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Immediate improvement in coronary flow reserve after alcohol septal ablation in patients with hypertrophic
W A Jaber1, E H Yang, R A Nishimura
1Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Insights
Percutaneous alcohol septal ablation significantly improves coronary flow reserve (CFR) in patients with hypertrophic cardiomyopathy (HCM). This procedure normalizes reduced CFR, likely due to improved systolic coronary flow after reducing the outflow tract gradient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Hypertrophic cardiomyopathy (HCM) is associated with impaired coronary flow reserve (CFR).
- The impact of septal ablation on CFR in HCM remains incompletely understood.
Purpose of the Study:
- To investigate the effect of percutaneous alcohol septal ablation on coronary flow reserve (CFR) in patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM).
Main Methods:
- Coronary flow reserve (CFR) was measured immediately before and after septal ablation in patients with symptomatic obstructive HCM.
- CFR was also assessed in age-matched normal subjects for comparison.
Main Results:
- Patients with HCM exhibited lower baseline CFR, higher coronary resistance, and altered diastolic/systolic velocity ratios compared to normal subjects.
- Septal ablation successfully reduced the outflow tract gradient and led to immediate normalization of CFR and diastolic/systolic velocity ratios.
- Ablation also increased coronary resistance, potentially due to improved systolic coronary flow.
Conclusions:
- Successful septal ablation in patients with symptomatic HCM results in an immediate improvement in CFR.
- Reduced CFR in HCM may be partly attributed to increased systolic contraction load, which is alleviated by septal ablation.
Objectives:
To examine whether percutaneous alcohol septal ablation affects coronary flow reserve (CFR) in patients with hypertrophic cardiomyopathy (HCM).
Methods:
CFR was measured immediately before and after septal ablation in patients with symptomatic obstructive HCM. CFR was also obtained in normal subjects (NL) for comparison.
Results:
Patients with HCM (n = 11), compared with NL (n = 22), had a lower mean (SD) baseline CFR (1.96 (0.5) vs 3.0 (0.7), p<0.001), a lower coronary resistance (1.04 (0.45) vs 3.0 (2.6), p = 0.002), a higher coronary diastolic/systolic velocity ratio (DSVR; 5.1 (3.0) vs 1.8 (0.5), p = 0.04) and a lower hyperaemic coronary flow per left ventricular (LV) mass (0.73 (0.4) vs 1.1 (0.6) ml/min/g, p = 0.007). Septal ablation in the HCM group (n = 7) reduced the outflow tract gradient but not the left atrial or LV diastolic pressures. Ablation resulted in immediate normalisation of CFR (to 3.1 (1), p = 0.01) and DSVR (to 1.9 (0.8), p = 0.09) and an increase in coronary resistance (to 1.91 (0.6), p = 0.02). This was probably related to an improvement in the systolic coronary flow.
Conclusions:
This study demonstrates that successful septal ablation in patients with symptomatic HCM results in immediate improvement in CFR, which is reduced in HCM partly because of the increased systolic contraction load.
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