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Crean AM, Small GR, Saleem Z, Maharajh G, Ruel M, Chow BJW. Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 205:481-492. [PMID: 37683571 DOI: 10.1016/j.amjcard.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy is a common inherited cardiac condition in which regional myocardial thickening and scarring can lead to a range of symptoms including breathlessness, dizziness, chest pain, and collapse with loss of consciousness. It is vital to be able to understand the mechanisms behind these epiphenomena and to be able to distinguish, for example, between syncope because of arrhythmia versus syncope because of mechanical outflow tract obstruction. Therefore, we require a technique that can characterize anatomy, physiology, and myocardial substrate. Traditionally, this role has been the preserve of cardiac magnetic resonance (CMR) imaging. This review makes the case for cardiac computed tomography (CT) as an alternative imaging method. We review the use of functional CT to identify the components of outflow tract obstruction (and obstruction at other levels, which may be simultaneous), and as an aid to interventional and surgical planning. We demonstrate the added value of multiplanar isotropic reformats in this condition, particularly in cases where the diagnosis may be more challenging or where complications (such as early apical aneurysm) may be difficult to recognize with 2-dimensional techniques. In conclusion, our aim is to convince readers that cardiac CT is a highly valuable and versatile tool, which deserves wider usage and greater recognition in those caring for patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Andrew M Crean
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zain Saleem
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gyaandeo Maharajh
- Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
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2
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Meng X, Wang WY, Gao J, Zhang K, Zheng J, Wang JJ, Liu Y, Shao C, Tang YD. Hypertrophic Obstructive Cardiomyopathy: Comparison of Outcomes After Myectomy or Alcohol Ablation. Front Cardiovasc Med 2022; 9:755376. [PMID: 35360040 PMCID: PMC8964041 DOI: 10.3389/fcvm.2022.755376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/21/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction and Objectives The risk of ventricular arrhythmia and heart failure in patients with hypertrophic obstructive cardiomyopathy (HOCM) is much higher than that in the general population. More and more pieces of evidence showed that HOCM is the leading cause of sudden cardiac death in young people. We reported our experience in a study, comparing surgical myectomy, alcohol septal ablation (ASA), and medical therapy. Methods The original cohort included 965 consecutive patients with HOCM. The patients were divided into three groups according to treatment strategies: myectomy group (n = 502), ASA group (n = 138), and medical treatment group (n = 325). The median follow-up duration was 42.99 ± 18.32 months, and the primary endpoints were all-cause mortality and heart transplantation. Results Both in short- and long-term observations, surgical myectomy reduced the left ventricular outflow tract (LVOT) gradients more effectively (7 days, 16.15 ± 12.07 mmHg vs. 42.33 ± 27.76 mmHg, p < 0.05; 1 year, 14.65 ± 13.18 mmHg vs. 41.17 ± 30.76 mmHg, p < 0.05). Among the three groups, the patients in the medical treatment group were at a higher risk of mortality and cardiac transplantation (vs. the myectomy group, p < 0.001 by log-rank test; vs. the alcohol septal ablation group, p = 0.017 by log-rank test), and the myectomy group shows a lower risk of reaching the primary endpoint than the two other groups. In the multivariate Cox regression analysis, previous atrial fibrillation (AF), N terminal pro B type natriuretic peptide (NT-pro-BNP), and surgical myectomy predicted an HOCM prognosis. However, the impact of surgical myectomy on HOCM prognosis seems to be limited to the <56 years group. Conclusions The patients with medical treatments seemed to suffer from the highest risk of achieving an all-cause mortality and the endpoint of heart transplantation. In the long-term survival and clinical outcome, myectomy seemed better than alcohol septal ablation, especially the younger patients. Due to the less-controllable degree, periprocedural complication frequency after alcohol septal ablation was higher, compared with myectomy. Furthermore, gradients after myectomy are lower at late follow-up. To sum up, when selecting treatment strategies, the patients should be individually evaluated by a multidisciplinary team of cardiologists and surgeons.
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Affiliation(s)
- Xiangbin Meng
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Wen-Yao Wang
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Jun Gao
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Kuo Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jilin Zheng
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Jia Wang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - YuPeng Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yi-Da Tang
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.,State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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3
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Jiang X, Qiao S. Prognostic Significance of Initial r-Wave in Leads V1 and aVR Before PTSMA in Patients with Hypertrophic Obstructive Cardiomyopathy. Int J Gen Med 2021; 14:9589-9598. [PMID: 34916839 PMCID: PMC8670858 DOI: 10.2147/ijgm.s343050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Percutaneous transluminal septal myocardial ablation (PTSMA) is one of the septal reduction therapies without all satisfactory results in hypertrophic obstructive cardiomyopathy (HOCM) patients. Initial r-wave in leads V1 and aVR on the surface electrocardiography is the sign of ventricular septal base depolarization. Whether the initial r-wave in leads V1 and aVR is predictive of good mid-term response to PTSMA in patients with HOCM remains unknown. Design, Settings, and Participants Among 546 consecutive patients evaluated in Fuwai Hospital (Beijing, China), we selected HOCM patients who underwent PTSMA. During the 3-year follow-up after PTSMA, primary outcomes included death, surgical myectomy, syncope, and NYHA classification III/IV. Results At last, 85 patients were selected, and were assigned to 3 groups based on the presence of initial r-wave in leads V1 and aVR. Through multivariable Cox and Kaplan–Meier method, patients with initial r-wave in both leads V1 and aVR were independently associated with a decreased risk of primary outcomes (HR: 0.112; 95% CI: 0.024 to 0.518; p = 0.005) during 3-years’ follow-up. Conclusion The results suggest that the presence of initial r-wave in both leads V1 and aVR on the surface 12-lead ECG is highly predictive of good mid-term response to PTSMA in patients with HOCM.
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Affiliation(s)
- Xiaowei Jiang
- Cardiology Department, Xiangya Hospital, Central South University; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
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4
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Liu Q, Qiu H, Jiang R, Tang X, Guo W, Zhou K, Chen Q, Sun Y, Yu L, Chen S, Zhang P, Sheng X, Zhu J, Lin J, Cheng H, Wang Y, Wang B, Yu C, Mao Y, Zhang J, Zhang Z, Zei PC, Fu G, Jiang C. Selective Interventricular Septal Radiofrequency Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: Who Can Benefit? Front Cardiovasc Med 2021; 8:743044. [PMID: 34869646 PMCID: PMC8635065 DOI: 10.3389/fcvm.2021.743044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation. Methods and Results: In this study, 20 patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After 6 months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (p < 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, p < 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, p = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, p < 0.01), and normally positioned papillary muscle (36.9 ± 7.1 vs. 75.0 ± 6.3, p < 0.05). Conclusions: Endocardial septal ablation appears to be a safe and effective procedure for alleviating LVOT gradient in patients with HOCM, especially in those with limited basal septal hypertrophy, shorter anterior mitral leaflet, and normal positioned papillary muscle.
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Affiliation(s)
- Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hangyuan Qiu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaomei Tang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenpu Guo
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kuangshi Zhou
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiufan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shiquan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Zhu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianwei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bei Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chan Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yankai Mao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Juhong Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuwen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Paul C Zei
- Medicine, Brigham and Women's Hospital Associate, Harvard Medical School, Boston, MA, United States
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Savarimuthu S, Harky A. Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy. J Card Surg 2020; 35:2017-2024. [PMID: 32652778 DOI: 10.1111/jocs.14815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Affecting 1 in 500 individuals; hypertrophic cardiomyopathy is an autosomal dominant cardiovascular disorder which is prevalent throughout the world. Surgical myectomy (SM) and alcohol septal ablation (ASA) are two methods currently used for the management of drug refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA may prove to be a useful, less invasive treatment in patients with HOCM METHODS: Electronic literature search was conducted to identify articles that discussed methods to treat drug refractory HOCM. No limits were placed on timing of the publication or the type of article. Keywords and MeSH terms were used and the results were summarized in the relevant section. RESULTS Current evidence suggests that alcohol septal ablation is a safe and effective procedure in treating patients with HOCM with similar short- and long-term outcomes when compared with SM. CONCLUSION ASA has been shown to be a safe and reliable procedure; imaging techniques and dedicated multi-disciplinary teams can be used to select patients with HOCM. Though SM is recommended as gold standard treatment for drug refractory HOCM, ASA may play an increasing role in the near future due an ageing population; both ASA and SM can have a beneficial role in treating those who are affected by HOCM when the appropriate group of patients are selected for each intervention.
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Affiliation(s)
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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6
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Liu F, Fu J, Hsi D, Sun C, He G, Hu R, Zhang J, Liu L. Percutaneous Intramyocardial Septal Radiofrequency Ablation for Interventricular Septal Reduction: An Ovine Model with 1-Year Outcomes. Cardiology 2019; 145:53-62. [PMID: 31747665 DOI: 10.1159/000502973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Percutaneous intramyocardial (PIM) septal radiofrequency ablation (SRA) is a novel treatment approach for hypertrophic obstructive cardiomyopathy patients, but there has been lack of a large animal model to study PIM-SRA. We aimed to validate the long-term safety and efficacy of PIM-SRA and to observe pathological changes of the ablated interventricular septum (IVS) in a healthy sheep model. METHODS AND RESULTS Twelve sheep were randomized to the PIM-SRA group (n = 6) and the sham group (n = 6). In the PIM-SRA group, a radiofrequency (RF) electrode was inserted into the IVS with a maximum power of 80 W for 5 min. In the sham group, the RF electrode tip was positioned in the IVS segment but without RF power delivery. Septal hypokinesis was seen in all PIM-SRA group animals immediately after the procedure; the systolic wall thickening rate and motion amplitude of the ablated region decreased (p < 0.01), and the diastolic IVS thickness also decreased significantly over time (p < 0.01). ECG showed that all the sheep had normal sinus rhythm during the follow-up. Pathological examinations revealed scar tissue in the ablated region as expected. CONCLUSIONS PIM-SRA produced precisely ablated myocardial tissue, reduced the IVS thickness significantly, preserved the global LV function, and avoided the incidence of conduction system damage in the long term. PIM-SRA was found to be a safe and effective minimally invasive septal reduction therapy.
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Affiliation(s)
- Fang Liu
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Ultrasound Medicine, Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianli Fu
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Ultrasound Department, Shaan Xi Province People's Hopital, Xi'an, China
| | - David Hsi
- Heart and Vascular Institute, Stamford Hospital, Stamford, Connecticut, USA
| | - Chao Sun
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangbin He
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Rui Hu
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Zhang
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Liwen Liu
- Department of Ultrasound Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China, .,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Fourth Military Medical University, Xi'an, China,
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7
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Aksu T, Guler T, Yalin K, Golcuk SE, Ozcan K. Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: Transcoronary and Endocardial Approach. Am J Med Sci 2016; 352:466-471. [PMID: 27865293 DOI: 10.1016/j.amjms.2016.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
Abstract
Septal reduction therapy is the gold standard treatment method for symptomatic, hypertrophic obstructive cardiomyopathy. Although surgical myectomy is a well-established and effective technique with decades of experience in its application, use of transcoronary alcohol septal ablation has increased precipitously owing to the less-invasive nature of the procedure. Moreover, endocardial septal ablation therapy is a relatively newly defined modality, and outcomes of the procedure are not clearly elucidated yet. In this review, we aimed to present nonsurgical septal reduction approaches in patients with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
| | - Tumer Guler
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Bayrampasa Kolan Hospital, Istanbul, Turkey
| | | | - Kazim Ozcan
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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Lu M, Du H, Gao Z, Song L, Cheng H, Zhang Y, Yin G, Chen X, Ling J, Jiang Y, Wang H, Li J, Huang J, He Z, Zhao S. Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Circ Cardiovasc Interv 2016; 9:e002675. [DOI: 10.1161/circinterventions.115.002675] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Minjie Lu
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Hui Du
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Zhan Gao
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Lei Song
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Huaibing Cheng
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Yan Zhang
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Gang Yin
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Xiuyu Chen
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Jian Ling
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Yong Jiang
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Hao Wang
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Jinghui Li
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Jinghan Huang
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Zuoxiang He
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center (M.L., H.D., Y.Z., G.Y., X.C., J. Ling, J. Li, S.Z.), Department of Cardiology (Z.G., L.S., H.C.), Department of Echocardiography (Y.J., H.W.), The Heart-lung Testing Center (J.H.), Nuclear Medicine (Z.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
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Cooper RM, Shahzad A, Hasleton J, Digiovanni J, Hall MC, Todd DM, Modi S, Stables RH. Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound®technology to guide ablation. Europace 2015; 18:113-20. [DOI: 10.1093/europace/euv302] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/10/2015] [Indexed: 01/16/2023] Open
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Cooper RM, Shahzad A, Newton J, Vejlstrup N, Axelsson A, Sharma V, Ormerod OI, Stables RH. Intra-cardiac echocardiography in alcohol septal ablation: a prospective comparative study against trans-thoracic echocardiography. Echo Res Pract 2015; 2:9-17. [PMID: 26693311 PMCID: PMC4676484 DOI: 10.1530/erp-15-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 01/17/2023] Open
Abstract
Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can be difficult in the laboratory environment. Intra-cardiac echocardiography (ICE) provides high-quality images. We aimed to assess ICE against TTE in ASA. The ability of ICE and TTE to assess three key domains (mitral valve (MV) anatomy and systolic anterior motion, visualisation of target septum, adjacent structures) was evaluated in 20 consecutive patients undergoing ASA. Two independent experts scored paired TTE and ICE images off line for each domain in both groups. The ability to see myocardial contrast following septal arterial injection was also assessed by the cardiologist performing ASA. In patients undergoing ASA, ICE was superior in viewing MV anatomy (P=0.02). TTE was superior in assessing adjacent structures (P=0.002). There was no difference in assessing target septum. Myocardial contrast: ICE did not clearly identify the area of contrast in 17/19 patients due to dense acoustic shadowing (8/19) and inadequate opacification of the myocardium (6/19). ICE only clearly localised contrast in 2/19 cases. ICE does not visualise myocardial contrast well and therefore cannot be used to guide ASA. TTE was substantially better at viewing myocardial contrast. There was no significant difference between ICE and TTE in the overall ability to comment on cardiac anatomy relevant to ASA.
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Affiliation(s)
- Robert M Cooper
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Adeel Shahzad
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | | | | | | | | | | | - Rodney H Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
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Steggerda RC, Geluk CA, Brouwer W, van Rossum AC, Ten Berg JM, van den Berg MP. Basal infarct location but not larger infarct size is associated with a successful outcome after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: a cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 2015; 31:831-9. [PMID: 25638485 DOI: 10.1007/s10554-015-0606-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
Alcohol septal ablation (ASA) is successful in most but not in all patients with obstructive hypertrophic cardiomyopathy (HCM). We therefore sought to investigate the relation between infarct location versus infarct size with outcome after ASA in patients with obstructive HCM. Baseline characteristics, procedural characteristics, and cardiovascular magnetic resonance findings at baseline and 4-6 month follow-up after ASA were analysed in 47 patients with obstructive HCM in a single-center retrospective study. Infarct size was determined using late gadolinium enhancement. Infarct location was divided into "basal infarction" and "distal infarction" based on an optimal cut-of value of the distance from the basal septum to the beginning of the infarction. A "successful" outcome was defined as 80% reduction of the invasive gradient with a post-procedural gradient of <10 mmHg. Basal infarctions (n = 31) compared to distal infarctions (n = 16) were associated with successful outcome (100 vs. 38%, P < 0.001). Larger infarct size (n = 20) compared to smaller infarct size (n = 27) was not associated with successful outcome (75 vs. 82%, P = 0.72). A more distal location of the infarction, was the only predictor of a less successful outcome (odds ratio 0.76, 95% confidence interval 0.54-0.98, P = 0.03). Basal versus distal infarctions were also associated with a lower provoked gradient at late (2.6 ± 2.2 years) follow-up (11 (6-20) vs. 27 (12-94) mmHg, P = 0.01). Basal infarctions were associated with a successful outcome after ASA. A larger infarct size was not associated with a better outcome.
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Affiliation(s)
- Robbert C Steggerda
- Department of Cardiology, Martini Hospital, Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands,
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van der Wall EE. New ESC guidelines on hypertrophic cardiomyopathy: new insights in invasive treatment? Neth Heart J 2014; 23:1-3. [PMID: 25475512 PMCID: PMC4268221 DOI: 10.1007/s12471-014-0636-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- E E van der Wall
- Interuniversity Cardiology Institute of the Netherlands (ICIN) - Netherlands Heart Institute (NHI), PO Box 19258, 3501, DG, Utrecht, the Netherlands,
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Periprocedural Complications and Long-Term Outcome After Alcohol Septal Ablation Versus Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy. JACC Cardiovasc Interv 2014; 7:1227-34. [DOI: 10.1016/j.jcin.2014.05.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/21/2014] [Accepted: 05/08/2014] [Indexed: 11/22/2022]
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