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Effect of successful alcohol septal ablation on microvascular function in patients with obstructive hypertrophic

Osama I I Soliman1, Marcel L Geleijnse, Michelle Michels

  • 1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.

The American Journal of Cardiology
|April 26, 2008
PubMed

Insights

Percutaneous transluminal septal myocardial ablation (PTSMA) in hypertrophic cardiomyopathy (HC) reduces obstruction and improves microvascular dysfunction. This procedure alleviates extravascular compression, enhancing myocardial blood flow in HC patients.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Obstructive hypertrophic cardiomyopathy (HC) is characterized by microvascular dysfunction.
  • This dysfunction is linked to extravascular compression caused by increased left ventricular (LV) mass and elevated LV end-diastolic pressure.

Purpose of the Study:

  • To investigate if percutaneous transluminal septal myocardial ablation (PTSMA) improves microvascular dysfunction in obstructive HC.
  • To determine if PTSMA relieves extravascular compression, thereby improving intramyocardial flow dynamics.

Main Methods:

  • The study included 14 patients with obstructive HC and 14 healthy volunteers.
  • LV hemodynamics and intramyocardial flow dynamics were assessed using Doppler echocardiography and adenosine myocardial contrast echocardiography before and 6 months after PTSMA.
  • LV end-diastolic pressure was estimated using transmitral early LV filling velocity to early diastolic mitral annular velocity ratio.

Main Results:

  • PTSMA significantly reduced LV outflow tract gradient and LV end-diastolic pressure.
  • Six months post-PTSMA, myocardial flow reserve improved but did not normalize compared to controls.
  • Septal hyperemic endo-to-epi myocardial blood flow ratio also showed significant improvement.

Conclusions:

  • PTSMA improves microvascular dysfunction in obstructive HC by relieving extravascular compression.
  • The observed improvements in myocardial blood flow correlate with reductions in LV end-diastolic pressure, LV mass index, and LV outflow tract gradient.

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