Minjie Lu1, Hui Du2, Zhan Gao2, Lei Song2, Huaibing Cheng2, Yan Zhang2, Gang Yin2, Xiuyu Chen2, Jian Ling2, Yong Jiang2, Hao Wang2, Jinghui Li2, Jinghan Huang2, Zuoxiang He2, Shihua Zhao1. 1. From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.). coolkan@163.com cjr.zhaoshihua@vip.163.com. 2. From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
Abstract
BACKGROUND: Alcohol septal ablation (ASA) is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe left ventricular outflow tract (LVOT) obstruction. The current recommendations restrict the procedure to adults with favorable anatomy and no other coexisting surgically amenable disease. Some patients remain symptomatic with residual LVOT obstruction, thus better patient selection is required. METHODS AND RESULTS: One-hundred and two consecutive subjects with hypertrophic obstructive cardiomyopathy who underwent cardiovascular magnetic resonance imaging, transthoracic echocardiography, and ASA were enrolled in this study. Successful ASA was defined as reduction of LVOT gradient ≥50% of baseline by echocardiographic follow-up 6 months post ASA. The relationships between segmental thickness assessed by cardiovascular magnetic resonance imaging and echocardiography and outcomes of ASA were compared between the 2 groups. The survival rate after ablation was 100% at 6-month follow-up. The LVOT gradient decreased ≥50% of baseline in 72% (73/102) patients. There were good correlations between the reduction of postoperative LVOT gradient and the thickness of basal anterior segment (r=0.371; P<0.001), basal anteroseptal segment (r=0.527; P<0.001), and total thickness of the above 2 segments (r=0.672; P<0.001). The area under the receiver operating curves were 0.68, 0.79 and 0.89 for predictive analysis (all P<0.001). The cutoff thickness of the segment 1+2 was 50.9 mm, which yielded a sensitivity of 86% and specificity of 77%. CONCLUSIONS: Both echocardiography and cardiovascular magnetic resonance imaging can be used effectively as noninvasive tools for patient selection for ASA procedure. A significantly thickened septum among hypertrophic obstructive cardiomyopathy patients may be associated with a poor outcome after ASA.
BACKGROUND:Alcohol septal ablation (ASA) is used for treatment of medically refractory hypertrophic obstructive cardiomyopathypatients with severe left ventricular outflow tract (LVOT) obstruction. The current recommendations restrict the procedure to adults with favorable anatomy and no other coexisting surgically amenable disease. Some patients remain symptomatic with residual LVOT obstruction, thus better patient selection is required. METHODS AND RESULTS: One-hundred and two consecutive subjects with hypertrophic obstructive cardiomyopathy who underwent cardiovascular magnetic resonance imaging, transthoracic echocardiography, and ASA were enrolled in this study. Successful ASA was defined as reduction of LVOT gradient ≥50% of baseline by echocardiographic follow-up 6 months post ASA. The relationships between segmental thickness assessed by cardiovascular magnetic resonance imaging and echocardiography and outcomes of ASA were compared between the 2 groups. The survival rate after ablation was 100% at 6-month follow-up. The LVOT gradient decreased ≥50% of baseline in 72% (73/102) patients. There were good correlations between the reduction of postoperative LVOT gradient and the thickness of basal anterior segment (r=0.371; P<0.001), basal anteroseptal segment (r=0.527; P<0.001), and total thickness of the above 2 segments (r=0.672; P<0.001). The area under the receiver operating curves were 0.68, 0.79 and 0.89 for predictive analysis (all P<0.001). The cutoff thickness of the segment 1+2 was 50.9 mm, which yielded a sensitivity of 86% and specificity of 77%. CONCLUSIONS: Both echocardiography and cardiovascular magnetic resonance imaging can be used effectively as noninvasive tools for patient selection for ASA procedure. A significantly thickened septum among hypertrophic obstructive cardiomyopathypatients may be associated with a poor outcome after ASA.