Significance of periprocedural decrease in left ventricular outflow tract gradient after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

Česká verzia

Authors: T. Honěk ^1,2; J. Krejčí ^1,2; J. Máchal ^3,4; L. Groch ^1,4; J. Sitár ^1,4; J. Meluzín ^1,2,4; L. Špinarová ^1,2
Authors place of work: I. interní kardioangiologická klinika FN u sv. Anny v Brně ¹; Lékařská fakulta MU, Brno ²; Ústav patologické fyziologie, LF MU, Brno ³; Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ⁴
Published in the journal: Kardiol Rev Int Med 2016, 18(3): 208-213

Summary

Introduction:
Alcohol septal ablation (ASA) is one of the non-pharmacological treatment options for highly symptomatic patients with hypertrophic obstructive cardiomyopathy resistant to pharmacotherapy. Objective: The aim of our study was to evaluate the relationship between an intraprocedural decrease in the left ventricular outflow tract gradient (LVOTG) measured invasively during the procedure and the development of clinical and echocardiographic parameters in the early period (3 months) and the later period (12 months) after ASA.

Patients and methods:
Our study included 32 patients, mean age 58.6 ± 12.6 years, who underwent ASA for pharmacoresistant limiting symptoms. The investigated parameters were the following: resting LVOTG, thickness of the interventricular septum and left ventricular posterior wall, left ventricular end-diastolic diameter, left atrium size, left ventricular ejection fraction and NYHA class; evaluated in the 3^rd and 12^th month after the procedure.

Results:
Intraprocedural LVOTG (iLVOTG) change correlated with a change of echocardiographically measured LVOTG during a 0–3-month period (r = 0.56; p < 0.001) and 0–12-month period (r = 0.40; p < 0.05). Correlation between iLVOTG change and change of other echocardiographic parameters and functional status was not found, with the exception of an end-diastolic diameter change in a 0–12-month period (r = –0.39; p < 0.05) and 3–12-month period (r = –0.41; p < 0.05).

Conclusion:
Invasively evaluated intraprocedural decline of LVOTG predicts the later development in LVOTG. The value of LVOTG in the 3rd month can be used to estimate the long-term effect of ASA.

Keywords:
hypertrophic obstructive cardiomyopathy – alcohol septal ablation – echocardiography

Zdroje

1. Gersh BJ, Maron BJ, Bonow RO et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124: e783–e831. doi: 10.1161/CIR.0b013e318223e2bd.

2. Elliott PM, Anastasakis A, Borger MA et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2733–2779. doi: 10.1093/eurheartj/ehu284.

3. Enriquez AD, Goldman ME. Management of hypertrophic cardiomyopathy. Ann Glob Health 2014; 80: 35–45. doi: 10.1016/j.aogh.2013.12.004.

4. Maron BJ, Ommen SR, Semsarian C et al. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol 2014; 64: 83–99. doi: 10.1016/j.jacc.2014.05.003.

5. Veselka J. Twenty years of alcohol septal ablation document more than a history of a single interventional procedure. Cor et Vasa 2015; 57: e16–e27.

6. Seggewiss H. Medical therapy versus interventional therapy in hypertrophic obstructive cardiomyopathy. Curr Control Trials Cardiovasc Med 2000; 1: 115–119.

7. Zemánek D. Patofyziologie a diagnóza obstrukce u hypertrofické kardiomyopatie. Kardiol Rev Int Med 2015; 17: 7–10.

8. Harrison DC, Braunwald E, Glick G et al. Effects of beta adrenergic blockade on the circulation, with particular reference to observations in patients with hypertrophic subaortic stenosis. Circulation 1964; 29: 84–98.

9. Epstein SE, Rosing DR. Verapamil: its potential for causing serious complications in patients with hypertrophic cardiomyopathy. Circulation 1981; 64: 437–441.

10. Agarwal S, Tuzcu EM, Desai MY et al. Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol 2010; 55: 823–834. doi: 10.1016/j.jacc.2009.09.047.

11. Ommen SR, Maron BJ, Olivotto I et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46: 470–476.

12. Krejci J, Gregor P, Zemanek D et al. Comparison of long-term effect of dual-chamber pacing and alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. Scientific World Journal 2013; 2013: 629–650. doi: 10.1155/2013/ /629650.

13. Kappenberger L, Linde C, Daubert C et al. Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. Eur Heart J 1997; 18: 1249–1256.

14. Maron BJ, Nishimura RA, McKenna WJ et al. Assessment of permanent dual-chamber pacing as a treatment for drug- refractory symptomatic patients with obstructive hypertrophic cardiomyopathy: a randomized, double-blind, crossover study (M-PATHY). Circulation 1999; 99: 2927–2933.

15. Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive myocardial infarction. Lancet 1995; 346: 211–214.

16. Popescu BA, Rosca M, Schwammenthal E et al. Dynamic obstruction in hypertrophic cardiomyopathy. Curr Opin Cardiol 2015; 30: 468–474. doi: 10.1097/HCO.0000000000000199.

17. Veselka J, Lawrenz T, Stellbrink C et al. Low incidence of procedure-related major adverse cardiac events after alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy. Can J Cardiol 2013; 29: 1415–1421. doi: 10.1016/j.cjca.2013.04.027.

18. Jensen MK, Almaas VM, Jacobsson L et al. Long-term outcome of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: a Scandinavian multicenter study. Circ Cardiovasc Interv 2011; 4: 256–265. doi: 10.1161/CIRCINTERVENTIONS.110.959718.

19. Seggewiss H, Gleichmann U, Faber L et al. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 1998; 31: 252–258.

20. Moss TJ, Krantz MJ, Zipse MM et al. Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy. Am J Cardiol 2014; 113: 1401–1404. doi: 10.1016/j.amjcard.2014.01.417.

21. Veselka J, Lawrenz T, Stellbrink C et al. Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a European multicenter and multinational study. Catheter Cardiovasc Interv 2014; 84: 101–107. doi: 10.1002/ccd.25 236.

22. Jassal DS, Neilan TG, Fifer MA et al. Sustained improvement in left ventricular diastolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Eur Heart J 2006; 27: 1805–1810.

23. Sorajja P, Nishimura RA, Ommen SR et al. Effect of septal ablation on myocardial relaxation and left atrial pressure in hypertrophic cardiomyopathy an invasive hemodynamic study. JACC Cardiovasc Interv 2008; 1: 552–560. doi: 10.1016/j.jcin.2008.07.004.

24. Nistri S, Olivotto I, Betocchi S et al. Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy). Am J Cardiol 2006; 98: 960–965.

25. Steendijk P, Meliga E, Valgimigli M et al. Acute effects of alcohol septal ablation on systolic and diastolic left ventricular function in patients with hypertrophic obstructive cardiomyopathy. Heart 2008; 94: 1318–1322. doi: 10.1136/hrt.2007.139535.

26. Veselka J, Tomašov P, Zemánek D. Long-term effects of varying alcohol dosing in percutaneous septal ablation for obstructive hypertrophic cardiomyopathy: a randomized study with a follow-up up to 11 years. Can J Cardiol 2011; 27: 763–767. doi: 10.1016/j.cjca.2011.09.001.

27. Aqel R, Hage FG, AlJaroudi W et al. How much alcohol should we infuse in the coronary artery of hypertrophic cardiomyopathy patients? J Invasive Cardiol 2010; 22: 22–26.

28. Kuhn H, Lawrenz T, Lieder F et al. Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience. Clin Res Cardiol 2008; 97: 234–243.