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Association between left ventricular reverse remodeling and long-term outcomes after alcohol septal ablation for

Fu-Jian Duan1, You-Zhou Chen2, Jian-Song Yuan3

  • 1Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Being, People's Republic of China.

The International Journal of Cardiovascular Imaging
|November 2, 2022
PubMed

Insights

Left ventricular reverse remodeling (r-LVR) after alcohol septal ablation (ASA) improves diastolic function and outcomes in hypertrophic obstructive cardiomyopathy (HOCM). Higher baseline left ventricular mass (LVM) predicts less r-LVR and poorer diastolic function post-ASA.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents challenges in managing left ventricular (LV) diastolic dysfunction.
  • Alcohol septal ablation (ASA) is a treatment option for HOCM, but its impact on LV reverse remodeling (r-LVR) and diastolic function requires further investigation.

Purpose of the Study:

  • To assess the effect of r-LVR on diastolic function and clinical outcomes following ASA in HOCM patients.
  • To identify predictors of r-LVR after ASA.

Main Methods:

  • Eighty-seven HOCM patients underwent echocardiography and cardiovascular magnetic resonance (CMR) imaging at baseline and 27 months post-ASA.
  • Patients were stratified into groups based on the degree of r-LVR.
  • Kaplan-Meier analysis and multivariable regression were used to evaluate outcomes and predictors.

Main Results:

  • Greater r-LVR correlated with significant LV mass regression and improved diastolic function (E/e') post-ASA.
  • Patients with lesser r-LVR experienced worse composite clinical events.
  • Preablation LV mass (LVM) was associated with a decreased likelihood of r-LVR and less diastolic function improvement.

Conclusions:

  • r-LVR is associated with improved long-term outcomes and diastolic function in HOCM patients treated with ASA.
  • Preablation LVM may hinder reverse remodeling, suggesting its potential role in risk stratification and prognosis after ASA.

Keywords:
Alcohol septal ablationHypertrophic obstructive cardiomyopathyPrognosisRemodeling

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