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lar Dysfunction in Symptomatic Hypertrophic Cardiomyopathy,” American Journal Of Physiology, pp. 1–34, 2007. 14 S. E. Petersen, M. Jerosch-Herold, L. E. Hudsmith, M. D. Robson, J. M. Francis, H. a Doll, J. B. Selvanayagam, S. Neubauer, and H. Watkins, “Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging.,” Circulation, vol. 115, no. 18, pp. 2418–25, May 2007. 15 N. H. Pijls, B. De Bruyne, K. Peels, P. H. Van Der Voort, H. J. Bonnier, J. J. Bartunek J Koolen, and J. J. Koolen, “Measurement of fractional flow reserve to assess the functional severity of coronary artery stenoses.,” The New England journal of medicine, vol. 334, no. 26, pp. 1703–8, Jun. 1996. 16 B. Beleslin, M. Ostojic, A. Djordjevic-Dikic, V. Vukcevic, S. Stojkovic, M. Nedeljkovic, G. Stankovic, D. Orlic, N. Milic, J. Stepanovic, V. Giga, and J. Saponjski, “The value of fractional and coronary flow reserve in predicting myocardial recovery in patients with previous myocardial infarction.,” European heart journal, vol. 29, no. 21, pp. 2617– 24, Nov. 2008. 17 M. J. Kern and H. Samady, “Current concepts of integrated coronary physiology in the catheterization laboratory.,” Journal of the American College of Cardiology, vol. 55, no. 3, pp. 173–85, Jan. 2010. 18 N. Melikian, P. De Bondt, P. Tonino, O. De Winter, E. Wyffels, J. Bartunek, G. R. Heyndrickx, W. F. Fearon, N. H. J. Pijls, W. Wijns, and B. De Bruyne, “Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease.,” JACC. Cardiovascular interventions, vol. 3, no. 3, pp. 307– 14, Mar. 2010. 19 B. De Bruyne, N. H. J. Pijls, B. Kalesan, E. Barbato, P. a L. Tonino, Z. Piroth, N. Jagic, S. Mobius- Winckler, G. Rioufol, N. Witt, P. Kala, P. MacCarthy, T. Engström, K. G. Oldroyd, K. Mavromatis, G. Manoharan, P. Verlee, O. Frobert, N. Curzen, J. B. Johnson, P. Jüni, and W. F. Fearon, “Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.,” The New England journal of medicine, vol. 367, no. 11, pp. 991–1001, Sep. 2012. 20 N. H. J. Pijls and J.-W. E. M. Sels, “Functional measurement of coronary stenosis.,” Journal of the American College of Cardiology, vol. 59, no. 12, pp. 1045–57, Mar. 2012. 21 A. M. ElGuindy and R. O. Bonow, “FAME 2 – The best initial strategy for patients with stable coronary artery disease: Do we have an answer at last?,” Global Cardiology Science and Practice, vol. 2012, no. 2, p. 18, Dec. 2012. 22 J. Escaned, J. Cortés, A. Flores, J. Goicolea, F. Alfonso, R. Hernández, A. Fernández-Ortiz, M. Sabaté, C. Bañuelos, and C. Macaya, “Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging,” Journal of the American College of Cardiology, vol. 42, no. 2, pp. 226–233, Jul. 2003. 23 M. Kersemans, F. Van Heuverswyn, M. De Pauw, P. Gheeraert, Y. Taeymans, and B. Drieghe, “Hemodynamic effect of myocardial bridging.,” Circulation. Cardiovascular interventions, vol. 2, no. 4, pp. 361–2, Aug. 2009. Pre-operative coronary angiogram. Still images in the RAO cranial projection are shown. The mid segment (arrow) of the LAD shows near-total obliteration at end-systole (A) and appears completely unaffected during end-diastole (B). Septal perforators arising from the mid are also squeezed during systole leading to complete obliteration of their lumen (arrow heads). 1 Post-operative coronary angiogram. Still images in the RAO cranial projection are shown. The mid segment (arrow) of the LAD is fully patent during end-systole with no residual systolic obliteration (A) compared to end-diastole (B). Systolic obliteration of the septal perforators remains unchanged (arrow heads). 2 Pre- and post-operative coronary pressure measurements as thermodilutionderived coronary flow reserve and microcirculatory resistance measurements. Pre-operative (A) FFR calculated from mean pressures (FFRmean) was 0.91, however, when diastolic pressures were used, FFR was 0.75 (FFRdia). Postoperative (B) FFRdia was 0.98 which is very close to FFRmean calculated at the same time suggesting complete relief of systolic squeezing. Thermodilution curves at basal conditions and after induction of steady-state maximum hyperemia are also shown in both the pre- and post-operative studies along with the derived CFR and IMR values. 3 Contact david.groke@siemens.com 1A 2A 3A 1B 2B 3B Charity Cardiology AXIOM Innovations | December 2013 | www.siemens.com/angiography  55


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