title: Effect of alcohol septal ablation in patients with hypertrophic cardiomyopathy on left-ventricular mechanical dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging.
abstract: Patients with hypertrophic cardiomyopathy (HCM) may have delayed septal activation and left ventricular (LV) mechanical dyssynchrony, and may improve after alcohol septal ablation (ASA). This study used phase analysis of gated SPECT myocardial perfusion imaging (MPI) to evaluate septal activation and LV dyssynchrony in HCM patients pre- and post-ASA. Phase analysis was applied to 28 controls, and 32 HCM patients having rest MPI pre- and post-ASA to assess septal-lateral mechanical activation delay (SLD) and consequent LV dyssynchrony. In addition, phase analysis was applied to another group of 30 patients having serial MPI to measure variability of the LV dyssynchrony parameters on serial studies. ASA significantly reduced SLD and improved LV synchrony in the HCM patients with SLD < 0° due to earlier activation of the lateral wall relative to the septum. Based on the measured variability, 12 HCM patients had significant (Z < -1.65, P < 0.05) and 4 had moderate (Z < -1.00, P < 0.15) improvement in LV synchrony post-ASA. SLD < 0° predicted improvement in LV synchrony after ASA with a sensitivity of 81% and a specificity of 88%. SLD and LV dyssynchrony were frequent in HCM patients. HCM patients, whose septal activation became later than lateral activation, had significant reduction in septal activation delay and improvement in LV synchrony after ASA.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322, USA. jchen22@emory.edu
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
authors.forename: Hosakote
authors.initials: H
authors.lastname: Nagaraj
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhambhani
authors.forename: Dustin E
authors.initials: DE
authors.lastname: Kliner
authors.forename: Prem
authors.initials: P
authors.lastname: Soman
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Jaekyeong
authors.initials: J
authors.lastname: Heo
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left
chemical_list: D000431:Ethanol