Zsolt Zimmermann

Five-year experience with transradial coronary angioplasty in ST-segment-elevation myocardial infarction

BACKGROUND AND PURPOSE Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI). METHODS AND MATERIALS The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study. Forty-three patients were excluded from the present study due to cardiogenic shock or rescue PCI. Patients (n=539) were categorized into the TR group (n=167) or the TF group (n=372), and several parameters were evaluated to assess the advantages and drawbacks of TR access: access-site crossover, rate of access-site complications, procedure time, fluoroscopy time, X-ray area dose, major adverse cardiac events (MACE) at 1 month, and consumption of angioplasty equipment. RESULTS In the TR group, the crossover rate to femoral access was 5%, while in the TF group, it was 0.8% (P<.05). There was a significant difference, in both major and minor access-site complications, between the TR group and the TF group (0% vs. 5%, P<.05, and 4% vs. 9%, P<.05, respectively). Consumption of angioplasty equipment proved to be the same for the two groups. The MACE rate was 4% in the TR group and 11% in the TF group (P<.05). CONCLUSIONS Our results suggest that the TR approach is a safe and effective way to treat STEMI; furthermore, site-related complications are less common with this approach.

Vessel masking improves densitometric myocardial perfusion assessment.

Introduction The objective of treatment in acute myocardial infarction (AMI) is reperfusion of the myocardium at risk. Our goal was to evaluate the effect of vessel masking on videodensitometric assessment of myocardial reperfusion. Methods Epicardial vessels were masked out from the densitometric region of interest, where average rise slope (Gmax/Tmax) of time–density curves (TDC) were measured. Measurements were tested to detect indicators of reperfusion as cumulative creatine-kinase (CK) release and ST-resolution by receiver operating characteristic (ROC) curve analysis. Results When vessel masking was applied before Gmax/Tmax measurement, an improvement has been observed in sensitivity and area under ROC curve to detect indicators of reperfusion as cumulative enzyme release (sensitivity (Se): 85% vs. 61%, area under the curve (AUC): 0.84 vs. 0.76) and ST-resolution (Se: 74% vs. 67%, AUC: 0.83 vs. 0.79). Conclusions Selective myocardial perfusion measurement on coronary angiograms is feasible and serves as an informative method to detect myocardial viability after AMI and revascularization therapy. The present study demonstrated that vessel masking improves results compared to simple densitometric analysis.

Myocardium selective densitometric perfusion assessment after acute myocardial infarction

BACKGROUND Myocardial perfusion is an important prognostic factor after recanalisation in acute myocardial infarction patients. We present a computerized, densitometric measurement method to assess myocardial perfusion on phase-matched digitally subtracted coronary angiograms. METHODS AND MATERIALS Quantitative myocardial perfusion was assessed by the G(max)/T(max) parameter of the time-density curves (TDCs) in infarct-related myocardial regions on X-ray coronary angiograms. Arteries were masked out from regions of measurement. This novel method has been compared with enzymatic infarct size, ST-segment resolution, and ejection fraction after successful revascularization of 62 patients with acute myocardial infarction. RESULTS Significant correlations were found between G(max)/T(max) and enzymatic infarct size (R=-0.445, P<.001), ST-segment resolution (R=0.364, P=.004), and ejection fraction (R=0.278, P=.029). Bland and Altman plot of G(max)/T(max) reveals good interobserver agreement. CONCLUSIONS G(max)/T(max) of the TDC measured in the infarct-related myocardial area is a reliable parameter to assess clinical indicators of myocardial reperfusion. Therefore, results suggest that it could be used to immediately assess the success of recanalisation at the tissue perfusion level during coronary intervention, and as an objective end point in clinical trials of new interventional devices and drugs.

Correlations between myocardium selective videodensitometric perfusion parameters and corrected TIMI frame count in patients with normal epicardial coronary arteries

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Validation of videodensitometric myocardial perfusion assessment

IntroductionInvasive methods for assessment of coronary microcirculatory function are time- and instrumentation-consuming tools. Recently, novel computer-assisted videodensitometric methods have been demonstrated to provide quantitative information on myocardial (re)perfusion. The aim of the present prospective study was to evaluate the accuracy of videodensitometry-derived perfusion parameters in patients with stable angina undergoing elective coronary angiography.MethodsThe study comprised 13 patients with borderline epicardial coronary artery stenosis (40–70%). Coronary flow reserve and index of microcirculatory resistance were measured by using an intracoronary pressure and temperature sensor-tipped guidewire. A videodensitometric quantitative parameter of myocardial perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) of the time-density curves in regions of interest on conventional coronary angiograms. Myocardium perfusion reserve was calculated as a ratio of hyperemic and baseline Gmax/Tmax.ResultsAt hyperemia a significant increase in Gmax/Tmax could be observed (p <0.0001). Significant correlations were found between myocardium perfusion reserve and coronary flow reserve (r =0.82, p =0.0008) and between hyperemic Gmax/Tmax and hyperemic index of microcirculatory resistance (r =−0.72, p =0.0058).ConclusionsVideodensitometric Gmax/Tmax assessment seems to be a promising method to assess the myocardial microcirculatory state.

Aortic valve stenosis is associated with reduced myocardial perfusion as assessed by videodensitometry in coronary angiograms

UNLABELLED Aortic valve stenosis may be accompanied by angina despite coronary arteries free of significant stenosis due to microvascular abnormalities. AIMS The aim of the current study was to test whether densitometry-derived myocardial perfusion on coronary angiogram is reduced in patients with aortic valve stenosis. METHODS The study comprised 20 patients with aortic valve stenosis (mean transvalvular gradient: 47.4±15.2 mm Hg) and 30 control subjects without significant epicardial coronary artery stenosis. A quantitative parameter of myocardial perfusion was calculated by the ratio of maximal density (Gmax) and time to reach maximum density (Tmax) on time-density curves in regions of interest of each coronary artery on coronary angiograms. RESULTS Mean three-vessel Gmax/Tmax proved to be significantly lower in patients with aortic valve stenosis compared to control subjects (2.55±1.02 1/sec vs. 3.39±1.09 1/sec, p<0.01). CONCLUSIONS Reduced Gmax/Tmax values indicative of myocardial perfusion abnormalities as measured by densitometry on coronary angiograms could be demonstrated in patients with aortic valve stenosis compared to controls.

Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction

INTRODUCTION It is known that there is a relationship between myocardial perfusion and left ventricular function. AIM The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. METHOD The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. RESULTS Significant correlations were demonstrated between left ventricular ejection fraction and Gmax (r = 0.40, p = 0.05) and Gmax/Tmax (r = 0.41, p = 0.04) following vessel masking. CONCLUSIONS The results demonstrate significant relationship between densitometric Gmax/Tmax and late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187-193.