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European Heart Journal Advance Access originally published online on June 14, 2006
European Heart Journal 2006 27(15):1805-1810; doi:10.1093/eurheartj/ehl106
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sustained improvement in left ventricular diastolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy

Davinder S. Jassal1, Tomas G. Neilan1, Michael A. Fifer1, Igor F. Palacios1, Patrica A. Lowry1, Gus J. Vlahakes2, Michael H. Picard1 and Danita M. Yoerger1,*

1 Cardiac Ultrasound Laboratory, Cardiology Division, Massachusetts General Hospital, YAW 5, 55 Fruit Street, Boston, MA 02114, USA
2 Cardiac Surgical Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Received 23 March 2006; revised 22 May 2006; accepted 26 May 2006; online publish-ahead-of-print 14 June 2006.

* Corresponding author. Tel: +1 617 726 1543; fax: +1 617 726 7684. E-mail address: dyoerger{at}partners.org

See page 1769 for the editorial comment on this article (doi:10.1093/eurheartj/ehl127)

Aims Impaired diastolic function is responsible for many of the clinical features of hypertrophic cardiomyopathy. In patients with hypertrophic obstructive cardiomyopathy (HOCM) whose symptoms are refractory to medical therapy, alcohol septal ablation (ASA) reduces left ventricular (LV) outflow tract gradient, with short-term improvement in LV diastolic function. Little is known about the longer term impact of ASA on diastolic function.

Methods and results We evaluated LV diastolic function at baseline and 1- and 2-year follow-up after successful ASA. In 30 patients (58±15 years, 22 men) who underwent successful ASA, New York Heart Association class was lower at 1-year follow-up compared with baseline (3.0±0.5 to 1.5±0.7; P<0.0001). LV outflow tract gradient (76±37 to 19±12; P<0.0001), interventricular septal thickness (19±2 to 14±2; P<0.0001), and left atrial volume (26±5 to 20±4; P<0.0001) were decreased. Significant improvement in E-wave deceleration time, isovolumic relaxation time, early diastolic mitral lateral annular velocity (E'), mitral inflow propagation velocity (Vp), ratio of transmitral early LV filling velocity (E) to early diastolic Doppler tissue imaging of the mitral annulus (E/E'), and E/Vp were observed at 1 year following successful ASA. These changes persisted in the subset cohort (n=21) for whom 2-year data were available.

Conclusion Successful ASA for HOCM leads to significant and sustained improvement in echocardiographic measures of diastolic function, which may contribute to improved functional status after successful ASA.

Key Words: Echocardiography • Hypertrophic obstructive cardiomyopathy • Diastolic dysfunction • Alcohol septal ablation


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