Effects of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy on Doppler Tei Index: A Midterm Follow‐Up

Abstract

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.

Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review of Published Studies

“…We included all the case series published in English and the English versions of foreign case series when available. A total of 42 studies/case series 10–21,24–27,33–58 were included in the final review. Inclusion criteria in these studies included symptomatic HOCM despite reported medical therapy, persistence of symptoms after dual chamber sequential pacing, or surgical myomectomy.…”

“…ASA is performed through a percutaneous approach, in which 1–3 cc of absolute ethanol is introduced into a major septal artery to create a controlled septal infarction and necrosis at the base of the hypertrophied interventricular septum 17–23 . This approach results in resolution of the LVOT gradient due to decreased basal septal myocardial contractility initially, followed by thinning and scarring of the septal base leading into LVOT widening, restricted septal excursion, decreased mitral regurgitation, and subsequent global left ventricular remodeling 15,24–31 …”

Effects of exercise on the duration of diastole and on interventricular phase differences in patients with hypertrophic cardiomyopathy: relationship to cardiac output reserve

“…22 The underlying improvement in cardiac performance was related to a shortening in LV ejection time and a decrease in Tei-index which incorporates both systolic and diastolic time intervals for expressing global ventricular performance. 23 HCM is considered to be predominantly an obstructive disease and exercise the only provocative maneuver that is truly physiologically based and appropriate to identify symptomatic patients not otherwise regarded as potential candidates for septal reduction therapy. 12 Therefore, identification of changes in cardiac performance associated with LV outflow tract obstruction may be important to understand the complex pathophysiological mechanisms leading to symptom development in these patients.…”

Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

“…Moreover, a small decrease in the ejection fraction is noted in these follow up studies with a paradoxical increase in global systolic indices (shortening index and Tei index) [17, 20]. Diastolic function has been extensively studied in patients with HCM and follow up studies of post-ASA patients have shown a significant and sustained improvement in echocardiographic diastolic parameters [20, 21]. In a recent study by Jassal et al , all patients had a pseudonormal or an impaired relaxation pattern at baseline along with left atrial dilation.…”

“…These studies showed a significant decrease in myocardial mass and LV wall thickness both in the infarcted and non infarcted areas at early and midterm follow up after ASA [17-19]. Moreover, a small decrease in the ejection fraction is noted in these follow up studies with a paradoxical increase in global systolic indices (shortening index and Tei index) [17, 20]. Diastolic function has been extensively studied in patients with HCM and follow up studies of post-ASA patients have shown a significant and sustained improvement in echocardiographic diastolic parameters [20, 21].…”