Cardiomyopathy
Follow-Up by Cardiac Magnetic Resonance Imaging in Patients With Hypertrophic Cardiomyopathy Who Underwent Percutaneous Ventricular Septal Ablation

https://doi.org/10.1016/j.amjcard.2010.07.017Get rights and content

To evaluate myocardial infarction and describe the early to mid-term changes induced by percutaneous ventricular septal ablation (PVSA) in symptomatic patients with hypertrophic cardiomyopathy using cardiac magnetic resonance imaging. Cardiac magnetic resonance imaging was performed before and 1 week and 1 year after PVSA in 52 patients. The relation between the infarction size and other factors was determined. At 1 week after PVSA, regional hyperenhancement was visualized in the basal interventricular septum in all patients. The mean infarction size was 29.5 ± 15.9 g. The infarction size correlated well with the ethanol volume. The left ventricular myocardial mass decreased significantly from 196.1 ± 65.9 g at baseline to 183.4 ± 63.6 g 1 week after PVSA (p <0.001) and 164.1 ± 60.9 g within the 1-year follow-up period (p <0.001). In conclusion, cardiac magnetic resonance imaging allowed a detailed evaluation of the size and location of septal myocardial infarction induced by PVSA. The left ventricular myocardial mass decreased significantly during the follow-up period.

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Methods

The study population included 57 patients with symptomatic HC despite optimal medical treatment. The study period was January 2005 to September 2008. All subjects demonstrated a dynamic LV outflow tract (LVOT) pressure gradient of ≥50 mm Hg at rest or 100 mm Hg on provocation. Patients with symptoms limiting daily activities (New York Heart Association or Canadian Cardiovascular Society functional class II or exercise-induced syncope), together with a substantial degree of outflow obstruction,

Results

The baseline characteristics of our patients are listed in Table 1. During the ablation procedure, ethanol was injected in 1 septal artery in 40 patients, 2 septal arteries were ablated in 8 patients, and 3 septal arteries in 3 patients. The mean amount of alcohol injected was 2.6 ± 1.3 ml. The creatine phosphokinase peak was 1,545.4 ± 685.3 U/L, the creatine kinase-MB fraction was 177.9 ± 82.5 U/L, and the lactate dehydrogenase peak was 682.3 ± 246.9 U/L. Two patients (3.8%) developed

Discussion

The range of myocardial infarction size was large (8.5 to 77.7 g). Factors that can influence the infarction size include differences in septal coronary anatomy, position of the inflated balloon within the target artery during ethanol infusion, and the ethanol volume administered. The ethanol volume administered is a very important factor in the PVSA procedure. It has been demonstrated that the amount of alcohol injected can influence the incidence of atrioventricular block.5 With guidance from

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This study was supported by the Youth Fund from the Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, People's Republic of China.

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