Echocardiographic examination before alcohol septal ablation for hypertrophic obstructive cardiomyopathy can predict residual pressure gradient
Abstract
Background: Alcohol septal ablation is an effective procedure in the treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. Objectives: We sought to assess the capability of echocardiographic parameters in predicting the left ventricular outflow pressure gradient six months after alcohol septal ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).
Methods: The group consists of 29 consecutive patients with symptomatic HOCM (17 women, mean age 54 +- 14 years) enrolled for an echocardiography-guided PTSMA procedure. Clinical and echocardiographic data were collected at baseline and at six months after PTSMA.
Results: At six-month follow-up, both the maximal resting pressure gradient and the isosorbide dinitrate-provoked gradient decreased significantly (69 +- 44 to 19 +- 17 mm Hg and 111 +- 53 to 25 +- 22 mm Hg, respectively; p < 0.01). Left ventricular remodelling was associated with significant left ventricular dilatation (LVd) (p < 0.05), decrease in left ventricular ejection fraction (LVEF) (p < 0.01) and baseline interventricular septal thickness (IVSd) (p < 0.01).
All patients reported an improvement of dyspnea and angina pectoris at follow-up (p < 0.01). There were statistically significant correlations between outflow pressure gradients at follow-up and baseline LVd (r = - 0.52; p < 0.01), IVSd (r = 0.50; p < 0.01) and LVEF (r = 0.44; p < 0.05).
Stepwise regression analysis showed statistical dependence of the outflow pressure gradient at follow-up on two baseline echocardiographic predictors: IVSd and LVd (r = 0.62, p = 0.002). Conclusions: PTSMA is an effective method in the treatment of symptomatic patients with HOCM resulting in symptomatic improvement and left ventricular remodelling.
Results of our study suggest that the hemodynamic effect of PTSMA could be predicted by baseline echocardiographic evaluation of IVSd and LVd.