title: Basal infarct location but not larger infarct size is associated with a successful outcome after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: a cardiovascular magnetic resonance imaging study.
abstract: Alcohol septal ablation (ASA) is successful in most but not in all patients with obstructive hypertrophic cardiomyopathy (HCM). We therefore sought to investigate the relation between infarct location versus infarct size with outcome after ASA in patients with obstructive HCM. Baseline characteristics, procedural characteristics, and cardiovascular magnetic resonance findings at baseline and 4-6 month follow-up after ASA were analysed in 47 patients with obstructive HCM in a single-center retrospective study. Infarct size was determined using late gadolinium enhancement. Infarct location was divided into "basal infarction" and "distal infarction" based on an optimal cut-of value of the distance from the basal septum to the beginning of the infarction. A "successful" outcome was defined as 80% reduction of the invasive gradient with a post-procedural gradient of <10 mmHg. Basal infarctions (n = 31) compared to distal infarctions (n = 16) were associated with successful outcome (100 vs. 38%, P < 0.001). Larger infarct size (n = 20) compared to smaller infarct size (n = 27) was not associated with successful outcome (75 vs. 82%, P = 0.72). A more distal location of the infarction, was the only predictor of a less successful outcome (odds ratio 0.76, 95% confidence interval 0.54-0.98, P = 0.03). Basal versus distal infarctions were also associated with a lower provoked gradient at late (2.6 ± 2.2 years) follow-up (11 (6-20) vs. 27 (12-94) mmHg, P = 0.01). Basal infarctions were associated with a successful outcome after ASA. A larger infarct size was not associated with a better outcome.
authors: Department of Cardiology, Martini Hospital, Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands, r.c.steggerda@mzh.nl.
authors: Robbert C
authors: RC
authors: Steggerda
authors: Christiane A
authors: CA
authors: Geluk
authors: Wessel
authors: W
authors: Brouwer
authors: Albert C
authors: AC
authors: van Rossum
authors: Jurriën M
authors: JM
authors: Ten Berg
authors: Maarten P
authors: MP
authors: van den Berg
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D000431:Ethanol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D019786:Gadolinium DTPA; D006346:Heart Septum / Q000473:pathology / Q000601:surgery*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D000431:Ethanol; D019786:Gadolinium DTPA
references: Circulation. 1984 Jan;69(1):43-9
references: 6537786
references: Eur Heart J. 2009 May;30(9):1080-7
references: 19233857
references: J Am Coll Cardiol. 2010 Feb 23;55(8):823-34
references: 20170823
references: Radiol Med. 2011 Mar;116(2):197-210
references: 20981502
references: Circulation. 2004 Feb 24;109(7):824-7
references: 14967729
references: Circulation. 2012 Nov 13;126(20):2374-80
references: 23076968
references: J Am Coll Cardiol. 2007 Jan 23;49(3):350-7
references: 17239717
references: Circulation. 2005 May 17;111(19):2503-8
references: 15867172
references: Neth Heart J. 2013 Nov;21(11):504-9
references: 23881756
references: Am J Cardiol. 2008 May 1;101(9):1315-20
references: 18435964
references: J Am Coll Cardiol. 2004 Jan 7;43(1):27-34
references: 14715178
references: Lancet. 2013 Jan 19;381(9862):242-55
references: 22874472
references: Circ Heart Fail. 2010 May;3(3):362-9
references: 20332420
references: Heart Rhythm. 2011 Feb;8(2):221-7
references: 20951231
references: J Am Coll Cardiol. 2011 Nov 22;58(22):2322-8
references: 22093510
references: Catheter Cardiovasc Interv. 2004 Oct;63(2):231-5
references: 15390343
references: Circ Cardiovasc Interv. 2010 Apr;3(2):97-104
references: 20197511
references: Am J Cardiol. 2010 Nov 15;106(10):1487-91
references: 21059441
references: Heart. 2013 Jul;99(14):1012-7
references: 23644300
references: J Am Coll Cardiol. 2011 Nov 22;58(22):2313-21
references: 22093509