Related Experiment Video
Updated: Nov 8, 2025
Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Hemodynamic change in patients with hypertrophic obstructive cardiomyopathy before and after alcohol septal ablation
Kenichiro Suwa1, Keitaro Akita2, Keisuke Iguchi2
1Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan. k-suwa@hama-med.ac.jp.
Insights
Alcohol septal ablation (ASA) reduces abnormal blood flow patterns in the ascending aorta (AAO) and left ventricle (LV) of hypertrophic obstructive cardiomyopathy (HOCM) patients. These hemodynamic changes correlate with reduced pressure gradients post-procedure.
Area of Science:
- Cardiovascular Imaging
- Hemodynamics
- Interventional Cardiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by abnormal hemodynamics.
- Alcohol septal ablation (ASA) is a treatment for drug-refractory HOCM.
- Understanding hemodynamic changes post-ASA is crucial for patient management.
Purpose of the Study:
- To evaluate changes in ascending aorta (AAO) and intra-left ventricle (LV) flow after ASA using 4D flow MRI.
- To correlate hemodynamic changes with peak pressure gradient (PPG) reduction.
Main Methods:
- Retrospective observational study of 11 HOCM patients.
- 4D flow MRI performed before and 1 week after ASA.
- Analysis of AAO vortex/helix flow and LV anterior vortex size.
- Correlation analysis between hemodynamic changes and PPG.
Main Results:
- ASA significantly reduced AAO vortex/helix flow incidence, duration, and phase count.
- LV anterior vortex area significantly increased post-ASA.
- Changes in AAO vortex/helix flow phase count correlated significantly with PPG reduction.
Conclusions:
- ASA alters hemodynamics, decreasing AAO flow abnormalities and increasing LV vortex flow.
- 4D flow MRI can detect these aberrant hemodynamic changes in HOCM patients post-ASA.
Background:
The hemodynamics in the left ventricle (LV) and the ascending aorta (AAO) before and after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) is elucidated. Our objective was to evaluate the pattern changes in AAO and intra-LV flow assessed by four-dimensional (4D) flow magnetic resonance imaging (MRI) before and after ASA and to clarify the association between 4D flow MRI-derived hemodynamic characteristics and the peak pressure gradient (PPG) in patients with drug-refractory HOCM.
Methods:
In this retrospective observational study, 11 patients with HOCM underwent 4D flow MRI before and a week after ASA. The 4D flow MRI included blood flow visualization and quantification using streamline images. The combined score of vortex and helix in AAO was analyzed. The duration and phase count of the AAO vortex or helix flow and the size of the intra-LV anterior vortex were quantified. The correlation between the changes in hemodynamics and the resting PPG at LV outflow tract was also analyzed. We used the paired t-test for the comparison between before and after ASA and the Pearson's correlation coefficient for the analysis.
Results:
The combined score for the incidence of vortex and/or helix flow in AAO after ASA was significantly lower than that before ASA (1.45 ± 0.52 vs. 1.09 ± 0.30, p = 0.046). The duration (744 ± 291 ms vs. 467 ± 258 ms, p < 0.001) and phase count (14.8 ± 4.4 phases vs. 10.5 ± 5.8 phases, p < 0.001) of the vortex or helix flow in AAO were significantly decreased after ASA. The LV anterior vortex area after ASA was significantly larger than that before ASA (1628 ± 420 mm2 vs. 2974 ± 539 mm2, p = 0.009). The delta phase count of the AAO vortex or helix before and a week after ASA was significantly correlated with delta PPG before and a week after ASA (R = 0.79, p = 0.004) and with delta PPG before and 6 months after ASA (R = 0.83, p = 0.002).
Conclusions:
Lower vortex or helix flow in AAO and larger diastolic vortex flow in LV were observed after ASA, which suggests the possibility to detect the changes of aberrant hemodynamics in HOCM.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
09:23Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension
Published on: February 11, 2017
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management