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Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: Long-Term Follow-Up of Deformations and
Kenichiro Suwa1, Kazuto Ohno1, Terumori Satoh1
1Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Insights
Alcohol septal ablation (ASA) improves heart function in hypertrophic obstructive cardiomyopathy (HOCM) patients, enhancing systolic and diastolic performance. Cardiac MRI reveals these benefits, showing improved LV function and associated diastolic vortex changes.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Research
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) pathophysiology requires detailed hemodynamic and morphologic evaluation.
- Alcohol septal ablation (ASA) is a treatment for HOCM, necessitating assessment of its effects.
Purpose of the Study:
- To investigate global cardiac volume, myocardial deformation, and hemodynamics before and after ASA in HOCM patients.
- To assess long-term follow-up changes post-ASA using advanced MRI techniques.
Main Methods:
- Retrospective study of 23 HOCM patients undergoing MRI before and after ASA.
- Utilized 3T MRI with cine, inversion recovery-prepared fast gradient echo, and 4D flow sequences.
- Assessed global LV volume, myocardial strain (feature-tracking), and hemodynamics (4D flow MRI).
Main Results:
- Significant increase in global radial strain (16.6% to 20.1%) and decrease in global longitudinal strain (-10.5% to -12.1%) post-ASA.
- Significant increase in diastolic LV anterior vortex area after ASA (2256.1 to 3826.1 mm²).
- Correlation found between LV volume/deformation parameters and diastolic LV anterior vortex area (Rs=0.43).
Conclusions:
- Feature-tracking and 4D flow MRI demonstrate improved systolic and diastolic LV function after ASA.
- Diastolic LV vortex is linked to LV volume and deformation parameters.
- Comprehensive cardiac MRI aids in understanding the beneficial effects of ASA on HOCM.
Background:
A detailed evaluation of hemodynamics, supportive morphology, and deformation may help uncover the pathophysiology of hypertrophic obstructive cardiomyopathy (HOCM) and the changes wrought by alcohol septal ablation (ASA).
Purpose:
To investigate the global cardiac volume, myocardial deformation, and hemodynamic characteristics before and during long-term follow-up after ASA in patients with HOCM.
Study Type:
Retrospective.
Subjects:
Twenty-three patients (68.1 ± 8.6 years, 21.7% male) with HOCM who underwent MRI before and after ASA.
Field Strength/Sequence:
A 3T, Two-dimensional fast imaging employing steady-state acquisition, inversion recovery-prepared fast gradient echo sequences, and cine and time-resolved three-dimensional cine phase-contrast (4D flow) MRI.
Assessment:
Global left ventricular (LV) volume by cine, peak strain, and strain rate by myocardial feature-tracking MRI, and hemodynamic characteristics by 4D flow MRI.
Statistical Tests:
Paired t-test and Wilcoxon signed-rank test compared normally and nonnormally distributed data, respectively. Chi-squared or Fisher's exact tests were used to compare categorical data, as appropriate. Pearson's or Spearman's correlation coefficient evaluated the correlations. Statistical significance was set at q ≤ 0.10 or p < 0.05.
Results:
In LV long-axis images, the global radial strain increased significantly (16.6% ± 5.8% vs. 20.1% ± 6.8%), whereas the global longitudinal strain decreased significantly after ASA (-10.5% ± 3.2% vs. -12.1% ± 3.5%). The diastolic LV anterior vortex area increased significantly after ASA (2256.1 [703.6, 4038.4] vs. 3826.1 [1914.3, 4820.1] mm2). Multiplication of the LV end-diastolic volume index, global circumferential strain, and diastolic radial peak strain rate in LV long-axis images revealed a significant correlation with the diastolic LV anterior vortex area (Rs = 0.43).
Data Conclusions:
Feature-tracking and 4D flow MRI revealed improved systolic and diastolic LV function during long-term follow-up after ASA. The diastolic LV vortex was associated with the combined parameters of LV volume and deformation. Comprehensive cardiac MRI may help understand the beneficial effects of ASA.
Evidence Level:
3.
Technical Efficacy:
Stage 5.
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