Why the study?
Transthyretin amyloid cardiomyopathy with left ventricular outflow tract obstruction challenges accurate diagnosis due to overlap with hypertrophic cardiomyopathy, and medical management is complicated by the opposing effects of beta-blockers and diuretics.
Does transcatheter alcohol septal ablation resolve left ventricular outflow tract obstruction and improve symptoms in a patient with wild-type transthyretin amyloid cardiomyopathy refractory to medical therapy?
Does transcatheter alcohol septal ablation resolve left ventricular outflow tract obstruction and improve symptoms in a patient with wild-type transthyretin amyloid cardiomyopathy refractory to medical therapy?
Answers are grounded in this paper and cite their sources.
This case report provides the first documented evidence that alcohol septal ablation can safely and effectively resolve left ventricular outflow tract obstruction and improve symptoms in a patient with wild-type transthyretin amyloid cardiomyopathy when medical management with beta-blockers and diuretics fails.
Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a restrictive cardiomyopathy caused by amyloid deposition in the myocardium. Its phenotypical overlap with hypertrophic cardiomyopathy, particularly in cases involving left ventricular outflow tract obstruction (LVOTO), challenges accurate diagnosis. Medical management of LVOTO in ATTR-CM is challenged by the opposing effects of beta-blockers and diuretics. Case summary: A 79-year-old male with left ventricular hypertrophy and LVOTO presented with worsening dyspnoea. Full diagnostic work-up confirmed wild-type ATTR-CM. A conservative medical approach with diuretics and beta-blockers proved challenging. Alcohol septal ablation was successfully performed without major complication, resolving the LVOTO and improving symptoms. Discussion: The diagnosis and management of ATTR-CM with LVOTO are complex. A thorough diagnostic approach is needed to avoid mismanagement. Diuretics and beta-blockers must be carefully balanced to achieve optimal clinical results. Alcohol septal ablation may be considered in patients with persistent symptoms and high LVOT gradients despite optimal medical therapy.
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Mejren et al. (2025) studied this question.
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