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Gragnano F, Pelliccia F, Guarnaccia N, Niccoli G, De Rosa S, Piccolo R, Moscarella E, Fabris E, Montone RA, Cesaro A, Porto I, Indolfi C, Sinagra G, Perrone Filardi P, Andò G, Calabrò P. Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective. J Clin Med 2023; 12:jcm12082810. [PMID: 37109147 PMCID: PMC10142866 DOI: 10.3390/jcm12082810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient's hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients-the Cardiomyopathy Team.
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Affiliation(s)
- Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 83043 Naples, Italy
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Francesco Pelliccia
- Department of Cardiovascular Sciences, University Sapienza, 00185 Rome, Italy
| | - Natale Guarnaccia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 83043 Naples, Italy
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 83043 Naples, Italy
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34127 Trieste, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 83043 Naples, Italy
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Italo Porto
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34127 Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinic "G. Martino", 98122 Messina, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 83043 Naples, Italy
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
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2
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Cui H, Schaff HV, Wang S, Lahr BD, Rowin EJ, Rastegar H, Hu S, Eleid MF, Dearani JA, Kimmelstiel C, Maron BJ, Nishimura RA, Ommen SR, Maron MS. Survival Following Alcohol Septal Ablation or Septal Myectomy for Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1647-1655. [PMID: 35483751 DOI: 10.1016/j.jacc.2022.02.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is little information regarding long-term mortality comparing the 2 most common procedures for septal reduction for obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA), and septal myectomy. OBJECTIVES This study sought to compare the long-term mortality of patients with obstructive HCM following septal myectomy or ASA. METHODS We evaluated outcomes of 3,859 patients who underwent ASA or septal myectomy in 3 specialized HCM centers. All-cause mortality was the primary endpoint of the study. RESULTS In the study cohort, 585 (15.2%) patients underwent ASA, and 3,274 (84.8%) underwent septal myectomy. Patients undergoing ASA were significantly older (median age: 63.0 years [IQR: 52.7-72.8 years] vs 53.7 years [IQR: 44.9-62.8 years]; P < 0.001) and had smaller septal thickness (19.0 mm [IQR: 17.0-22.0 mm] vs 20.0 mm [IQR: 17.0-23.0 mm]; P = 0.007). Patients undergoing ASA also had more comorbidities, including renal failure, diabetes, hypertension, and coronary artery disease. There were 4 (0.7%) early deaths in the ASA group and 9 (0.3%) in the myectomy group. Over a median follow-up of 6.4 years (IQR: 3.6-10.2 years), the 10-year all-cause mortality rate was 26.1% in the ASA group and 8.2% in the myectomy group. After adjustment for age, sex, and comorbidities, the mortality remained greater in patients having septal reduction by ASA (HR: 1.68; 95% CI: 1.29-2.19; P < 0.001). CONCLUSIONS In patients with obstructive hypertrophic cardiomyopathy, ASA is associated with increased long-term all-cause mortality compared with septal myectomy. This impact on survival is independent of other known factors but may be influenced by unmeasured confounding patient characteristics.
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Affiliation(s)
- Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Ethan J Rowin
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Hassan Rastegar
- Division of Cardiothoracic Surgery, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Shengshou Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carey Kimmelstiel
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Barry J Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin S Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts, USA
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3
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Aguiar Rosa S, Fiarresga A, Galrinho A, Cacela D, Ramos R, de Sousa L, Gonçalves A, Bernardes L, Patrício L, Branco LM, Ferreira RC. Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of a reference center. Rev Port Cardiol 2019; 38:473-480. [PMID: 31495717 DOI: 10.1016/j.repc.2019.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 12/09/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. METHODS We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. RESULTS A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. CONCLUSION ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.
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Affiliation(s)
- Sílvia Aguiar Rosa
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal.
| | - António Fiarresga
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Ana Galrinho
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Duarte Cacela
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Ruben Ramos
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Lídia de Sousa
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - António Gonçalves
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Luís Bernardes
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Lino Patrício
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Luísa Moura Branco
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
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Aguiar Rosa S, Fiarresga A, Galrinho A, Cacela D, Ramos R, de Sousa L, Gonçalves A, Bernardes L, Patrício L, Branco LM, Ferreira RC. Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of a reference center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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5
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The effects of septal myectomy and alcohol septal ablation for hypertrophic cardiomyopathy on the cardiac conduction system. J Interv Card Electrophysiol 2018; 52:403-408. [DOI: 10.1007/s10840-018-0433-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/27/2018] [Indexed: 01/08/2023]
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6
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An SY, Yang YJ, Hang F, Wang ZM, Fan CM. Procedural complication and long term outcomes after alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: data from China. Sci Rep 2017; 7:9506. [PMID: 28842653 PMCID: PMC5572739 DOI: 10.1038/s41598-017-10144-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
Data on procedural complications and long term survival after alcohol septal ablation (ASA) in Chinese patients with obstructive hypertrophic cardiomyopathy (HOCM) are lacking. We aimed to investigate long-term survival of HOCM patients after ASA and compared to the non-obstructive hypertrophic cardiomyopathy(NOHCM). A total of 233 patients with HOCM and a peak pressure gradient of ≥50 mm Hg at rest or with provocation were consecutively enrolled from Fuwai Hospital in China between 2000 and 2012. Another 297 patients without left ventricular outflow tract obstruction were regarded as control group. Periprocedural mortality of ASA were low (0.89%). Periprocedural lethal ventricular arrhythmia occurred in 9 patients (4.0%). Alcohol volume (RR 1.44, 95% CI: 1.03–2.03, P = 0.034) and age ≤40 years old (RR 4.63, 95% CI: 1.07–20.0, P = 0.040) were independent predictors for periprocedural lethal ventricular arrhythmia. The 10- year overall survival was 94.6% in the ASA group, similar with 92.9% in the NOHCM group (P = 0.930). In conclusion, periprocedural mortality and complications were rare in ASA. Long term survival after ASA were satisfactory and comparable to NOHCM. Patients under 40 years old should be more cautious undergoing ASA, for these patients were more likely to endure lethal ventricular arrhythmia during periprocedural period of ASA.
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Affiliation(s)
- Shuo-Yan An
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin-Jian Yang
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Hang
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Min Wang
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao-Mei Fan
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Pontone G, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Aquaro GD. Clinical recommendations of cardiac magnetic resonance, Part II. J Cardiovasc Med (Hagerstown) 2017; 18:209-222. [DOI: 10.2459/jcm.0000000000000499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Yang YJ, Fan CM, Yuan JQ, Wang SY, Song YH, Qiao SB, You SJ, Wang ZM, Duan FJ, Li YS. Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction. J Interv Cardiol 2016; 29:619-627. [PMID: 27545664 DOI: 10.1111/joic.12331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair. RESULTS Baseline midventricular pressure gradient and symptoms were comparable between the ASA and TEM groups. During follow-up, both groups demonstrated substantial reduction in pressure gradient (the ASA group: 79.7 ± 21.2 mm Hg to 43.7 ± 28.9 mm Hg, P < 0.001; the TEM group: 69.0 ± 23.9 mm Hg to 15.0 ± 16.9 mm Hg, P < 0.001). The reduction in pressure gradient was greater (78.9 ± 18.6% vs. 46.4 ± 33.4%, P < 0.001) and the residual pressure gradient was lower after TEM versus ASA (P < 0.001). Patients with New York Heart Association class III/IV dyspnea decreased from 59.1 to 18.2% (P = 0.022) in the ASA group and from 56.8 to 5.6% (P < 0.001) in the TEM group. Patients with Canadian Cardiovascular Society class III/IV angina decreased from 40.9 to 9.1% (P = 0.016) in the ASA group and from 32.4 to 0% (P < 0.001) in the TEM group. CONCLUSIONS While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.
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Affiliation(s)
- Yin-Jian Yang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Chao-Mei Fan
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Qing Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shui-Yun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Hu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Bin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shi-Jie You
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Min Wang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Jian Duan
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Shi Li
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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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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Kalisz K, Rajiah P. Impact of cardiac magnetic resonance imaging in non-ischemic cardiomyopathies. World J Cardiol 2016; 8:132-145. [PMID: 26981210 PMCID: PMC4766265 DOI: 10.4330/wjc.v8.i2.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/23/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Non-ischemic cardiomyopathies include a wide spectrum of disease states afflicting the heart, whether a primary process or secondary to a systemic condition. Cardiac magnetic resonance imaging (CMR) has established itself as an important imaging modality in the evaluation of non-ischemic cardiomyopathies. CMR is useful in the diagnosis of cardiomyopathy, quantification of ventricular function, establishing etiology, determining prognosis and risk stratification. Technical advances and extensive research over the last decade have resulted in the accumulation of a tremendous amount of data with regards to the utility of CMR in these cardiomyopathies. In this article, we review CMR findings of various non-ischemic cardiomyopathies and focus on current literature investigating the clinical impact of CMR on risk stratification, treatment, and prognosis.
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11
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Ablación con alcohol en miocardiopatía hipertrófica: localización y cuantificación con ecocardiografía 3D del miocardio dependiente de la septal diana. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Alcohol Ablation in Hypertrophic Cardiomyopathy: Localization and Quantification of Target Septal Artery-dependent Myocardium With 3-Dimensional Echocardiography. ACTA ACUST UNITED AC 2015; 68:531-3. [PMID: 25935148 DOI: 10.1016/j.rec.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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13
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SCHULLER JOSEPHL, ZIPSE MATTHEWM, KRANTZ MORIJ, BLAKER BRIAN, SALCEDO ERNESTO, GROVES BERTRONM, MESSENGER JOHNC, BEATY BRENDA, SAUER WILLIAMH. Incidence and Predictors of Late Complete Heart Block After Alcohol Septal Ablation Treatment of Hypertrophic Obstructive Cardiomyopathy. J Interv Cardiol 2015; 28:90-7. [DOI: 10.1111/joic.12178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- JOSEPH L. SCHULLER
- Cardiology Division; Denver Health; Denver Colorado
- University of Colorado School of Medicine; Aurora Colorado
| | | | - MORI J. KRANTZ
- Cardiology Division; Denver Health; Denver Colorado
- University of Colorado School of Medicine; Aurora Colorado
| | - BRIAN BLAKER
- Cardiology Division; Denver Health; Denver Colorado
| | | | | | | | - BRENDA BEATY
- University of Colorado School of Medicine; Aurora Colorado
- Colorado Health Outcomes Program; Aurora Colorado
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14
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Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Freitas A, Habib G, Kitsiou A, Petersen SE, Schroeder S, Lancellotti P, Camici P, Dulgheru R, Hagendorff A, Lombardi M, Muraru D, Sicari R. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 2015; 16:280. [PMID: 25650407 DOI: 10.1093/ehjci/jeu291] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.
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MESH Headings
- Cardiac Imaging Techniques/methods
- Cardiac Imaging Techniques/standards
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Consensus
- Echocardiography, Doppler/methods
- Echocardiography, Doppler/standards
- Europe
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine/methods
- Magnetic Resonance Imaging, Cine/standards
- Male
- Multimodal Imaging/methods
- Multimodal Imaging/standards
- Positron-Emission Tomography/methods
- Positron-Emission Tomography/standards
- Practice Guidelines as Topic/standards
- Role
- Saudi Arabia
- Societies, Medical/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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15
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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: 4] [Impact Index Per Article: 0.4] [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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16
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Wang C, Wang Z, Wang Y, Xia R, Chen W, Cai W, Lu X, Liao J, Zhang B, Chen Y, Zhang R, Gao F. Remote myocardial remodeling of biventricular hypertrophic cardiomyopathy after alcohol septal ablation on cardiac magnetic resonance. Circ J 2014; 78:2776-8. [PMID: 25212879 DOI: 10.1253/circj.cj-14-0574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Chunhua Wang
- Department of Radiology, West China Hospital, Sichuan University
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17
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Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733-79. [PMID: 25173338 DOI: 10.1093/eurheartj/ehu284] [Citation(s) in RCA: 2848] [Impact Index Per Article: 284.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Ablation Techniques/methods
- Adult
- Angina Pectoris/etiology
- Arrhythmias, Cardiac/etiology
- Cardiac Imaging Techniques/methods
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Clinical Laboratory Techniques/methods
- Death, Sudden, Cardiac/prevention & control
- Delivery of Health Care
- Diagnosis, Differential
- Electrocardiography/methods
- Female
- Genetic Counseling/methods
- Genetic Testing/methods
- Heart Failure/etiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Medical History Taking/methods
- Pedigree
- Physical Examination/methods
- Preconception Care/methods
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prenatal Care/methods
- Risk Factors
- Sports Medicine
- Syncope/etiology
- Thoracic Surgical Procedures/methods
- Ventricular Outflow Obstruction/etiology
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18
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Yuan J, Chen S, Qiao S, Duan F, Zhang J, Wang H. Characteristics of myocardial postsystolic shortening in patients with symptomatic hypertrophic obstructive cardiomyopathy before and half a year after alcohol septal ablation assessed by speckle tracking echocardiography. PLoS One 2014; 9:e99014. [PMID: 24922531 PMCID: PMC4055631 DOI: 10.1371/journal.pone.0099014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/08/2014] [Indexed: 02/05/2023] Open
Abstract
Objectives Postsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on PSS in HOCM patients using speckle tracking imaging. Methods Conventional echocardiographic and PSS parameters were obtained in 18 healthy controls and 30 HOCM patients before and half a year after PTSMA. Results Compared with the healthy controls, the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. At 6 months after PTSMA, both the number of segments having PSS (10.5±2.8 vs. 13.2±2.6; P<0.001) and the average value of PSS (−1.24±0.57 vs. −1.55±0.56; P = 0.009) were significantly reduced. Moreover, the reductions in the average value of PSS correlated well with the reductions in the E-to-Ea ratio (r = 0.705, P<0.001). Conclusions Both the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. PTSMA has a favourable effect on PSS, which may partly account for the persistent improvement in LV diastolic function in HOCM patients after PTSMA.
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Affiliation(s)
- Jiansong Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
| | - Fujian Duan
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiafen Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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19
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Evaluation of left ventricular myocardial perfusion and function using gated SPECT in patients with hypertrophic obstruction cardiomyopathy following percutaneous transluminal septal myocardial ablation. Nucl Med Commun 2014; 35:762-6. [PMID: 24681766 DOI: 10.1097/mnm.0000000000000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was designed to evaluate the left ventricular myocardial perfusion and function in hypertrophic obstruction cardiomyopathy patients following percutaneous transluminal septal myocardial ablation (PTSMA) using rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging. PATIENTS AND METHODS Thirty-five patients (24 men and 11 women, 48±11 years old) with hypertrophic obstruction cardiomyopathy underwent rest-gated Tc-MIBI SPECT imaging 4±10 days before (baseline) and 4.7±1.0 days (short-term) and 15.5±8.2 months (mid-term) after PTSMA. Semiquantitative and QGS quantitative evaluations of perfusion and function were carried out in 17 left ventricular segments. RESULTS Myocardial perfusion of the septum following PTSMA was significantly reduced compared with baseline in all patients (P<0.05), but the myocardial perfusion in the basal septum was significantly higher at mid-term compared with short-term following PTSMA (P<0.05). Left ventricular ejection fraction was significantly decreased following PTSMA (P<0.05). Regional wall motion assessed in the basal anterior, basal septum, and basal inferior areas following PTSMA was significantly reduced compared with baseline (P<0.05), and wall thickening of the interventricular septum was decreased following PTSMA (P<0.05). CONCLUSION Rest-gated SPECT imaging can be used to assess left ventricular myocardial perfusion and function and to investigate the efficacy of PTSMA during follow-up.
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20
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The emerging role of cardiovascular MRI for risk stratification in hypertrophic cardiomyopathy. Clin Radiol 2014; 69:221-30. [DOI: 10.1016/j.crad.2013.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/06/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022]
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21
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Green tea halts progression of cardiac transthyretin amyloidosis: an observational report. Clin Res Cardiol 2012; 101:805-13. [PMID: 22584381 PMCID: PMC3445797 DOI: 10.1007/s00392-012-0463-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/19/2012] [Indexed: 12/14/2022]
Abstract
Background Treatment options in patients with amyloidotic transthyretin (ATTR) cardiomyopathy are limited. Epigallocatechin-3-gallate (EGCG), the most abundant catechin in green tea (GT), inhibits fibril formation from several amyloidogenic proteins in vitro. Thus, it might also halt progression of TTR amyloidosis. This is a single-center observational report on the effects of GT consumption in patients with ATTR cardiomopathy. Methods 19 patients with ATTR cardiomyopathy were evaluated by standard blood tests, echocardiography, and cardiac MRI (n = 9) before and after consumption of GT and/or green tea extracts (GTE) for 12 months. Results Five patients were not followed up for reasons of death (n = 2), discontinuation of GT/GTE consumption (n = 2), and heart transplantation (n = 1). After 12 months no increase of left ventricular (LV) wall thickness and LV myocardial mass was observed by echocardiography. In the subgroup of patients evaluated by cardiac MRI a mean decrease of LV myocardial mass (−12.5 %) was detected in all patients. This was accompanied by an increase of mean mitral annular systolic velocity of 9 % in all 14 patients. Total cholesterol (191.9 ± 8.9 vs. 172.7 ± 9.4 mg/dL; p < 0.01) and LDL cholesterol (105.8 ± 7.6 vs. 89.5 ± 8.0 mg/dL; p < 0.01) decreased significantly during the observational period. No serious adverse effects were reported by any of the participants. Conclusions Our observation suggests an inhibitory effect of GT and/or GTE on the progression of cardiac amyloidosis. We propose a randomized placebo-controlled investigation to confirm our observation. Electronic supplementary material The online version of this article (doi:10.1007/s00392-012-0463-z) contains supplementary material, which is available to authorized users.
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22
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Maron MS. Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2012; 14:13. [PMID: 22296938 PMCID: PMC3293092 DOI: 10.1186/1532-429x-14-13] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 02/01/2012] [Indexed: 12/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by substantial genetic and phenotypic heterogeneity, leading to considerable diversity in clinical course including the most common cause of sudden death in young people and a determinant of heart failure symptoms in patients of any age. Traditionally, two-dimensional echocardiography has been the most reliable method for establishing a clinical diagnosis of HCM. However, cardiovascular magnetic resonance (CMR), with its high spatial resolution and tomographic imaging capability, has emerged as a technique particularly well suited to characterize the diverse phenotypic expression of this complex disease. For example, CMR is often superior to echocardiography for HCM diagnosis, by identifying areas of segmental hypertrophy (ie., anterolateral wall or apex) not reliably visualized by echocardiography (or underestimated in terms of extent). High-risk HCM patient subgroups identified with CMR include those with thin-walled scarred LV apical aneurysms (which prior to CMR imaging in HCM remained largely undetected), end-stage systolic dysfunction, and massive LV hypertrophy. CMR observations also suggest that the cardiomyopathic process in HCM is more diffuse than previously regarded, extending beyond the LV myocardium to include thickening of the right ventricular wall as well as substantial morphologic diversity with regard to papillary muscles and mitral valve. These findings have implications for management strategies in patients undergoing invasive septal reduction therapy. Among HCM family members, CMR has identified unique phenotypic markers of affected genetic status in the absence of LV hypertrophy including: myocardial crypts, elongated mitral valve leaflets and late gadolinium enhancement. The unique capability of contrast-enhanced CMR with late gadolinium enhancement to identify myocardial fibrosis has raised the expectation that this may represent a novel marker, which may enhance risk stratification. At this time, late gadolinium enhancement appears to be an important determinant of adverse LV remodeling associated with systolic dysfunction. However, the predictive significance of LGE for sudden death is incompletely resolved and ultimately future large prospective studies may provide greater insights into this issue. These observations underscore an important role for CMR in the contemporary assessment of patients with HCM, providing important information impacting diagnosis and clinical management strategies.
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MESH Headings
- Cardiomyopathy, Hypertrophic, Familial/complications
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/mortality
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Contrast Media
- Death, Sudden, Cardiac/etiology
- Disease Progression
- Fibrosis
- Genetic Predisposition to Disease
- Heart Failure/genetics
- Humans
- Magnetic Resonance Imaging
- Mitral Valve/pathology
- Myocardium/pathology
- Papillary Muscles/pathology
- Phenotype
- Predictive Value of Tests
- Prognosis
- Ventricular Function, Left
- Ventricular Remodeling
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Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA.
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