title: Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: An Echocardiography and Cardiovascular Magnetic Resonance Imaging Study.
abstract: BACKGROUND
  Alcohol septal ablation (ASA) is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe left ventricular outflow tract (LVOT) obstruction. The current recommendations restrict the procedure to adults with favorable anatomy and no other coexisting surgically amenable disease. Some patients remain symptomatic with residual LVOT obstruction, thus better patient selection is required.
  
  
  RESULTS
  One-hundred and two consecutive subjects with hypertrophic obstructive cardiomyopathy who underwent cardiovascular magnetic resonance imaging, transthoracic echocardiography, and ASA were enrolled in this study. Successful ASA was defined as reduction of LVOT gradient ≥50% of baseline by echocardiographic follow-up 6 months post ASA. The relationships between segmental thickness assessed by cardiovascular magnetic resonance imaging and echocardiography and outcomes of ASA were compared between the 2 groups. The survival rate after ablation was 100% at 6-month follow-up. The LVOT gradient decreased ≥50% of baseline in 72% (73/102) patients. There were good correlations between the reduction of postoperative LVOT gradient and the thickness of basal anterior segment (r=0.371; P<0.001), basal anteroseptal segment (r=0.527; P<0.001), and total thickness of the above 2 segments (r=0.672; P<0.001). The area under the receiver operating curves were 0.68, 0.79 and 0.89 for predictive analysis (all P<0.001). The cutoff thickness of the segment 1+2 was 50.9 mm, which yielded a sensitivity of 86% and specificity of 77%.
  
  
  CONCLUSIONS
  Both echocardiography and cardiovascular magnetic resonance imaging can be used effectively as noninvasive tools for patient selection for ASA procedure. A significantly thickened septum among hypertrophic obstructive cardiomyopathy patients may be associated with a poor outcome after ASA.
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.). coolkan@163.com cjr.zhaoshihua@vip.163.com.
authors.forename: Minjie
authors.initials: M
authors.lastname: Lu
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Hui
authors.initials: H
authors.lastname: Du
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Zhan
authors.initials: Z
authors.lastname: Gao
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Lei
authors.initials: L
authors.lastname: Song
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Huaibing
authors.initials: H
authors.lastname: Cheng
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Gang
authors.initials: G
authors.lastname: Yin
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Xiuyu
authors.initials: X
authors.lastname: Chen
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Jian
authors.initials: J
authors.lastname: Ling
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Yong
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Jinghui
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Jinghan
authors.initials: J
authors.lastname: Huang
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.).
authors.forename: Zuoxiang
authors.initials: Z
authors.lastname: He
authors.affiliation: From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Magnetic Resonance Imaging, Cardiovascular Disease Hospital of Shanxi Province, Taiyuan City, Shanxi Province, China (H.D.). coolkan@163.com cjr.zhaoshihua@vip.163.com.
authors.forename: Shihua
authors.initials: S
authors.lastname: Zhao
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D019540:Area Under Curve; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000431:Ethanol
keywords: cardiomyopathy, hypertrophic; echocardiography; magnetic resonance imaging; survival rate; treatment outcome