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Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy

Travis J Moss1, Mori J Krantz2, Matthew M Zipse1

  • 1Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

The American Journal of Cardiology
|March 1, 2014
PubMed

Insights

Alcohol septal ablation (ASA) for hypertrophic cardiomyopathy (HC) preserves left ventricular (LV) systolic function in most patients. This treatment effectively reduces LV outflow tract obstruction and improves symptoms, with only mild LV dysfunction observed in a small minority.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Alcohol septal ablation (ASA) is a treatment for symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction.
  • ASA intentionally creates a myocardial infarct, raising concerns about potential long-term decline in LV systolic function.

Purpose of the Study:

  • To evaluate the longitudinal changes in LV systolic function and other echocardiographic parameters in patients undergoing ASA for symptomatic HC.

Main Methods:

  • A cohort of 145 consecutive patients with HC who underwent 167 ASA procedures between 2002 and 2011 were studied.
  • Echocardiographic follow-up, including LV ejection fraction (LVEF), mitral regurgitation, and LVOT gradients, was performed on 139 patients (96%) over a mean of 3.1 years.

Main Results:

  • LV ejection fraction (LVEF) was preserved in 97.1% of patients, with only 4 patients (2.9%) developing mild LV systolic dysfunction (LVEF 44-54%).
  • Significant improvements were observed in mitral regurgitation severity (67% improved), resting LVOT gradient (75 to 19 mm Hg), provoked LVOT gradient (101 to 33 mm Hg), and New York Heart Association class (2.9 to 1.3).

Conclusions:

  • Alcohol septal ablation for symptomatic HC results in only mild reduction of LV systolic function in a minority of patients.
  • The procedure leads to significant improvements in echocardiographic and functional parameters, supporting its role in managing HC.

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