Skip Navigation

European Heart Journal 1999 20(24):1808-1817; doi:10.1053/euhj.1999.1692
Copyright © 1999 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (19)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kuhn, H.
Right arrow Articles by Schober, O.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kuhn, H.
Right arrow Articles by Schober, O.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Changes in the left ventricular outflow tract after transcoronary ablation of septal hypertrophy (TASH) for hypertrophic obstructive cardiomyopathy as assessed by transoesophageal echocardiography and by measuring myocardial glucose utilization and perfusion

H. Kuhna,f1, F.H. Gietzena, M. Schäfersa, M. Freicka, B. Gockela, C. Strunk-Müllera, E. Jachmanna and O. Schoberb

a Department of Internal Medicine and Division of Cardiology, The Bielefeld Hospital, Academic Teaching Hospital of the University of Müster, Bielefeld, Germany
b Department of Nuclear Medicine, University of Müster, Müster, Germany

revised May 7, 1999; accepted May 12, 1999

Abstract

Aims and Methods Transcoronary ablation of septal hypertrophy (TASH) leads to marked clinical and haemodynamic improvement in patients with hypertrophic obstructive cardiomyopathy. In order to obtain more detailed information about changes in the outflow tract after TASH, transoesophageal echocardiography and a repeat invasive investigation were conducted before as well as 2 weeks and 6 months after TASH (n=62). In a subset of patients (n=11), metabolism and perfusion of the myocardium (18F-FDG-PET and99mTc-MIBI-SPET) were investigated.

Results After TASH there was a typical regional subaortic contraction disorder. It was quantified by a significant decrease in the fractional shortening of the left ventricular end-diastolic diameter, which declined from an average of 40·6% to 18·0%. The end-diastolic diameter increased from an average of 39·1 to 40·6mm. There was also a significant reduction in septal thickness, which continued for up to 6 months after TASH, from an average of 20·0mm to 11·1mm in the region of ablation and from 23·2 to 21·7mm outside this region. The decrease in the gradient post TASH corresponded with a concomitant significant increase in the outflow tract area from a mean value of 1·04cm2before the process to a value of 3·0cm2after. In contrast to coronary heart disease, these changes were accompanied by non-diffuse, well demarcated subaortic–septal necrosis verified by18F-FDG-PET and99mTc-MIBI-SPET. On average the TASH induced necrotic area comprised 6·6% of the left ventricle and correlated significantly with echocardiographic changes in the outflow tract.

Conclusions Alterations post TASH indicated that this catheter interventional treatment for hypertrophic obstructive cardiomyopathy affects the specific region of obstruction. The changes reflect a ‘therapeutic remodelling’ of the outflow tract of the left ventricle. They were demonstrable over the entire 6 months investigation period and obviously constituted the basis of post TASH clinical and haemodynamic improvement. Progressive alterations post TASH (post TASH reduction of subaortic septal thickness and an increase in the end-diastolic diameter) need special consideration during long-term follow up.

Key Words: Hypertrophic obstructive cardiomyopathy, catheter therapy, perfusion and glucose metabolism, TASH

f1 Correspondence: H. Kuhn, MD, FESC, Professor of Internal Medicine/Cardiology, The Bielefeld Hospital, Teutoburgerstraße 50, D-33604 Bielefeld, Germany.

References

  1. Brugada P, De Swart H, Smeets ILRM, Wellens HJJ. Transcoronary chemical ablation of ventricular tachycardia. Circulation. 1989;79:475–482[Abstract/Free Full Text]
  2. Kuhn H. Transkoronare Ablation der Septum-Hypertrophie (TASH) Bericht über das 1. Bielefelder Werkstattgespräch. Z Kardiol. 1997;87:244–248
  3. Kuhn H, Gietzen F, Leuner Ch, Gerenkamp T. Induction of subaortic septal ischemia to reduce obstruction in hypertrophic obstructive cardiomyopathy. Studies to develop a new catheter-based concept of treatment. Eur Heart J. 1997;18:846–851[Abstract/Free Full Text]
  4. Kuhn H. Induced septal infarction/non surgical septal reduction for hypertrophic obstructive cardiomyopathy (Correspondence). Circulation. 1998;97:708–709[Free Full Text]
  5. Gietzen F, Leuner C, Gerenkamp T, Kuhn H. Abnahme der Obstruktion bei hypertrophischer Kardiomyopathie während passagerer Okklusion des ersten Septalastes der linken Koronararterie. Z Kardiol. 1994;83:146[ISI][Medline]
  6. Gietzen FH, Leuner CJ, Raute-Kreinsen U. Acute and long-term results after transcoronary ablation of septum hypertrophy (TASH). A catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J. 1999;20:1342–1354[Abstract/Free Full Text]
  7. Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98:2415–2421[Abstract/Free Full Text]
  8. Knight C, Kurbaan AS, Seggewiss H. Non-surgical septum reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation. 1997;95:2075–2081[Abstract/Free Full Text]
  9. Lakkis N, Kleiman N, Killip D, Spencer WH III. Hypertrophic obstructive cardiomyopathy: alternative therapeutic options. Clin Cardiol. 1997;20:417–418[ISI][Medline]
  10. Boekstegers P, Steinbigler P, Schwaibelmair M, Steinbeck G. Small but correctly localized myocardial infarctions induced by transcoronary alcohol ablation are associated with a high efficacy and a low complication rate in patients with hypertrophic obstructive cardiomyopathy. Eur Heart J. 1998;19:12[ISI][Medline]
  11. Bhargava B, Aggarval R, Kaul U, Manchanda SC, Wasir HS. Transcatheter alcohol ablation of the septum in a patient of hypertrophic obstructive cardiomyopathy. Cathet Cardiovasc Diagn. 1997;41:56–58[CrossRef][ISI][Medline]
  12. Lakkis NM, Nagueh SF, Kleiman NS. Echocardiography-guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy. Circulation. 1998;98:1750–1755[Abstract/Free Full Text]
  13. Nagueh SF, Lakkis NM, He ZX. Role of myocardial contrast echocardiography during nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 1998;32:225–229[Abstract/Free Full Text]
  14. Braunwald E. A new treatment for hypertrophic cardiomyopathy? Eur Heart J. 1997;18:709–710[Free Full Text]
  15. Spirito P, Maron BI. Perspectives of the role of new treatment strategies in hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 1999;33:1071–1075[Free Full Text]
  16. Kuhn H, Mercier J, Köhler E, Frenzel H, Hort W, Loogen F. Differential diagnosis of hypertrophic cardiomyopathies: typical (subaortic) hypertrophic obstructive cardiomyopathy. Atypical (midventricular) hypertrophic obstructive cardiomyopathy and hypertrophic non obstructive cardiomyopathy. Eur Heart J. 1983;4:93–104
  17. Kuhn H. Evidence for the importance of obstruction in hypertrophic cardiomyopathy. Goodwin JF. Current status of clinical cardiology. Heart muscle disease. : MTP Press; 1985. p. 213
  18. Seward JB, Khandheria BK, Oh JK. Transesophageal echocardiography: Technique, anatomic correlations, implementation, and clinical applications. Myo Clin Proc. 1988;63:649–680
  19. Wienhard K, Grootoonk S, Casey M, Pietrzyk U, Heiss WD. Performance evaluation of the positron scanner ECAT EXACT. J Comput Assist Tomogr. 1992;16:804–813[ISI][Medline]
  20. Bax JJ, Veening MA, Visser FC. Optimal metabolic conditions during fluorine-18 flurodeoxyglucose imaging: a comparative study using different protocols. Eur J Nucl Med. 1997;24:35–41[CrossRef][ISI][Medline]
  21. Knuuti MJ, Nuutila P, Ruotsalainen U. Euglycemic hyperinsulinemic clamp and oral glucose load in stimulating myocardial glucose utilization during positron emission tomography (see comments]. J Nucl Med. 1992;33:1255–1262[Abstract/Free Full Text]
  22. Ferrannini E, Santoro D, Bonadonna R, Natali A, Parodi O, Camici PG. Metabolic and hemodynamic effects of insulin on human hearts. Am J Physiol. 1993;264:E308–315
  23. Choi Y, Hawkins RA, Huang SC. Parametric images of myocardial metabolic rate of glucose generated from dynamic cardiac PET and 2-[18F]fluoro-2-deoxy-d-glucose studies. J Nucl Med. 1991;32:733–738[Abstract/Free Full Text]
  24. Gambhir SS, Schwaiger M, Huang SC. Simple noninvasive quantification method for measuring myocardial glucose utilization in humans employing positron emission tomography and fluorine-18 deoxyglucose. J Nucl Med. 1989;30:359–366[Abstract/Free Full Text]
  25. Patlak CS, Blasberg RG. Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. Generalizations. J Cereb Blood Flow Metab. 1985;5:584–590[ISI][Medline]
  26. Ohtake T, Kosaka N, Watanabe T. Noninvasive method to obtain input function for measuring tissue glucose utilization of thoracic and abdominal organs. J Nucl Med. 1991;32:1432–1438[ISI][Medline]
  27. Pietrzyk U, Herholz K, Heiss WD. Three-dimensional alignment of functional and morphological tomograms. J Comp Assist Tomogr. 1990;14:51–59[ISI][Medline]
  28. Pietrzyk U, Herholz K, Fink G. An interactive technique for three-dimensional image registration: validation for PET, SPECT, MRI and CT brain studies. J Nucl Med. 1994;35:2011–2018[Abstract/Free Full Text]
  29. Biedenstein S, Schäfers M, Stegger L, Kuwert T, Schober O. Three-dimensional contour detection of left ventricular myocardium using elastic surfaces. Eur J Nucl Med. 1999;:
  30. Franke A, Schöndube FA, Kühl HP. Quantitative assessment of the operative results after extended myectomy and surgical reconstruction of the subvalvular mitral apparatus in hypertrophic obstructive cardiomyopathy using dynamic three-dimensional transesophageal echocardiography. J Am Coll Cardiol. 1998;31:1641–1649[Abstract/Free Full Text]
  31. Kuhn H. Hypertrophische obstruktive Kardiomyopathie (HOCM). Schölmerich H, Just H, Meinertz T. Handbuch der Inneren Medizin IX/5. Berlin, Heidelberg: Springer; 1989. p. 70–109
  32. Kuhn H, Gietzen F, Schäfers M. Catheter interventional therapy of hypertrophic obstructive cardiomyopathy by transcoronary ablation of septum hypertrophy: changes of the subaortic septum. Eur Heart J. 1997;18:605
  33. Fishbein MC, Maclean D, Marocko PR. The histopathological evolution of myocardial infarction. Chest. 1978;73:843[Free Full Text]
  34. Page DL, Caulfield JB, Kastor JA. Myocardial changes associated with cardiogenic shock. N Engl J Med. 1971;285:133[ISI][Medline]
  35. Alonso DR, Scheidt S, Post M, Killip D. Pathophysiology of cardiogenic shock; quantification of myocardial necrosis, clinical, pathologic and electrocardiographic correlation. Circulation. 1973;48:588[Abstract/Free Full Text]
  36. Curtius JM, Stoecker J, Loesse B, Welslau R, Scholz D. Changes of the degree of hypertrophy in hypertrophic obstructive cardiomyopathy under medical and surgical treatment. Cardiology. 1989;76:255–263[ISI][Medline]
  37. Köhler E, Neuhaus Ch, Thurow J. Clinical and echocardiographic observations in patients after surgical treatment of hypertrophic obstructive cardiomyopathy. Z Kardiol. 1978;67:826–836[ISI][Medline]
  38. Schwartzkopff B, Stark P, Schulte HD. Early changes in systolic and diastolic function at rest and under exercise in patients with hypertrophic cardiomyopathy (HOCM) after myectomy. Z Kardiol. 1997;86:438–439[CrossRef][ISI][Medline]
  39. Kusmierczyk-Droszcz B, Ruzyllo W, Choinowska L. Does myocardial contrast echocardiography identify patients at risk for heart block after transcoronary ablation of septum hypertrophy? Eur Heart J. 1998;19:215
  40. Schulz-Menger J, Friedrich MG, Strohm O, Dietz R. Magnetresonanztomographie eignet sich zur Verlaufskontrolle nach interventioneller Septumarterienembolisation bei hypertrophischer obstruktiver Kardiomyopathie. Z Kardiol. 1997;86:280
  41. Klues HG, Leuner C, Kuhn H. Left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: Increase in gradient after exercise. J Am Coll Cardiol. 1992;19:527–533[Abstract]
  42. Lerch H, Schäfers M, Gietzen F. Myocardial perfusion and metabolism after transcoronary ablation of septum hypertrophy (TASH) in hypertrophic obstructive cardiomyopathy. Nuklearmedizin. 1997;36:218–222[Medline]
  43. Haines DE, Whayne JG, DiMarco JP. Intracoronary ethanol ablation in swine: effects of ethanol concentration on lesion formation and response to programmed ventricular stimulation. J Cardiovasc Electrophysiol. 1994;5:422–431[ISI][Medline]
  44. Kuhn H, Gietzen F, Jachmann E, Gockel B, Freick M. Die Bedeutung der Belastungsdopplerechokardiographie bei HOCM für die Behandlung mittels transkoronarer Ablation der Septumhypertrophie (TASH). Z Kardiol. 1999;88:138
  45. Limbruno U, Strata G, Zucchi R. Altered autonomic cardiac control in hypertrophic cardiomyopathy—role of outflow tract obstruction and myocardial hypertrophy. Eur Heart J. 1998;19:146–153[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Journal of Diagnostic Medical SonographyHome page
K. Chadwell
Interventional Echocardiography
Journal of Diagnostic Medical Sonography, July 1, 2006; 22(4): 231 - 240.
[Abstract] [PDF]

Home page
 HeartHome page
F H Gietzen, C J Leuner, L Obergassel, C Strunk-Mueller, and H Kuhn
Transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy: feasibility, clinical benefit, and short term results in elderly patients
Heart, June 1, 2004; 90(6): 638 - 644.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1687 - 1713.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
Eur. Heart J., November 1, 2003; 24(21): 1965 - 1991.
[Full Text] [PDF]

Home page
 NEJMHome page
W. Shamim, M. Yousufuddin, D. Wang, M. Henein, H. Seggewiss, M. Flather, A. J.S. Coats, and U. Sigwart
Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy
N. Engl. J. Med., October 24, 2002; 347(17): 1326 - 1333.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
F. H. Gietzen, C. J. Leuner, L. Obergassel, C. Strunk-Mueller, and H. Kuhn
Role of Transcoronary Ablation of Septal Hypertrophy in Patients With Hypertrophic Cardiomyopathy, New York Heart Association Functional Class III or IV, and Outflow Obstruction Only Under Provocable Conditions
Circulation, July 23, 2002; 106(4): 454 - 459.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
F.H. Gietzen, CH.J. Leuner, J. Hegselmann, C. Strunk-Mueller, and H. Khun
A reply
Eur. Heart J., April 1, 2000; 21(7): 591 - 593.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (19)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kuhn, H.
Right arrow Articles by Schober, O.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kuhn, H.
Right arrow Articles by Schober, O.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?