CardiomyopathyEffect of Successful Alcohol Septal Ablation on Microvascular Function in Patients With Obstructive Hypertrophic Cardiomyopathy
Section snippets
Methods
The study comprised 14 consecutive patients (mean age 55 ± 12 years, 11 men) with obstructive HC and normal epicardial coronary arteries who underwent successful PTSMA and 14 healthy volunteers (mean age 31 ± 4 years, 11 men) who served as a control group. All patients with HC were in New York Heart Association functional class III with or without angina pectoris and had a LV outflow tract peak systolic gradient ≥50 mm Hg at rest or provocation.
The study protocol consisted of clinical
Results
Baseline and 6 months post-PTSMA characteristics of the 14 patients with HC are summarized in Table 1. New York Heart Association functional class decreased from 3.0 ± 0.3 to 1.2 ± 0.4 (p <0.0001), and none of the patients had angina pectoris at 6-month follow-up after PTSMA. After-PTSMA medications such as β blockers and calcium antagonists were withheld in most patients.
Immediately after PTSMA, the invasive LV outflow tract peak systolic gradient decreased from 119 ± 35 to 17 ± 16 mm Hg (p
Discussion
The main finding of our study is that patients with obstructive HC and normal epicardial coronary arteries have impaired vasodilator reserve, in particular in the subendocardium, as evidenced by adenosine stress MCE. After successful PTSMA, a decrease in LV outflow tract peak systolic gradient, LV mass index, and LV end-diastolic pressure and an improvement in vasodilator reserve in noninfarcted myocardium, including the endo-to-epi ratio, were seen. The degree of reduction in LV outflow tract
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