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European Heart Journal Advance Access published online on June 14, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl106
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved

Clinical research

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

Davinder S. Jassal 1, Tomas G. Neilan 1, Michael A. Fifer 1, Igor F. Palacios 1, Patrica A. Lowry 1, Gus J. Vlahakes 2, Michael H. Picard 1, and Danita M. Yoerger 1 *

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

* To whom correspondence should be addressed.
Danita M. Yoerger, E-mail: dyoerger{at}partners.org


  Abstract

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.

Keywords: Echocardiography; Hypertrophic obstructive cardiomyopathy; Diastolic dysfunction; Alcohol septal ablation.
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