title: Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy.
abstract: Because alcohol septal ablation (ASA) for the treatment of symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction results in a myocardial infarct of up to 10% of ventricular mass, LV systolic function could decline over time. We evaluated LV function during longitudinal follow-up in a cohort of patients who underwent ASA. We studied 145 consecutive patients with HC that underwent 167 ASA procedures from 2002 to 2011. Echocardiographic follow-up was available in 139 patients (96%). Echocardiographic indexes included LV ejection fraction (LVEF), mitral regurgitation severity, systolic anterior motion of the anterior mitral leaflet, and resting and provoked LVOT gradients. All patients had a baseline LVEF of >55%. LVEF was preserved in 97.1% of patients over a mean follow-up time of 3.1±2.3 years (maximum 9.7). Mild LV systolic dysfunction was observed (LVEF range 44% to 54%) in only 4 patients. Mitral regurgitation severity improved in 67% (n=112 of 138 with complete data). Resting LVOT gradient declined from a mean of 75 to 19 mm Hg (p<0.001), and provoked gradient declined from a mean of 101 to 33 mm Hg (p<0.001). New York Heart Association class improved from a mean of 2.9±0.4 to 1.3±0.5 (p<0.001). In conclusion, LV systolic function is only mildly reduced in a minority of patients after ASA for symptomatic HC; other echocardiographic and functional measures were significantly improved.
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Moss
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiology Division, Denver Health Medical Center, Denver, Colorado.
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Zipse
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Quaife
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Bertron M
authors.initials: BM
authors.lastname: Groves
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Ernesto E
authors.initials: EE
authors.lastname: Salcedo
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiology Division, Denver Health Medical Center, Denver, Colorado. Electronic address: joseph.schuller@ucdenver.edu.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Schuller
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004452:Echocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012997:Solvents / Q000008:administration & dosage; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D012997:Solvents; D000431:Ethanol