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Mitral valve morphological abnormalities, specifically redundant anterior mitral leaflet, greater posterior mitral leaflet projection, and anterior displacement of the coaptation point, are associated with suboptimal procedural outcomes in patients undergoing alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026Open Access

Mitral Valve Abnormalities as Predictors of Procedural Success in Alcohol Septal Ablation: A Pilot Study

Key Points

Non-responders had greater mitral valve redundancy, indicating potential predictors of poor outcomes.
Echocardiographic analysis revealed significant differences in mitral valve morphology between responders and non-responders.

Structured PICO

Do specific mitral valve morphological features predict procedural success in patients with obstructive hypertrophic cardiomyopathy undergoing alcohol septal ablation?

Population

38 patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent alcohol septal ablation (ASA) and had complete echocardiographic data

Intervention

Alcohol septal ablation (ASA)

Comparator

Responders (n=32) vs. Non-responders (n=6)

Outcome

Procedural success/response at 6-month follow-up (defined as >50% reduction in LVOT pressure gradient and/or residual LVOT gradient < 50 mmHg)surrogate

Specific baseline mitral valve morphological features, including redundant anterior leaflets and greater posterior leaflet projection, are associated with suboptimal hemodynamic responses to alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy.

Abstract

Background/Objectives: Alcohol septal ablation (ASA) is an established interventional therapy for patients with obstructive hypertrophic cardiomyopathy (OHCM) who remain symptomatic despite optimal medical treatment. Nevertheless, 10-20% of patients fail to achieve a satisfactory hemodynamic or clinical response, highlighting the need for improved patient selection. Given that mitral valve (MV) morphology plays a central role in left ventricular outflow tract (LVOT) obstruction, we aimed to evaluate the impact of MV anatomical parameters on ASA outcomes. Methods: We retrospectively analyzed 38 OHCM patients who underwent ASA and had complete echocardiographic data before and at 6-month follow-up. Patients were stratified into responders (n = 32, defined as >50% reduction in LVOT pressure gradient and/or residual LVOT gradient n = 6, Results: Non-responders demonstrated significantly greater AML redundancy (13.16 ± 1.72 vs. 9.96 ± 1.99 mm, p p = 0.006), and lower AML/PML projection ratio (0.80 ± 0.15 vs. 1.34 ± 0.45, p = 0.007). These parameters were associated with reduced post-procedural LVOT gradient reduction in univariate logistic regression (p = 0.01, p = 0.027, p = 0.015, respectively). Multivariate modeling was not pursued due to collinearity among MV parameters and the limited number of non-responder events, which precluded robust adjustment. Conclusions: Mitral valve morphological features-particularly redundant AML, greater PML projection, and anterior displacement of the coaptation point-were associated with suboptimal ASA outcomes in univariate analysis. These data emphasize the need for comprehensive MV imaging in pre-procedural assessment. Integrating MV morphology into current selection algorithms may refine ASA patient selection and improve long-term success rates.

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