Key result
Left-sided microvascular obstruction identified by MRI after PTSMA was associated with complete improvement in clinical symptoms and pressure gradients, whereas right-sided MO was not.
Why the study?
Does the location of microvascular obstruction on MRI predict clinical and hemodynamic improvement after PTSMA in patients with HOCM?
Observational (n=23)
Does the location of microvascular obstruction on MRI predict clinical and hemodynamic improvement after PTSMA in patients with HOCM?
The location of microvascular obstruction on MRI after PTSMA may predict short-term clinical and hemodynamic success in patients with HOCM.
Post-PTSMA MRI for MO sidedness may refine outcome prediction; extends RCT evidence on ablation-specific effects.
BACKGROUND: The clinical significance of microvascular obstruction (MO) in hypertrophic cardiomyopathy (HOCM) after percutaneous transluminal septal myocardial ablation (PTSMA) remains unknown. PURPOSE: To assess the relationship between the location of MO and the improvement in symptoms and pressure gradient after PTSMA in patients with HOCM. MATERIAL AND METHODS: Twenty-three patients with HOCM underwent MRI within 24 weeks after PTSMA. The MO was defined visually as the hypointense region adjacent to the left or right ventricular cavity, which was surrounded by myocardial infarction. The location of MO and improvement in clinical symptoms and pressure gradient at 3-6 months follow-up were assessed. RESULTS: MO was observed in 16 patients who underwent MRI within 7 weeks after PTSMA. Left-sided MO was observed in 12 patients, and right-sided MO was observed in four patients. Improvement in clinical symptoms and reduction in the pressure gradient were not sufficient in the patients with right-sided MO, while PTSMA was effective in the patients with the left-sided MO. CONCLUSION: The location of MO identified by MRI may be related to the effectiveness of PTSMA at the short-term follow-up. The left-sided MO is related to complete improvement in clinical symptoms and pressure gradients.
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Amano et al. (2014) conducted an observational in Hypertrophic obstructive cardiomyopathy (n=23). Left-sided microvascular obstruction vs. Right-sided microvascular obstruction was evaluated on Improvement in clinical symptoms and pressure gradient. Left-sided microvascular obstruction identified by MRI after PTSMA was associated with complete improvement in clinical symptoms and pressure gradients, whereas right-sided MO was not.
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