Alcohol septal ablation markedly reduces energy loss in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: A four-dimensional flow cardiac magnetic resonance study. (December 2021)

• Record Type: Journal Article
• Authors: Dai, Zhehao; Iguchi, Nobuo; Takamisawa, Itaru; Takayama, Morimasa; Nanasato, Mamoru; Kanisawa, Mitsuru; Mizuno, Naokazu; Miyazaki, Shohei; Isobe, Mitsuaki
• Is Part Of: IJC heart & vasculature. Volume 37(2021)
• Publication Date: 2021-12
• Subjects: 4D flow MRI -- Energy loss -- Alcohol septal ablation -- Hypertrophic cardiomyopathy -- Left ventricular outflow tract obstruction; ASA alcohol septal ablation -- HCM hypertrophic cardiomyopathy -- LV left ventricle/left ventricular -- LVOT left ventricular outflow tract -- LVOTO left ventricular outflow tract obstruction -- MRI magnetic resonance imaging -- NYHA New York Heart Association -- ROI region of interest -- TTE transthoracic echocardiography -- 4D four-dimensional; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100886
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Functional follow-up modalities of hypertrophic cardiomyopathy (HCM) with left ventricular (LV) outflow tract obstruction (LVOTO) subjected to alcohol septal ablation (ASA) are limited. Methods: This retrospective cohort study included patients of HCM with LVOTO who underwent ASA and four-dimensional (4D) flow cardiac magnetic resonance imaging (MRI) both before and after ASA. We analyzed energy loss in one cardiac cycle within the three-chamber plane of the LV and aortic root, and compared between pre- and post-ASA measurements. Results: Of the 26 included patients, 10 (39%) were male, and median age was 71 (interquartile range 58–78) years. ASA significantly reduced not only LVOT pressure gradient (70 [19–50] to 9 [3–16], P < 0.001), but also energy loss during one cardiac cycle within the three-chamber plane of the LV and aortic root (80 [65–99] to 56 [45–70], P < 0.001). A linear association was observed between the reductions of energy loss and pressure gradient ( R 2 = 0.58, P < 0.001). Conclusions: ASA significantly reduced energy loss within the LV and aortic root as quantified by 4D flow MRI, reflecting the decreased cardiac workload. This approach is a promising candidate for serial functional follow-up in patients undergoing ASA.