Myocardial mechanics of percutaneous intramyocardial septal radiofrequency ablation. Issue 4 (21st October 2022)

• Record Type: Journal Article
• Authors: Li, Jing; Zhang, Juan; Shi, Yu; Sievert, Horst; Taub, Cynthia C; Bertog, Stefan; Ta, Shengjun; Changhui, Lei; Senser, Ethan; Wang, Jing; Hu, Rui; Huang, Junzhe; Ruan, Fangqi; Han, Yupeng; Li, Xiaojuan; Wang, Bo; Zhao, Xueli; Liu, Jiao; Hsi, David H; Liu, Liwen
• Is Part Of: Heart. Volume 109:Issue 4(2023)
• Page Start: 289
• Page End: 296
• Publication Date: 2022-10-21
• Subjects: echocardiography -- cardiomyopathy, hypertrophic; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2022-321597
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Echocardiography-guided Percutaneous IntraMyocardial Septal Radiofrequency Ablation (PIMSRA, Liwen procedure) is a novel treatment option for hypertrophic obstructive cardiomyopathy (HOCM). The impact of PIMSRA on myocardial mechanics is unknown. Methods: Between October 2016 and June 2019, PIMSRA and 3-dimentional speckle tracking echocardiography were performed in 82 patients. Echocardiographic imaging, qualitative and quantitative clinical assessment were completed at baseline, immediately postprocedure and 1-year follow-up. Results: There was a significant reduction in the peak left ventricular outflow tract (LVOT) gradients immediately following PIMSRA and at 1-year follow-up (resting gradients: from 83.50 (61.25) to 23.00 (41.75) mm Hg, p<0.001 and 13.50 (21.75) mm Hg, p<0.001, respectively; stress-induced gradients: from 118.25 (96.02) to 47.00 (74.50) mm Hg (1 year), p<0.001). There was an improvement in exercise time on stress echocardiography (p<0.001) and distance by 6 min walk test (p=0.034). Immediately after PIMSRA, there was a significant reduction in radial and circumferential strain in the ablated segments (p<0.001), with no change of longitudinal strain. At 1-year follow-up, the radial and circumferential strain recovered in the ablated segments. Meanwhile, left ventricular regional and global longitudinal strain had improved significantly (p<0.05). Conclusions: PIMSRA is an effective treatment for symptomatic HOCM that resulted in a sustained improvement in exercise capacity, a persistent decrease in LVOT gradient, and a measurable increase in myocardial contractile function. Trial registration number: NCT04777188 .