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Biomedical subjects

Albert C van Rossum

Publications and source records attributed to Albert C van Rossum.

At least 19 recordsLinked to original sources
PubMed2006

The effect of left bundle branch block on left ventricular remodeling, dyssynchrony and deformation of the mitral valve apparatus: an observational cardiovascular magnetic resonance imaging study.

BACKGROUND: The effect of a left bundle branch block (LBBB) on cardiac function and remodeling in patients at different stages of heart failure (HF) is unknown. We used cardiac magnetic resonance imaging (CMR) to evaluate the effect of LBBB on left ventricular (LV) remodeling, mechanical dyssynchrony, functional mitral regurgitation (FMR) and deformation of the mitral valve apparatus (MVA) in LBBB patients at different stages of HF. METHODS: In 12 LBBB patients with HF, 4 patients with isolated LBBB, and 4 controls, cine CMR was performed to measure LV remodeling, FMR grade and deformation of the MVA. CMR tagging was used to measure septal-to-lateral onset of shortening delay and coefficient of circumferential strain variation (CV) to quantify dyssynchrony. RESULTS: LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were largest in LBBB patients with HF. Patients with isolated LBBB tended to have a larger LVESV and smaller LV ejection fraction compared to controls, (56 +/- 22 ml/m2 versus 45 +/- 9 ml/m2, P = ns, 42 +/- 9% versus 53 +/- 4 %, P = ns). QRS duration and septal-to-lateral-onset-of-shortening delay were comparable between LBBB patients with HF and isolated LBBB patients, CV was larger (98 +/- 45 versus 40 +/- 4, P < 0.05). MVA tenting and FMR were present both in LBBB patients with HF and patients with isolated LBBB and were not observed in controls. CONCLUSION: The presence of a LBBB in asymptomatic patients is related to mechanical dyssynchrony and deformation of the MVA and may be associated with LV remodeling. If confirmed, close monitoring or even timely initiation of therapy may be warranted in patients with isolated LBBB. This advocates to conduct a longitudinal CMR follow-up study on the clinical course in patients with isolated LBBB.

Action Potentials↗
PubMed2006

Structural abnormalities of the inferoseptal left ventricular wall detected by cardiac magnetic resonance imaging in carriers of hypertrophic cardiomyopathy mutations.

OBJECTIVES: The purpose of this study was to evaluate whether structural left ventricular (LV) abnormalities can be observed in hypertrophic cardiomyopathy (HCM) mutation carriers who have not yet developed echocardiographic signs of hypertrophy by using cardiac magnetic resonance imaging (CMR). BACKGROUND: Hypertrophic cardiomyopathy is caused by mutations of genes encoding for sarcomeric proteins. Myocyte disarray and interstitial fibrosis precede the development of regional hypertrophy in HCM mutation carriers (carriers). No macroscopic LV structural abnormalities have been observed in carriers without LV hypertrophy. METHODS: A CMR, echocardiogram, and electrocardiogram (ECG) were performed in 16 carriers. Delayed contrast enhancement imaging was used with CMR to detect fibrosis. In 16 age- and gender-matched control subjects, CMR and ECG were performed and an echocardiogram was made when structural abnormalities were detected with CMR. All carriers had an LV wall thickness <13 mm in the year before the study, measured by echocardiography. RESULTS: In 13 carriers (81%), crypts were discerned with CMR in the basal and mid inferoseptal LV wall, not detected by routine echocardiography and not observed in healthy volunteers. In 4 of the crypt-positive carriers, both the echocardiogram and ECG were normal. Two HCM carriers revealed regional hypertrophy of the inferoseptum not detected by echocardiography, and in both carriers, focal fibrosis was present. CONCLUSIONS: In carriers who have not yet developed frank hypertrophy, crypts can be detected with CMR in the inferoseptal LV wall, even when echocardiography and ECG are normal. The crypts might represent one of the early pathological alterations of myocardium in carriers that ultimately progress into manifest HCM.

Adult↗
PubMed2006

Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis.

AIMS: Alcohol septal ablation (ASA) has been successful in the treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study is to evaluate the effects of ethanol-induced myocardial infarcts on regional myocardial function using cardiac magnetic resonance (CMR) tissue tagging and 3-dimensional (3D) strain analysis. METHODS AND RESULTS: In nine patients (age 52+/-15 years) who underwent ASA, CMR was performed prior to and 6 months after the procedure. Regional myocardial mass was evaluated using cine imaging. Myocardial tagging was used to calculate systolic 3D myocardial strain values. These strain values were used to calculate the shortening index (SI), a robust parameter for myocardial contraction. Maximum end-systolic (ES) SI and systolic SI rate were quantified in three circumferential segments: septum, adjacent, and remote (lateral) myocardium. Compared with baseline, septal and non-septal mass decreased at follow-up (from 72+/-27 to 59+/-21 g; P=0.008 and from 131+/-34 to 109+/-30 g; P=0.008, respectively). In the septum, maximum ES SI and SI rate remained unchanged after ASA. In adjacent myocardium, ES SI remained unchanged, whereas SI rate improved (from -56.5+/-21.1 to -70.0+/-16.7%/s; P=0.02). Both ES SI and SI rate improved significantly in remote myocardium (from -16.9+/-2.8 to -18.8+/-3.2%; P=0.02 and from -70.3+/-9.2 to -86.1+/-15.0%/s; P=0.01, respectively). CONCLUSION: Reduction of left ventricular (LV) outflow tract obstruction in symptomatic HOCM is associated with a significant reduction in myocardial mass and improvement of intramural systolic function in the lateral (remote) wall, indicating reversed LV remodelling.

Adolescent↗
PubMed2006

Myocardial strain and torsion quantified by cardiovascular magnetic resonance tissue tagging: studies in normal and impaired left ventricular function.

Accurate quantification and timing of regional myocardial function allows early identification of dysfunction, and therefore becomes increasingly important for clinical risk assessment, patient management, and evaluation of therapeutic efficacy. For this purpose, the application of tissue Doppler echocardiography has rapidly increased. However, echocardiography has some major inherent limitations. Cardiovascular magnetic resonance imaging with tissue tagging provides highly reproducible data on myocardial function, not only in longitudinal and radial directions, but also in the circumferential direction. Because of the development of faster imaging protocols, improved temporal resolution, less time-consuming postprocessing procedures, and the potential of quantifying myocardial deformation in 3 dimensions at any point in the heart, this technique may serve as an alternative for tissue Doppler echocardiography and is now ready for more widespread clinical use. This review discusses the clinical use of cardiovascular magnetic resonance tissue tagging for quantitative assessment of regional myocardial function, thereby underlining the specific features and emerging role of this technique.

Heart↗
PubMed2006

Clinical applications of cardiovascular magnetic resonance imaging.

Cardiovascular magnetic resonance imaging (MRI) has evolved from an effective research tool into a clinically proven, safe and comprehensive imaging modality. It provides anatomic and functional information in acquired and congenital heart disease and is the most precise technique for quantification of ventricular volumes, function and mass. Owing to its excellent interstudy reproducibility, cardiovascular MRI is the optimal method for assessment of changes in ventricular parameters after therapeutic intervention. Delayed contrast enhancement is an accurate and robust method used in the diagnosis of ischemic and nonischemic cardiomyopathies and less common diseases, such as cardiac sarcoidosis and myocarditis. First-pass magnetic contrast myocardial perfusion is becoming an alternative to radionuclide techniques for the detection of coronary atherosclerotic disease. In this review we outline the techniques used in cardiovascular MRI and discuss the most common clinical applications.

Cardiovascular Diseases↗
PubMed2006

DENSE and HARP: two views on the same technique of phase-based strain imaging.

PURPOSE: To discuss differences between displacement encoding with stimulated echoes (DENSE) and the harmonic phase (HARP) in imaging and reconstruction strategies. MATERIALS AND METHODS: HARP and DENSE are presented in their historical context: while the HARP method was developed from the framework of myocardial tagging, DENSE arose from the framework of stimulated echo and displacement encoding using bipolar gradients. Both techniques have evolved since their introduction, thereby becoming more similar over time and losing their distinct features. Newly introduced improvements have successfully been applied in both methods. Differences between both methods are discussed point by point. RESULTS: From this discussion it follows that almost all apparent differences are in fact nonexistent. CONCLUSION: In the literature, both techniques are still regarded as distinctly different techniques, where a more general treatment of the technique is justified. Once it is realized that both frameworks are easily merged, the benefits are 1) less confusion about the (dis)advantages of either technique, and 2) understanding of phase-based strain imaging that is more general than HARP or DENSE alone.

Algorithms↗
PubMed2006

Intracoronary infusion of autologous mononuclear bone marrow cells or peripheral mononuclear blood cells after primary percutaneous coronary intervention: rationale and design of the HEBE trial--a prospective, multicenter, randomized trial.

BACKGROUND: Recently, several preliminary reports have demonstrated that cell transplantation after acute myocardial infarction in humans is safe and leads to better preserved left ventricular function and improved myocardial perfusion and coronary flow reserve. METHODS: The HEBE trial is a multicenter, prospective, randomized, 3-arm open trial with blinded evaluation of end points. Patients with acute large myocardial infarction treated with primary percutaneous coronary intervention (PCI) will undergo magnetic resonance imaging (MRI) and echocardiography. A total of 200 patients are randomized to treatment with (1) intracoronary infusion of autologous mononuclear bone marrow cells, (2) intracoronary infusion of peripheral mononuclear blood cells, or (3) standard therapy. Mononuclear cells are isolated from bone marrow aspirate or venous blood by density gradient centrifugation. Within 7 days after PCI and within 24 hours after bone marrow aspiration or blood collection, a catheterization for intracoronary infusion of the mononuclear cells in the infarct-related artery is performed. In all patients, follow-up will be obtained at 1, 4, and 12 months. MRI and catheterization are repeated at 4 months, and all images are analyzed by a core laboratory blinded to randomization. The primary end point of the study is the change in regional myocardial function in dysfunctional segments at 4 months relative to baseline, based on segmental analysis as measured by MRI. IMPLICATIONS: If intracoronary infusion of autologous mononuclear bone marrow cells or peripheral mononuclear blood cells is proven to be beneficial after primary PCI; it could be a valuable tool in preventing heart failure-related morbidity and mortality after myocardial infarction.

Angioplasty, Balloon, Coronary↗
PubMed2006

Regional heterogeneity of resting perfusion in hypertrophic cardiomyopathy is related to delayed contrast enhancement but not to systolic function: a PET and MRI study.

BACKGROUND: Regional differences in resting myocardial blood flow (MBF) have been observed in patients with hypertrophic cardiomyopathy (HCM), but their determinants are currently unknown. This study verifies whether MBF at rest in HCM is related to delayed contrast enhancement (DCE) or regional systolic function (or both) as determined by magnetic resonance imaging. METHODS AND RESULTS: Fourteen patients with HCM were studied. MBF was measured with positron emission tomography by use of oxygen 15-labeled water. DCE and tissue tagging, to calculate end-systolic circumferential shortening (Ecc), were obtained with magnetic resonance imaging. The mean resting MBF was 0.78 +/- 0.19 mL x min(-1) x mL(-1), and there was a trend toward reduced MBF in the septum (0.72 +/- 0.11 mL x min(-1) x mL(-1)) compared with that in the lateral wall (0.84 +/- 0.29 mL x min(-1) x mL(-1)) (P = .092). The distribution patterns of DCE and Ecc were both heterogeneous, displaying significantly increased enhancement and impaired regional systolic function in the hypertrophic septum compared with the lateral wall (both P < .001). Resting MBF was inversely related to the extent of DCE (r = -0.30, P < .001), whereas MBF was not significantly related to Ecc (r = -0.15, P = .072). CONCLUSIONS: Regional heterogeneity of resting perfusion in HCM is related to the extent of DCE but not to regional systolic function.

Adult↗
PubMed2006

Does myocardial fibrosis hinder contractile function and perfusion in idiopathic dilated cardiomyopathy? PET and MR imaging study.

PURPOSE: To prospectively evaluate, by using positron emission tomography (PET) and magnetic resonance (MR) imaging, the interrelationships between regional myocardial fibrosis, perfusion, and contractile function in patients with idiopathic dilated cardiomyopathy (DCM). MATERIALS AND METHODS: The study protocol was approved by the hospital ethics committee, and all subjects gave written informed consent. Sixteen patients with idiopathic DCM (mean age, 54 years +/- 11 [standard deviation]; nine men) and six healthy control subjects (mean age, 28 years +/- 2; five men) were examined with PET and MR tissue tagging. Oxygen 15-labeled water and carbon monoxide were used as tracers at PET to assess myocardial blood flow (MBF) and the perfusable tissue index (PTI), which is inversely related to fibrosis. MBF was determined at rest and during pharmacologically induced hyperemia. Maximum circumferential shortening (E(cc)) was determined with MR tissue tagging. Student t tests were performed for comparison of data sets, and linear regression was used to investigate the association between parameters. RESULTS: Mean global hyperemic MBF (2.23 mL/min/mL +/- 0.73), E(cc) (-10.5% +/- 2.9), and PTI (0.95 +/- 0.10) were lower in the patients with DCM than in the control subjects (4.33 mL/min/mL +/- 0.85, -17.4% +/- 0.6, and 1.09 +/- 0.12, respectively; P < .05 for all). In the patients with DCM, regional PTI was related to E(cc) (r = -0.21, P = .009) but not to resting or hyperemic MBF. Furthermore, regional E(cc) was correlated to both resting (r = -0.28, P = .004) and hyperemic MBF (r = -0.29, P < .001). In addition, the ratio of left ventricular end-diastolic volume to mass, as a reflection of wall stress, was related to global hyperemic MBF (r = -0.52, P = .047) and to global E(cc) (r = 0.69, P = .003). CONCLUSION: In idiopathic DCM, the extent of myocardial fibrosis is related to the impairment in contractile function, whereas fibrosis and perfusion do not seem to be interrelated. The degree of impairment of hyperemic myocardial perfusion is related to contractility and end-diastolic wall stress.

Adult↗
PubMed2005

Propagation of onset and peak time of myocardial shortening in time of myocardial shortening in ischemic versus nonischemic cardiomyopathy: assessment by magnetic resonance imaging myocardial tagging.

OBJECTIVES: We aimed to study the relation between onset and peak time of circumferential shortening and the direction of propagation of these parameters in both ischemic and nonischemic patients. BACKGROUND: Peak time is often used to select patients for cardiac resynchronization therapy, whereas pacing influences only the onset times directly. Furthermore, it is unclear whether there is a consistent direction of propagation delay and whether this depends on the etiology. METHODS: Magnetic resonance imaging myocardial tagging with high temporal resolution (14 ms) was applied to 29 patients (18 nonischemic, 11 ischemic) and 17 healthy control subjects. Time to onset (T(onset)), to first peak (T(peak,first)), and to maximum peak (T(peak,max)) of circumferential shortening were determined. Three-dimensional vectors were calculated to denote the main direction of asynchrony. RESULTS: In both patient groups, T(onset) showed a significant positive relation with both T(peak,first) and T(peak,max); however, T(peak,first) correlated considerably better with T(onset) than did T(peak,max) (p < 0.0001 for nonischemic, and p < 0.01 for ischemic patients). Moreover, the relations between T(peak) and T(onset) were stronger in the nonischemic patients than in the ischemic patients (p < 0.001). In nonischemic patients, the propagation of T(onset) was consistently from septum to lateral wall. In the ischemic patients, however, no consistent direction of propagation was found. For both groups, the longitudinal propagation delays (between apex and base) were negligible compared with the short-axis delays. CONCLUSIONS: The relation between peak time and onset time of shortening is strongest in nonischemic patients and is most consistent when time to first peak is used (instead of time to maximum peak).

Aged↗
PubMed2005

Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging.

PURPOSE: To prospectively assess the effect of including or excluding endocardial trabeculae in left ventricular (LV) measurements and the reproducibility of these measurements at cine cardiovascular magnetic resonance (MR) imaging with true fast imaging with steady-state precession (FISP). MATERIALS AND METHODS: The study was approved by the local ethics committee, and each subject gave informed consent before participating. Twenty healthy subjects and 20 consecutive patients underwent 1.5-T cardiovascular MR imaging. Seven to 12 short-axis views encompassing the entire LV were acquired by using true FISP. Endocardial and epicardial contours were traced manually. The data sets in each patient were analyzed twice: with inclusion of endocardial trabeculae in the LV cavity volume and with exclusion of endocardial trabeculae from the cavity volume. On the basis of these two contour sets, the end-diastolic (ED) and end-systolic (ES) LV volumes, ejection fraction (EF), and LV mass were calculated. Additionally, interobserver and interexamination reproducibility was assessed by using Bland-Altman analysis. RESULTS: Compared with exclusion of trabeculae, inclusion of trabeculae in the LV cavity volume resulted in significantly larger ED and ES LV volumes (mean differences, 21 mL +/- 11 [standard deviation] and 19 mL +/- 33, respectively; P < .001) and lower EFs (mean difference, -2% +/- 2; P < .001). The calculated LV mass was significantly smaller with inclusion than with exclusion of trabeculae (mean difference, -21 g +/- 12; P < .001). All interobserver and interexamination limits of agreement based on inclusion of trabeculae, except those for EF measurements, were superior to those based on exclusion of trabeculae. At measurement reproducibility comparisons, differences in interobserver ED LV volume and LV mass and interexamination LV mass were statistically significant, favoring the inclusion of trabeculae in the LV cavity volume. CONCLUSION: Trabeculae significantly affect quantifications of LV volume and mass. The superior reproducibility of LV measurements with the inclusion of endocardial trabeculae in the cavity volume favors this tracing algorithm for clinical use.

Adult↗
PubMed2005

Early onset and progression of left ventricular remodeling after alcohol septal ablation in hypertrophic obstructive cardiomyopathy.

BACKGROUND: Alcohol septal ablation (ASA) reduces left ventricular outflow tract (LVOT) pressure gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM), which leads to left ventricular remodeling. We sought to describe the early to midterm changes and modulating factors of the remodeling process using cardiac MRI (CMR). METHODS AND RESULTS: CMR was performed at baseline and 1 and 6 months after ASA in 29 patients with HOCM (age 52+/-16 years). Contrast-enhanced CMR showed no infarct-related hyperenhancement outside the target septal area. Septal mass decreased from 75+/-23 g at baseline to 68+/-22 and 58+/-19 g (P<0.001) at 1- and 6-month follow-up, respectively. Remote, nonseptal mass decreased from 141+/-41 to 132+/-40 and 111+/-27 g (P<0.001), respectively. Analysis of temporal trends revealed that septal mass reduction was positively associated with contrast-enhanced infarct size and transmural or left-sided septal infarct location at both 1 and 6 months. Remote mass reduction was associated with infarct location at 6 months but not with contrast-enhanced infarct size. By linear regression analysis, percentage remote mass reduction correlated significantly with LVOT gradient reduction at 6-month follow-up (P=0.03). CONCLUSIONS: Left ventricular remodeling after ASA occurs early and progresses on midterm follow-up, modulated by CMR infarct size and location. Remote mass reduction is associated with infarct location and correlates with reduction of the LVOT pressure gradient. Thus, myocardial hypertrophy in HOCM is, at least in part, afterload dependent and reversible and is not exclusively caused by the genetic disorder.

Adult↗
PubMed2005

Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR.

PURPOSE: To evaluate a standardized definition of delayed hyperenhancement in the analysis of contrast-enhanced cardiac magnetic resonance (ceCMR) imaging. PATIENTS AND METHODS: CeCMR was performed in 15 patients with chronic ischemic heart disease. Delayed hyperenhancement was analyzed both by visual analysis by an experienced team of observers, and after thresholding the window setting of the images at 2, 3, 4, 5, and 6 SD above the mean signal intensity of remote, normal myocardium in the same slice. In each patient, total infarct size (TIS) and segmental infarct extent (SIE) were calculated. RESULTS: TIS and SIE were 22.9 +/- 12.2 mL and 32 +/- 28% after visual analysis. Thresholding the window setting at 2, 3, 4, and 6 SD above signal intensity of remote caused a 40%, 31%, and 17% increase (p < 0.007) and a 7% decrease (p = NS) in TIS, and a 75%, 41%, and 16% increase and 22% decrease in SIE (p < 0.001), respectively. There was no difference between visual analysis and analysis after thresholding at 5 SD. CONCLUSION: Analyzing ceCMR with a standardized definition of hyperenhancement related to the signal of remote, nonenhanced myocardium may result in considerable overestimation of infarct size at the usual cut-off of 2 SD.

Contrast Media↗
PubMed2005

Delayed contrast enhancement and perfusable tissue index in hypertrophic cardiomyopathy: comparison between cardiac MRI and PET.

UNLABELLED: Delayed contrast enhancement (DCE) visualized by cardiac MRI (CMR) is a common feature in patients with hypertrophic cardiomyopathy (HCM), presumed to be related to myocardial fibrosis. The pathophysiologic basis of hyperenhancement in this patient group, however, remains unclear as limited histologic comparisons are available. The present study compares the perfusable tissue index (PTI), an alternative marker of myocardial fibrosis obtained by PET, with DCE-CMR in HCM. METHODS: Twenty-one patients with asymmetric septal HCM, 12 chronic myocardial infarction (MI) patients, and 6 age-matched healthy control subjects were studied with DCE-CMR and PET. PET was performed using (15)O-labeled water and carbon monoxide to obtain the PTI. RESULTS: No hyperenhancement was observed in control subjects and the PTI was within normal limits (1.10 +/- 0.07 [mean +/- SD]). In MI patients, the extent of hyperenhancement (25% +/- 16% [mean +/- SD]) was inversely related to the decrease in the PTI (0.94 +/- 0.12; r = -0.65, P < 0.05). Average hyperenhancement in HCM was 14% +/- 12%, predominantly located in the interventricular septum. The PTI in the hypertrophied interventricular septum, however, was not reduced (1.12 +/- 0.13). Furthermore, in contrast to MI patients, there was a modest positive correlation between the extent of DCE and the PTI in HCM (r = 0.45, P < 0.05). CONCLUSION: DCE in the hypertrophied septum of HCM patients is not accompanied by a decline in the PTI, and there is a positive correlation between the extent of DCE and the PTI. These results suggest that hyperenhancement may not be caused solely by fibrotic replacement scarring in this patient group. Other pathologic changes associated with HCM may also cause gadolinium-diethylenetriaminepentaacetic acid hyperenhancement.

Adult↗
PubMed2004

Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging.

OBJECTIVES: The aim of this study was to evaluate myocardial infarction induced by percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy using contrast-enhanced (CE) magnetic resonance imaging (MRI). BACKGROUND: Contrast-enhanced MRI delineates the extent of myocardial infarction in coronary artery disease, but its role in ethanol-induced infarction has not been established. METHODS: Cine and CE MRI were performed before and one month after PTSMA in 24 patients. Size and location of the induced infarction were related to left ventricular (LV) mass reduction, enzyme release, volume of ethanol administered, LV outflow tract gradient reduction, and coronary ablation site. RESULTS: One month after PTSMA, regional hyperenhancement was visualized in the basal interventricular septum in all patients. Mean infarction size was 20 +/- 9 g, corresponding to 10 +/- 5% and 31 +/- 16% of total LV and septal mass, respectively. Total LV mass decreased from 219 +/- 64 to 205 +/- 64 g (p < 0.01), and septal mass from 76 +/- 25 to 68 +/- 22 g (p < 0.01). Total LV mass reduction exceeded septal mass reduction (p < 0.01). Infarction size correlated with peak creatine phosphokinase-MB (beta = 0.67, p < 0.01), volume of ethanol administered (beta = 0.47, p = 0.02), total LV and septal mass reduction (beta = 0.50, p = 0.02; beta = 0.73, p < 0.01), and gradient reduction (beta = 0.63, p < 0.01). Seven patients with exclusively right-sided septal infarction had smaller infarction size and less gradient reduction than remaining patients with left-sided or transmural infarction (p < 0.01). In five of these, PTSMA was performed distal in the target artery. CONCLUSIONS: Contrast-enhanced MRI allowed detailed evaluation of size and location of septal myocardial infarction induced by PTSMA. Infarction size correlated well with clinical indexes of infarct size.

Cardiac Catheterization↗