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European Heart Journal Advance Access originally published online on November 10, 2006
European Heart Journal 2006 27(23):2833-2839; doi:10.1093/eurheartj/ehl358
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis

Willem G. van Dockum1,*, Joost P.A. Kuijer2, Marco J.W. Götte1, Folkert J. ten Cate3, Jurrien M. ten Berg4, Aernout M. Beek1, Jos W.R. Twisk5, Johannes Tim Marcus2, Cees A. Visser1 and Albert C. van Rossum1

1 Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1081 HV Amsterdam, The Netherlands
2 Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
3 Department of Cardiology, Thoraxcenter Erasmus Medical Center, Rotterdam, The Netherlands
4 Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
5 Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

Received 1 March 2006; revised 12 October 2006; accepted 19 October 2006; online publish-ahead-of-print 10 November 2006.

* Corresponding author. Tel: +31 20 4442244; fax: +31 20 4442446. E-mail address: wg.vandockum{at}vumc.nl

See page 2746 for the editorial comment on this article (doi:10.1093/eurheartj/ehl324)

Aims Alcohol septal ablation (ASA) has been successful in the treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study is to evaluate the effects of ethanol-induced myocardial infarcts on regional myocardial function using cardiac magnetic resonance (CMR) tissue tagging and 3-dimensional (3D) strain analysis.

Methods and results In nine patients (age 52±15 years) who underwent ASA, CMR was performed prior to and 6 months after the procedure. Regional myocardial mass was evaluated using cine imaging. Myocardial tagging was used to calculate systolic 3D myocardial strain values. These strain values were used to calculate the shortening index (SI), a robust parameter for myocardial contraction. Maximum end-systolic (ES) SI and systolic SI rate were quantified in three circumferential segments: septum, adjacent, and remote (lateral) myocardium. Compared with baseline, septal and non-septal mass decreased at follow-up (from 72±27 to 59±21 g; P=0.008 and from 131±34 to 109±30 g; P=0.008, respectively). In the septum, maximum ES SI and SI rate remained unchanged after ASA. In adjacent myocardium, ES SI remained unchanged, whereas SI rate improved (from –56.5±21.1 to –70.0±16.7%/s; P=0.02). Both ES SI and SI rate improved significantly in remote myocardium (from –16.9±2.8 to –18.8±3.2%; P=0.02 and from –70.3±9.2 to –86.1±15.0%/s; P=0.01, respectively).

Conclusion Reduction of left ventricular (LV) outflow tract obstruction in symptomatic HOCM is associated with a significant reduction in myocardial mass and improvement of intramural systolic function in the lateral (remote) wall, indicating reversed LV remodelling.

Key Words: Hypertrophy • Cardiomyopathy • Myocardial ablation • Tagging • Magnetic resonance imaging


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