Left ventricular longitudinal systolic function after alcohol septal ablation for hypertrophic obstructive
Anders Sommer1, Steen Hvitfeldt Poulsen, Jens Mogensen
1Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. a.knudsen@dadlnet.dk
Insights
Transcoronary ablation of septal hypertrophy (TASH) reduces left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy (HOCM). However, TASH does not improve overall longitudinal systolic strain, suggesting HOCM is a primary myocardial disease.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Function
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by impaired myocardial function.
- Left ventricular (LV) longitudinal systolic function is crucial for cardiac output.
- Assessing myocardial function pre- and post-intervention is vital for HOCM management.
Purpose of the Study:
- To evaluate changes in LV longitudinal systolic myocardial function after transcoronary ablation of septal hypertrophy (TASH) in HOCM patients.
- To compare myocardial function before and after TASH using speckle tracking analysis.
- To investigate the impact of TASH on LV mass and LV outflow tract (LVOT) gradients.
Main Methods:
- Serial two-dimensional (2D) echocardiograms were analyzed using speckle tracking.
- LV longitudinal systolic strain was measured in patients with HOCM before and up to 36 months after TASH.
- LV mass and LVOT gradients were assessed to evaluate procedural success.
Main Results:
- Overall LV longitudinal systolic strain was reduced in HOCM patients, despite normal ejection fraction (EF).
- TASH significantly reduced LV mass and LVOT gradients, but did not improve average LV longitudinal systolic strain.
- Longitudinal systolic strain improved in basal LV segments remote from the ablation site, but not in alcohol-treated septal segments.
Conclusions:
- LV longitudinal myocardial systolic function is depressed in HOCM, independent of EF.
- TASH effectively reduces LVOT obstruction but does not enhance overall LV longitudinal systolic 2D strain.
- The lack of improvement in global systolic function post-TASH, unlike after aortic valve replacement, may indicate HOCM as a primary myocardial disease.
Aims:
To examine left ventricular (LV) longitudinal systolic myocardial function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH).
Methods And Results:
Twenty-three of 39 consecutive patients with HOCM had serial two-dimensional (2D) echocardiograms available for speckle tracking analyses before and up to 36 months after TASH. Before TASH, overall LV myocardial longitudinal systolic 2D strain was decreased despite normal LV ejection fraction (EF). A significant reduction of LV mass and left ventricular outflow tract (LVOT) gradients occurred during long-term follow-up after TASH, but this was not accompanied by improvement of average LV longitudinal systolic strain. However, in the basal LV segments remote to the site of alcohol injection longitudinal systolic strain increased [baseline: -13.1 ± 5.4%; 1 month: -16.0 ± 5.5% (NS); 12 months: -16.5 ± 4.9% (P < 0.05 vs. baseline); 36 months: -17.4 ± 4.2% (P < 0.01 vs. baseline)]. In contrast, the alcohol-treated basal segments of the septum and adjacent myocardium showed unchanged strain over time.
Conclusion:
Average LV longitudinal myocardial systolic function is depressed in HOCM despite normal LV EF. TASH-induced reduction of the LVOT obstruction does not improve average LV longitudinal systolic 2D strain. This is in contrast to global improvement of longitudinal systolic function after valve replacement in aortic valve stenosis. The discrepancy may be caused by the fact that HOCM is a primary myocardial disease.
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