Does alcohol septal ablation improve myocardial deformation and hemodynamics in patients with hypertrophic obstructive cardiomyopathy?
Feature-tracking and 4D flow MRI demonstrate improved systolic and diastolic LV function during long-term follow-up after alcohol septal ablation in patients with HOCM.
ABSTRACT Background A detailed evaluation of hemodynamics, supportive morphology, and deformation may help uncover the pathophysiology of hypertrophic obstructive cardiomyopathy (HOCM) and the changes wrought by alcohol septal ablation (ASA). Purpose To investigate the global cardiac volume, myocardial deformation, and hemodynamic characteristics before and during long‐term follow‐up after ASA in patients with HOCM. Study Type Retrospective. Subjects Twenty‐three patients (68.1 ± 8.6 years, 21.7% male) with HOCM who underwent MRI before and after ASA. Field Strength/Sequence A 3T, Two‐dimensional fast imaging employing steady‐state acquisition, inversion recovery‐prepared fast gradient echo sequences, and cine and time‐resolved three‐dimensional cine phase‐contrast (4D flow) MRI. Assessment Global left ventricular (LV) volume by cine, peak strain, and strain rate by myocardial feature‐tracking MRI, and hemodynamic characteristics by 4D flow MRI. Statistical Tests Paired t ‐test and Wilcoxon signed–rank test compared normally and nonnormally distributed data, respectively. Chi‐squared or Fisher's exact tests were used to compare categorical data, as appropriate. Pearson's or Spearman's correlation coefficient evaluated the correlations. Statistical significance was set at q ≤ 0.10 or p < 0.05. Results In LV long‐axis images, the global radial strain increased significantly (16.6% ± 5.8% vs. 20.1% ± 6.8%), whereas the global longitudinal strain decreased significantly after ASA (−10.5% ± 3.2% vs. −12.1% ± 3.5%). The diastolic LV anterior vortex area increased significantly after ASA (2256.1 703.6, 4038.4 vs. 3826.1 1914.3, 4820.1 mm 2 ). Multiplication of the LV end‐diastolic volume index, global circumferential strain, and diastolic radial peak strain rate in LV long‐axis images revealed a significant correlation with the diastolic LV anterior vortex area (Rs = 0.43). Data Conclusions Feature‐tracking and 4D flow MRI revealed improved systolic and diastolic LV function during long‐term follow‐up after ASA. The diastolic LV vortex was associated with the combined parameters of LV volume and deformation. Comprehensive cardiac MRI may help understand the beneficial effects of ASA. Evidence Level 3. Technical Efficacy Stage 5.
Suwa et al. (Thu,) studied this question.