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TCT-506 Coronary sinus reduction improves myocardial perfusion reserve index assessed by dipyridamole stress cardiac magnetic resonance.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
TCT-505 Feasibility of a Novel Echo/X-Ray Fusion Software to Determine Implant Angulation during Transcatheter Aortic Valve Replacement Kevin Sinclair,1 Daniel Bamira,2 Erin Girard,3 Michael Szucs,4 Ryan Spilker,5 Sammy Elmariah,6 Jonathan Passeri,7 Ignacio Inglessis8 1 Massachusetts General Hospital, Boston, Massachusetts, United States; 2Sanford Medical Center, Brookline, Massachusetts, United States; 3Princeton, New Jersey, United States; 4Siemens, Issaquah, Washington, United States; 5Siemens Healthineers, Hoffman Estates, Illinois, United States; 6Massachusetts General Hospital, Boston, Massachusetts, United States; 7University of South Dakota; 8 Massachusetts General Hospital, GRB 820, Massachusetts, United States BACKGROUND The use of pre-procedural computed tomography (CT) is considered the paradigm to determine a working C-arm angle during transcatheter aortic valve replacement (TAVR). We evaluated whether C-arm angulations derived from landmarks overlaid using a novel Echo/X-Ray Fusion (EXF) prototype (Siemens Healthcare, Forchheim, Germany) were clinically acceptable at a similar frequency to those derived using pre-procedural CT. METHODS The EXF system requires parallel imaging using transesophageal echocardiography (TEE) and fluoroscopy. On TEE, the aortic valve leaflet hinge points were marked and a circle drawn to intersect all 3 points identifying the plane of the aortic valve annulus (Fig. 1A). The volume was then rotated to determine an optimal perpendicular implant angle using the landmarks as a guide (Fig. 1B). Angiography was performed at the CT and/or EXF-derived angle (Fig. 1C). An experienced interventional cardiologist was presented with modality-blinded (CT or EXF derived) aortograms and asked to grade if the angle was clinically acceptable for deployment.
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Milan, Milan, Italy; 5NHS, Newington, United Kingdom; 6San Raffaele Hospital; 7San Raffaele University hospital, Milan, Milan, Italy; 8USC; 9 University of Athens School of Medicine, Athens, Greece; 10H. Espírito Santo Évora, Portugal; 11San Raffaele Scientific Insitute, Milan, Milan, Italy; 12San Raffaele Hospital, Milan, Milan, Italy; 13San Raffaele Hospital, Milan, Italy; 14EMO-GVM Centro Cuore Columbus, Milan, Italy; 15San Raffaele Scientific Institute, Milan, Italy; 16Capricor Inc; 17 San Raffaele Scientific Institute, Milan, Italy BACKGROUND We evaluated the efficacy of the Coronary Sinus (CS) Reducer in improving myocardial perfusion assessed by myocardial perfusion reserve index (MPRI) determined from perfusion dipyridamole cardiac magnetic resonance (CMR) three months after the procedure. METHODS Thirty patients with refractory angina despite optimal medical therapy and no coronary revascularization options were successfully treated with CS Reducer implantation. Among them, 5 patients underwent pre-procedural and 3-month follow-up CMR perfusion scans at rest and during dipyridamole infusion (0.56 mg/kg infused in 4 minutes) to assess MPRI. MPRI (as defined as an index between relative upslope (RU) stress/RU rest, with RU defined as the ratio between the maximum upslope of the first pass myocardial perfusion time-intensity curve divided by the maximum upslope of the first-pass left ventricle cavity time-intensity curve) is a semiquantitative index that has been demonstrated to be useful for defining and quantifying myocardial ischemia. RESULTS An increase of MPRI was observed in 4 of 5 patients (80%) as reported in the Figure; mean MPRI increased from 1.5.0.4 to 2.40.7, with a mean improvement of MPRI per patient of 0.70.5 (p¼0.075). MPRI did not significantly increase in one patient with impaired myocardial flow without significant epicardial coronary disease (basal 1.7, post-implant 1.6).
RESULTS Twelve patients at our center underwent TAVR with Sapien S3 (n¼7, Edwards, Irvine, CA) or Evolut R (n¼ 5, Medtronic, Fridley, MN) using the EXF system. All 8 aortograms based on CT angles were considered satisfactory to proceed with TAVR. Of the 12 EXF-based aortograms, 10 were considered satisfactory. Barnard’s test shows no significant difference at a cutoff of p¼0.05.
CONCLUSION Coronary sinus Reducer implantation may be related to an improvement in MPRI in refractory angina patients. Further studies are needed to investigate our findings. CATEGORIES IMAGING: Non-Invasive CONCLUSION Preliminary data suggests that, when compared to CTderived deployment angles, the EXF prototype presents a clinically acceptable alternative in TAVR patients. CATEGORIES IMAGING: Non-Invasive TCT-506 Coronary sinus reduction improves myocardial perfusion reserve index assessed by dipyridamole stress cardiac magnetic resonance. Francesco Giannini,1 Andrea Aurelio,2 Antonio Esposito,3 Anna Palmisano,4 Richard Jabbour,5 Damiano Regazzoli,6 Roberto Spoladore,7 Massimo Slavich,8 Annarita Botta,9 Alessia Faccini,10 Marco Ancona,11 Antonio Mangieri,12 Matteo Montorfano,13 Azeem Latib,14 Alaide Chieffo,15 Francesco De Cobelli,16 Antonio Colombo17 1 Interventional Cardiology institute San Raffaele Hospital, Soverato, Reggio Calabria, Italy; 2San Raffaele Hospital - Milan, Taranto, Bari, Italy; 3Experimental Imaging Center, Department of Radiology, San Raffaele Scientific Institute, Milan, Milan, Italy; 4Experimental Imaging Center, Department of Radiology, San Raffaele Scientific Institute,
TCT-507 Computed Tomography Angiography Versus Angiography for Guiding Percutaneous Coronary Interventions in Bifurcation Lesions – Prospective Randomized Pilot Study Rafał Wolny,1 jerzy pregowski,2 Mariusz Kruk,3 Cezary Kepka,4 Artur Debski,5 Michal Ciszewski,6 Krzysztof Kukula,7 Maksymilian Opolski,8 Zbigniew Chmielak,9 Adam Witkowski10 1 University Hospital Limerick, Warsaw, Poland; 2Instytut Kardiologii, warsaw, Poland; 3Institute of Cardiology, warsaw, Poland; 4Unknown, Warsaw, Poland; 5Institute of Cardiology Warsaw Poland, Warszawa, Poland; 6Unknown, Warsaw, Poland; 7Institute of Cardiology, Warsaw, Poland; 8Institute of Cardiology, Warsaw, Poland; 9Instytut Kardiologii Prymasa Tysiaclecia, Warsaw, Poland; 10Institute of Cardiology, Warsaw, Poland BACKGROUND Coronary computed tomography angiography (CTA) is available in a growing number of patients scheduled for percutaneous coronary interventions (PCI). It is not known, how analysis of CTA images influences the immediate and long-term outcome of PCI in bifurcations.
TCT-505 Feasibility of a Novel Echo/X-Ray Fusion Software to Determine Implant Angulation during Transcatheter Aortic Valve Replacement Kevin Sinclair,1 Daniel Bamira,2 Erin Girard,3 Michael Szucs,4 Ryan Spilker,5 Sammy Elmariah,6 Jonathan Passeri,7 Ignacio Inglessis8 1 Massachusetts General Hospital, Boston, Massachusetts, United States; 2Sanford Medical Center, Brookline, Massachusetts, United States; 3Princeton, New Jersey, United States; 4Siemens, Issaquah, Washington, United States; 5Siemens Healthineers, Hoffman Estates, Illinois, United States; 6Massachusetts General Hospital, Boston, Massachusetts, United States; 7University of South Dakota; 8 Massachusetts General Hospital, GRB 820, Massachusetts, United States BACKGROUND The use of pre-procedural computed tomography (CT) is considered the paradigm to determine a working C-arm angle during transcatheter aortic valve replacement (TAVR). We evaluated whether C-arm angulations derived from landmarks overlaid using a novel Echo/X-Ray Fusion (EXF) prototype (Siemens Healthcare, Forchheim, Germany) were clinically acceptable at a similar frequency to those derived using pre-procedural CT. METHODS The EXF system requires parallel imaging using transesophageal echocardiography (TEE) and fluoroscopy. On TEE, the aortic valve leaflet hinge points were marked and a circle drawn to intersect all 3 points identifying the plane of the aortic valve annulus (Fig. 1A). The volume was then rotated to determine an optimal perpendicular implant angle using the landmarks as a guide (Fig. 1B). Angiography was performed at the CT and/or EXF-derived angle (Fig. 1C). An experienced interventional cardiologist was presented with modality-blinded (CT or EXF derived) aortograms and asked to grade if the angle was clinically acceptable for deployment.
B203
Milan, Milan, Italy; 5NHS, Newington, United Kingdom; 6San Raffaele Hospital; 7San Raffaele University hospital, Milan, Milan, Italy; 8USC; 9 University of Athens School of Medicine, Athens, Greece; 10H. Espírito Santo Évora, Portugal; 11San Raffaele Scientific Insitute, Milan, Milan, Italy; 12San Raffaele Hospital, Milan, Milan, Italy; 13San Raffaele Hospital, Milan, Italy; 14EMO-GVM Centro Cuore Columbus, Milan, Italy; 15San Raffaele Scientific Institute, Milan, Italy; 16Capricor Inc; 17 San Raffaele Scientific Institute, Milan, Italy BACKGROUND We evaluated the efficacy of the Coronary Sinus (CS) Reducer in improving myocardial perfusion assessed by myocardial perfusion reserve index (MPRI) determined from perfusion dipyridamole cardiac magnetic resonance (CMR) three months after the procedure. METHODS Thirty patients with refractory angina despite optimal medical therapy and no coronary revascularization options were successfully treated with CS Reducer implantation. Among them, 5 patients underwent pre-procedural and 3-month follow-up CMR perfusion scans at rest and during dipyridamole infusion (0.56 mg/kg infused in 4 minutes) to assess MPRI. MPRI (as defined as an index between relative upslope (RU) stress/RU rest, with RU defined as the ratio between the maximum upslope of the first pass myocardial perfusion time-intensity curve divided by the maximum upslope of the first-pass left ventricle cavity time-intensity curve) is a semiquantitative index that has been demonstrated to be useful for defining and quantifying myocardial ischemia. RESULTS An increase of MPRI was observed in 4 of 5 patients (80%) as reported in the Figure; mean MPRI increased from 1.5.0.4 to 2.40.7, with a mean improvement of MPRI per patient of 0.70.5 (p¼0.075). MPRI did not significantly increase in one patient with impaired myocardial flow without significant epicardial coronary disease (basal 1.7, post-implant 1.6).
RESULTS Twelve patients at our center underwent TAVR with Sapien S3 (n¼7, Edwards, Irvine, CA) or Evolut R (n¼ 5, Medtronic, Fridley, MN) using the EXF system. All 8 aortograms based on CT angles were considered satisfactory to proceed with TAVR. Of the 12 EXF-based aortograms, 10 were considered satisfactory. Barnard’s test shows no significant difference at a cutoff of p¼0.05.
CONCLUSION Coronary sinus Reducer implantation may be related to an improvement in MPRI in refractory angina patients. Further studies are needed to investigate our findings. CATEGORIES IMAGING: Non-Invasive CONCLUSION Preliminary data suggests that, when compared to CTderived deployment angles, the EXF prototype presents a clinically acceptable alternative in TAVR patients. CATEGORIES IMAGING: Non-Invasive TCT-506 Coronary sinus reduction improves myocardial perfusion reserve index assessed by dipyridamole stress cardiac magnetic resonance. Francesco Giannini,1 Andrea Aurelio,2 Antonio Esposito,3 Anna Palmisano,4 Richard Jabbour,5 Damiano Regazzoli,6 Roberto Spoladore,7 Massimo Slavich,8 Annarita Botta,9 Alessia Faccini,10 Marco Ancona,11 Antonio Mangieri,12 Matteo Montorfano,13 Azeem Latib,14 Alaide Chieffo,15 Francesco De Cobelli,16 Antonio Colombo17 1 Interventional Cardiology institute San Raffaele Hospital, Soverato, Reggio Calabria, Italy; 2San Raffaele Hospital - Milan, Taranto, Bari, Italy; 3Experimental Imaging Center, Department of Radiology, San Raffaele Scientific Institute, Milan, Milan, Italy; 4Experimental Imaging Center, Department of Radiology, San Raffaele Scientific Institute,
TCT-507 Computed Tomography Angiography Versus Angiography for Guiding Percutaneous Coronary Interventions in Bifurcation Lesions – Prospective Randomized Pilot Study Rafał Wolny,1 jerzy pregowski,2 Mariusz Kruk,3 Cezary Kepka,4 Artur Debski,5 Michal Ciszewski,6 Krzysztof Kukula,7 Maksymilian Opolski,8 Zbigniew Chmielak,9 Adam Witkowski10 1 University Hospital Limerick, Warsaw, Poland; 2Instytut Kardiologii, warsaw, Poland; 3Institute of Cardiology, warsaw, Poland; 4Unknown, Warsaw, Poland; 5Institute of Cardiology Warsaw Poland, Warszawa, Poland; 6Unknown, Warsaw, Poland; 7Institute of Cardiology, Warsaw, Poland; 8Institute of Cardiology, Warsaw, Poland; 9Instytut Kardiologii Prymasa Tysiaclecia, Warsaw, Poland; 10Institute of Cardiology, Warsaw, Poland BACKGROUND Coronary computed tomography angiography (CTA) is available in a growing number of patients scheduled for percutaneous coronary interventions (PCI). It is not known, how analysis of CTA images influences the immediate and long-term outcome of PCI in bifurcations.