes associated with CSR. Because blood draining from the non-ischemic region is not completely devoid of O2, the redistribution of blood to the capillaries in the ischemic region by CSR is beneficial especially when little or no oxygenated blood reaches these capillaries. This simulation study provides insights into the mechanisms of CSR in improving clinical symptoms. The mechanisms differ with the severity of the upstream stenosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Capillary transit time | |
| 650 | 4 | |a Coronary microcirculation | |
| 650 | 4 | |a Coronary sinus intervention | |
| 650 | 4 | |a Coronary stenosis | |
| 650 | 4 | |a Flow redistribution | |
| 700 | 1 | |a Fan, Lei |e verfasserin |4 aut | |
| 700 | 1 | |a Choy, Jenny S |e verfasserin |4 aut | |
| 700 | 1 | |a Kassab, Ghassan S |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Lik Chuan |e verfasserin |4 aut | |
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