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LV filling pressures can be estimated with reasonable accuracy in HCM patients by measuring E velocity/flow propagation velocity or E/Ea. These ratios also track changes in filling pressures.

Background-Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required. Methods and Results-We enrolled 33 symptomatic patients with HOCM and obstruction (Ն40 mm Hg gradient at rest or Ն60 mm Hg dobutamine-provoked). By contrast echocardiography, the bulging septum was localized and infarcted by injection of 2 to 5 mL of absolute ethanol into the septal artery(ies) supplying the hypertrophied area. Baseline echocardiograms with Doppler, myocardial perfusion tomograms, and treadmill exercise or pharmacological testing were compared with those at 6 weeks and 6 months. The mean rise in creatine kinase was 1964Ϯ796 U. All patients experienced symptomatic relief; NYHA class decreased from 3.0Ϯ0.5 to 0.9Ϯ0.6 (PϽ0.001). Exercise time increased from 286Ϯ193 to 421Ϯ181 seconds (Pϭ0.03). The resting and dobutamine-provoked gradient decreased from 49Ϯ33 and 96Ϯ34 mm Hg to 9Ϯ19 (PϽ0.001) and 24Ϯ31 mm Hg (PϽ0.001), respectively. Echocardiograms repeated at 6 weeks after the procedure showed a 28% reduction in septal thickness and 17% reduction in left ventricular mass. Myocardial perfusion imaging showed a "septal amputation pattern," with scarring in the upper and middle septal areas.Complete heart block developed in 11 patients, who then required permanent pacemaker implantation. Conclusions-Echocardiography-guided ethanol septal reduction in patients with HOCM is a safe, minimally invasive procedure that provides symptomatic relief with improved hemodynamic and left ventricular parameters. (Circulation. 1998;98:1750-1755.)

ACC/AHA = American College of Cardiology/American Heart Association; CABG =coronary artery bypass grafting; CAD =coronary artery disease; CHF =congestive heart failure; ECG =electrocardiographic; LV =left ventricular; MET =metabolic equivalent; MI =myocardial infarction; PTCA =percutaneous transluminal coronary angioplasty 524 For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.