Coronary CT perfusion territory analysis predicted ablation volume correlating with MRI edema (r=0.635) and CPK (r=0.711) in PTSMA patients, aiding procedural planning.
Does coronary CT angiography-based perfusion territory analysis predict ablation volume in patients with hypertrophic obstructive cardiomyopathy undergoing percutaneous transluminal septal myocardial ablation?
Pre-procedural coronary CT angiography perfusion territory analysis correlates with post-procedural myocardial edema and peak CPK, suggesting its utility in predicting ablation volume and guiding septal branch selection for PTSMA.
Absolute Event Rate: 0% vs 0%
Abstract Background Percutaneous transluminal septal myocardial ablation (PTSMA) is an effective treatment for hypertrophic obstructive cardiomyopathy (HOCM). It reduces left ventricular outflow tract pressure gradient (LVOT-PG) and improves heart failure symptoms. Appropriate selection of septal branches for ablation is crucial for effective treatment. However, methods for predicting target myocardial mass before the procedure remain unestablished. Coronary CT angiography-based perfusion territory analysis has proven useful for quantifying ischemic myocardium. Yet, its application to PTSMA has not been reported. Purpose To evaluate whether CT perfusion territory analysis can predict ablation volume and guide procedural strategy in PTSMA. Methods We retrospectively evaluated 22 HOCM patients with successful PTSMA. All patients had pre-procedural coronary CT with analyzable septal branch perfusion territories. Procedural success was defined as 50% reduction in LVOT-PG from baseline. In 19 patients, cardiac MRI was performed within 2 weeks post-procedure to measure myocardial edema volume. All patients underwent peak CPK measurement and pre/post-procedure echocardiography. Results PTSMA significantly reduced LVOT-PG (67.938.9-97.5 to 12.57.7-52.5 mmHg; P0.001) and BNP (152.186.0-461.3 to 97.847-308.8 pg/mL; P0.001). CT-derived perfusion volume showed correlation with MRI-measured myocardial edema volume (r=0.635; P=0.0035, Figure 1). Moreover, CT perfusion volume demonstrated strong positive correlation with peak CPK (r=0.711; P0.001, Figure 2). Cases requiring multiple-branch ablation had significantly smaller perfusion volume per septal branch than single-branch cases (7.7±2.5 vs 13.5±2.7 ml; P=0.003). Conclusion CT coronary perfusion territory analysis effectively predicts ablation volume and aids pre-procedural planning for PTSMA. When predicted myocardial volume is small, target vessel revision or multiple-branch ablation should be considered.Figure1 Figure2
Tashiro et al. (Sat,) reported a other. Coronary CT perfusion territory analysis predicted ablation volume correlating with MRI edema (r=0.635) and CPK (r=0.711) in PTSMA patients, aiding procedural planning.