title: Improvement in exercise capacity and exercise blood pressure response after transcoronary alcohol ablation therapy of septal hypertrophy in hypertrophic cardiomyopathy.
abstract: Transcoronary alcohol ablation (TAA) therapy of septal hypertrophy was recently proposed as a therapeutic modality for obstructive hypertrophic cardiomyopathy (HC). However, questions remain about the effect of TAA on exercise performance. We performed a time-course analysis of exercise capacity and exercise hemodynamics in 20 patients with symptomatic obstructive HC after TAA. Symptom-limited bicycle exercise testing was performed before and 3 and 12 months after TAA, and cardiac catheterization at 3-month follow-up. The pressure gradient of the left ventricular outflow tract immediately decreased from 58 +/- 8 to 4 +/- 1 mm Hg at rest (p <0.01) and from 143 +/- 11 to 30 +/- 6 mm Hg after extrasystole (p <0.01), but partially recovered at 3-month follow-up (14 +/- 4 and 40 +/- 9 mm Hg, respectively). Left ventricular end-diastolic pressure was not changed after TAA. Peak oxygen consumption increased from 19 +/- 2 to 23 +/- 1 ml/kg/min (p < 0.01) and exercise duration from 573 +/- 47 to 742 +/- 46 seconds (p <0.01) at 3-month follow-up, but thereafter reached a plateau. Abnormal patterns of exercise blood pressure response were shown in 9 patients but normalized after TAA. Major complications occurred in 4 patients: no reflow to the left anterior descending coronary artery in 2 patients and ventricular tachycardia requiring cardioversion in 2 patients. During the follow-up period, all patients survived with symptomatic improvement in 17 patients. Thus, TAA is a promising therapeutic modality with improvement in exercise capacity and abnormal exercise blood pressure response in obstructive HC. However, potential serious complications should be considered in the application of TAA.
authors.affiliation: Department of Medicine, University of Ulsan, and the Sports Medicine Center, Asan Medical Center, Seoul, Korea.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
authors.forename: C W
authors.initials: CW
authors.lastname: Lee
authors.forename: S W
authors.initials: SW
authors.lastname: Park
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: H Y
authors.initials: HY
authors.lastname: Lim
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: Y S
authors.initials: YS
authors.lastname: Jin
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000431:Ethanol