Patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM) are considered to be good candidates for percutaneous transluminal septal myocardial ablation (PTSMA). However, there is ongoing discussion regarding the optimal dose of alcohol injected into target septal artery and the impact of infarct sizes on the clinical and hemodynamic outcome. Thirty-four patients with symptomatic HOCM receiving maximum medical therapy were consecutively enrolled. Patients were randomized in a 1:1 ratio into one of the two arms according to dose of injected alcohol during echocardiography-guided PTSMA procedure. Clinical, electrocardiographic, and echocardiographic evaluation were performed 6 months after the procedure in all the patients. Both groups of patients matched in all clinical and echocardiographic data. The dose of alcohol injected was 1.6 +/- 0.4 and 3.4 +/- 0.9 (P< 0.001) with subsequent peak of CK-MB 1.9 and 3.2 microkat/L (P < 0.05) in group A and B, respectively. There was a correlation between amount of injected alcohol and the peak of CK-MB (r = 0.58; P < 0.01), whereas no significant relationship (r = 0.16; P = NS) was documented between the peak of CK-MB and left ventricular outflow gradient at follow-up. At 6-month follow-up, both groups of patients were not significantly different with regard to symptoms or electrocardiographic and echocardiographic findings. In conclusion, this study suggests that the low dose (1- 2 ml) of alcohol injected into target septal branch reduces size of necrosis. Moreover, the low dose is probably as safe and efficacious as usually used doses (2-4 ml).
Alcohol septal ablation (PTSMA) improves outflow gradient, left ventricular (LV) diastolic function, and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). Tei index (TI) is a Doppler parameter reflecting both systolic and diastolic LV function. Midterm changes of TI after PTSMA have not been determined up to now. Twenty-seven consecutive patients (mean age 53 +/- 13 years) with symptomatic HOCM underwent PTSMA procedure. Clinical and echocardiographic data were collected at baseline, 6 and 12 months after PTSMA. TI decreased from 0.67 +/- 0.11 to 0.55 +/- 0.06, isovolumic contractile time (ICT) decreased from 74 +/- 20 to 48 +/- 11 ms, isovolumic relaxation time decreased from 146 +/- 25 to 117 +/- 9 ms, and LV ejection time decreased from 330 +/- 42 to 298 +/- 13 ms. LV remodeling was determined by LV dimension increase from 46 +/- 6 to 48 +/- 6 mm and basal septum thickness reduction from 22 +/- 4 to 15 +/- 3 mm. LV ejection fraction decreased from 78 +/- 7 to 73 +/- 6% and maximal outflow gradient decreased from 69 +/- 44 to 15 +/- 11 mmHg. All changes were statistically significant (P <0.01). Symptomatic improvement was characterized by relief of dyspnea (2.5 +/- 0.7 versus 1.4 +/- 0.6 NYHA class; P <0.01) and angina pectoris (2.6 +/- 0.9 versus 0.7 +/- 0.7 CCS class; P <0.01). PTSMA is an effective method of therapy for HOCM. Shortening of TI suggests the improvement of LV myocardial performance in the midterm follow-up.
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