title: Serial evaluations of myocardial infarct size after alcohol septal ablation in hypertrophic cardiomyopathy and effects of the changes on clinical status and left ventricular outflow pressure gradients.
abstract: Alcohol septal ablation (ASA) as a treatment for obstructive hypertrophic cardiomyopathy produces septal infarction. There is a concern that such infarcts could be detrimental. Changes in the size of these infarcts by serial perfusion testing have not been studied. We performed resting serial-gated single-photon emission computed tomographic myocardial perfusion imaging in 30 patients (age 51+/-17 years, 57% were women) who had ASA between September 2003 and March 2007 before, 2+/-0.8 days (early), and 8.4+/-6.9 months (late) after ASA. Patients were also followed clinically and with serial 2-dimensional echocardiography. New York Heart Association class decreased from 3.50+/-0.51 before to 1.14+/-0.36 (p<0.0001) 3 months after ASA. The left ventricular (LV) outflow gradient (by Doppler echocardiography) decreased from 63+/-32 mm Hg before to 28+/-23 mm Hg after ASA (p<0.005). None of the patients had perfusion defects at rest before ASA. After ASA, perfusion defect size, involving the basal septum, decreased from 9.4+/-5.8% early to 5.2+/-4.2% of LV myocardium late after ASA (p<0.001). There were no changes in LV size and ejection fraction after ASA. In conclusion, ASA produces small basal ventricular septal infarcts (resting perfusion abnormality) involving<10% of the LV myocardium (including ventricular septum). There is a significant reduction in the perfusion abnormality late after ASA without an increase in LV outflow obstruction or recurrence of symptoms.
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA. raed.aqel@med.va.gov
authors.forename: Raed A
authors.initials: RA
authors.lastname: Aqel
authors.forename: Fadi G
authors.initials: FG
authors.lastname: Hage
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Zohgbi
authors.forename: Paul B
authors.initials: PB
authors.lastname: Tabereaux
authors.forename: David
authors.initials: D
authors.lastname: Lawson
authors.forename: Jaekyeong
authors.initials: J
authors.lastname: Heo
authors.forename: Gilbert
authors.initials: G
authors.lastname: Perry
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell' Italia
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017725:Ventricular Pressure
chemical_list: D019275:Radiopharmaceuticals; D000431:Ethanol; D017256:Technetium Tc 99m Sestamibi