How much alcohol should we infuse in the coronary artery of hypertrophic cardiomyopathy patients?
BACKGROUND
Although alcohol septal ablation (ASA) is increasingly used in hypertrophic cardiomyopathy (HC) patients who are refractory to medical therapy, the amount of alcohol that is required has not been well studied. This study sought to determine the amount of alcohol that is necessary to achieve clinical benefits of ASA.


METHODS
Myocardial perfusion imaging was used to determine the size of the myocardial infarction produced by ASA in 54 HC patients. Left ventricular outflow gradients (LVOTg) were determined invasively before and after ASA and by Doppler echocardiography before and at a median of 3 months after ASA.


RESULTS
LVOTg decreased at rest and after provocation in response to ASA and this was maintained on follow-up at 3 months. There was no relationship between the amount of alcohol infused and the infarct mass as determined by myocardial perfusion imaging. While the infarct mass was not correlated with the drop in the LVOTg at rest or with provocation, the quantity of alcohol infused was correlated with the drop in LVOTg at rest (r = 0.27, p = 0.05) and with provocation (r = 0.34, p = 0.02). Furthermore, infusing more than 2ml of absolute alcohol was associated with a drop in the LVOTg by more than 60 mmHg at rest (p = 0.02) and by more than 130 mmHg with provocation (p = 0.05).


CONCLUSIONS
Although lower amounts of alcohol infusion are desirable to avoid side-effects, it might be prudent to infuse around 2 ml of absolute alcohol in order to achieve the desirable degree of LVOTg reduction in ASA.
Aqel
Raed
R
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham Veterans Affairs Medical Center, Birmingham, AL 35294-0007, USA. raed.aqel@yahoo.com
Hage
Fadi G
FG
AlJaroudi
Wael
W
Lawson
David
D
Sweeney
Aaron
A
Hansalia
Sachin
S
Pothineni
Koteswara
K
Heo
Jaekyeong
J
Pajaro
Octavio
O
McGiffin
David
D
Dell'Italia
Louis
L
Iskandrian
Ami E
AE
D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D055414:Myocardial Perfusion Imaging; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
D000431:Ethanol