Forster, Tamás

Kalapos, Anita

Nemes, Attila

Sasi, Viktor

Sepp, Róbert

Ungi, Imre

Ungi, Tamás

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AUTHOR'S PROOFUNCORRECTEDPROOF123 IMAGING IN CARDIOLOGY4 Videodensitometric time-density curve change after alcohol5 septal ablation of obstructive hypertrophic cardiomyopathy6 A. Nemes & A. Kalapos & V. Sasi & T. Ungi & I. Ungi &7 T. Forster & R. Sepp89 # Springer Media / Bohn Stafleu van Loghum 20121011 Keywords Blush . Obstructive hypertrophic12 cardiomyopathy . Percutenous transluminal septal13 myocardial ablation . Videodensitometry14 A 35-year-old female patient with obstructive hypertrophic15 cardiomyopathy (HOCM), causing New York Heart Asso-16 ciation Class III symptoms, underwent alcohol septal abla-17 tion [1, 2]. Before and after ablation, coronary angiograms18 were recorded on the left anterior descendent artery, and19 subsequently phase-matched digital subtraction angiograms20 have been performed on the recordings off-line. The recently21developed computerized method for estimation of myocardial22perfusion, based on the analysis of the time-density curves23(TDC), was used to assess myocardial blush over a selected24myocardial region of interest representing the area supplied25by the ablated septal branch [3–5]. The ratio of Gmax (defined26as maximal amplitude of the TDC) and Tmax (defined as the27time to reach Gmax) was reduced after alcohol ablation com-28pared with pre-procedural levels indicating reduced perfusion29in the ablated septal area. This new method may allow30evaluation of myocardial perfusion parameters, and may as-31sist to judge the success of alcohol ablation in hypertrophic32cardiomyopathy Q3(Fig. 1).A. Nemes :A. Kalapos :V. Sasi : T. Ungi : I. Ungi : T. Forster :R. SeppDivision of Invasive Cardiology, Department of Cardiology,Medical Faculty, Albert Szent-Györgyi Clinical Center, Universityof Szeged, Szeged, HungaryA. Nemes (*)Q2 2nd Department of Medicine and Cardiology Center, MedicalFaculty, Albert Szent-Györgyi Clinical Center, University ofSzeged, Korányi fasor 6, PO Box 427, 6720, Szeged,Q1Hungarye-mail: nemes@in2nd.szote.u-szeged.huNeth Heart JDOI 10.1007/s12471-012-0342-2JrnlID 12471_ArtID 342_Proof# 1 - 14/11/2012AUTHOR'S PROOFUNCORRECTEDPROOF33Acknowledgments We gratefully acknowledge the skilled assistance34of the nursing staff of Cardiac Catheterization Unit (Head: Imre Ungi,35MD, PhD). Dr. Attila Nemes holds a János Bolyai Research Fellowship36(Budapest, Hungary).3738References 39401. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline41for the diagnosis and treatment of hypertrophic cardiomyopathy: a42report of the American College of Cardiology Foundation/American43Heart Association Task Force on Practice Guidelines. J Am Coll44Cardiol. 2011;58:e212–60.452. Seggewiss H, Rigopoulos A, Welge D, et al. Long-term46follow-up after percutaneous septal ablation in hypertrophic47obstructive cardiomyopathy. Clin Res Cardiol. 2007;96:856–4863.493. Ungi T, Ungi I, Jónás Z, et al. Myocardium selective densitometric50perfusion assessment after acute myocardial infarction. Cardiovasc51Revasc Med. 2009;10:49–54.524. Ungi T, Zimmermann Z, Balázs E, et al. Vessel masking improves53densitometric myocardial perfusion assessment. Int J Cardiovasc54Imaging. 2009;25:229–36.555. Nagy FT, Sasi V, Ungi T, et al. Correlations between myocardium56selective videodensitometric perfusion parameters and corrected57TIMI frame count in patients with normal epicardial coronary arter-58ies. Int J Cardiol. 2012;155:498–501.591A 1B 2A 2B 3A 3B Fig. 1 Digital subtraction angiographic and videodensitometricchanges after alcohol ablation in obstructive hypertrophic cardiomy-opathy. Insert 1. Coronary angiographic images of the left anteriordescending coronary artery shown from the cranial-right anterioroblique orientation in an HOCM patient before (1A) and after (1B)alcohol ablation. Arrow indicates a sub-branch of the first septalperforator artery which was ablated during the procedure. The absenceof the branch is evident on the post-procedure angiogram (1B). Insert2. Digital subtraction angiographic images shown from the sameorientation as Insert 1, before (2A) and after (2B) alcohol ablation.The region of interest (ROI), encircled in red, represents the areasupplied by the ablated branch. Myocardial blush is represented bygreyish opacification of the microvasculature, which is seeminglyreduced after ablation (2B). Insert 3. Time-density curves based onvideodensitometric evaluation of density in the region of interest fromInsert 2 indicating myocardial perfusion before (3A) and after (3B)alcohol ablation. The rise and fall of density (y axis) as a function oftime (x axis) is represented by a green curve (time-density curve,TDC). The maximal amplitude of TDC is defined as Gmax, while thetime to reach Gmax is defined as Tmax. Both values were automaticallycomputed and their ratio (Gmax/Tmax) was used as a parameter ofmyocardial perfusion changes. The ratio of Gmax/Tmax was reducedafter alcohol ablation compared with pre-procedural levels (3.21 vs.1.33) indicating reduced perfusion in the ablated septal areaNeth Heart JJrnlID 12471_ArtID 342_Proof# 1 - 14/11/2012

Videodensitometric time-density curve change after alcohol 5 septal ablation of obstructive hypertrophic cardiomyopathy

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