Cardiomyopathy
Biventricular Reverse Remodeling After Successful Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2014.11.030Get rights and content

The aim of the present study was to investigate the long-term effects of alcohol septal ablation (ASA) on left ventricular (LV) and right ventricular (RV) remodeling in patients with obstructive hypertrophic cardiomyopathy (HC) using cardiovascular magnetic resonance (CMR). CMR was performed at baseline and 16 months after ASA in 38 patients with obstructive HC (mean age 48 ± 9 years) despite optimal medical treatment. ASA resulted in significant reductions of LV outflow tract gradient (mean 89 ± 22 vs 24 ± 12 mm Hg, p <0.001) and improvements in New York Heart Association functional class (p <0.001) during the follow-up period. LV remote mass and septal mass decreased from 98.34 ± 37.02 to 84.23 ± 34.71 g and from 77.56 ± 16.40 to 68.43 ± 14.02 g, respectively (p <0.001 for both) at 16-month follow-up. There were significant reductions of RV mass (mean 53.69 ± 7.12 vs 47.49 ± 6.17 g, p <0.001) and improvements in RV end-diastolic volume (mean 110.58 ± 22.47 vs 124.22 ± 24.17 ml, p <0.001) and the RV ejection fraction (p <0.001) during 16-month follow-up. Linear regression analysis showed that LV outflow tract gradient reduction was correlated significantly with LV remote mass reduction (r = 0.475, p = 0.003) and RV mass reduction (r = 0.535, p = 0.001) at 16-month follow-up. In conclusion, successful ASA can lead to positive biventricular reverse remodeling, showing significant reductions of RV and LV mass as well as increased RV and LV end-diastolic volumes during follow-up.

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Methods

The study protocol was approved by the Institutional Ethics Committee of Fuwai Hospital. All patients gave informed consent before enrollment in the study. We studied 38 patients with obstructive HC who underwent ASA procedures from August 2005 to December 2012. Indications for ASA included severe, drug-refractory, New York Heart Association functional class III or IV heart failure with an LVOT gradient >50 mm Hg at rest or >100 mm Hg during provocation.11 No patients had previous surgical

Results

The study cohort had a mean age of 48 ± 9 years, and 28 of the 38 patients (74%) were men. Thirteen patients (34%) had angina pectoris, 8 (21%) had syncope, 29 (76%) had New York Heart Association functional class III or IV symptoms, and 8 (21%) had family histories of HC or sudden cardiac death (Table 1). The median follow-up time was 16 months (range 9 to 39).

ASA resulted in significant reductions of LVOT gradient at rest in all patients. The mean LVOT gradient decreased from 89 ± 22 to 34 ±

Discussion

In this study, we demonstrated LV and RV reverse remodeling after successful ASA, evidenced by the reductions of RV and LV mass as well as increased RV and LV end-diastolic volumes. Also, LVOT gradient reduction was correlated significantly with reductions in LV remote mass and RV mass during the 16-month follow-up. Furthermore, the reverse biventricular remodeling was accompanied by an improvement in functional status, evidenced by improvement in New York Heart Association functional class and

Acknowledgment

The authors thank Medis Medical Imaging Systems and QMass Software (version 7.6) for their support.

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