Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) (n=154). Intervention: Alcohol septal ablation (ASA) vs. Pre-procedural baseline status / MR change subgroups (improved vs unchanged vs increased MR). Primary outcome: Improvement in mitral regurgitation (MR) severity to mild or less among patients with at least moderate MR at baseline (p=0.003).

Q: What does this research mean for the field?

Alcohol septal ablation improves mitral regurgitation severity to mild or less in 90% of hypertrophic obstructive cardiomyopathy patients with at least moderate baseline regurgitation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Anna Damlin; Andreas Rück; Mesud Mustafic; Rebecka Jandér; Anette M. Rickenlund; Maria J. Eriksson; Nawzad Saleh; David Marlevi

doi:10.1186/s12872-026-06952-w

October 31, 2026BMC Cardiovascular DisordersOpen Access

Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study

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Key result

Alcohol septal ablation reduces mitral regurgitation to mild or less in ~90% of HOCM patients.

P=0.003
n=154

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Why the study?

Among patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation (ASA), the impact on mitral regurgitation (MR) and its underlying mechanisms remained less studied.

Does alcohol septal ablation improve mitral regurgitation severity in patients with hypertrophic obstructive cardiomyopathy?

Key Points

To assess the prevalence and severity changes of mitral regurgitation following alcohol septal ablation for hypertrophic obstructive cardiomyopathy and identify associated echocardiographic features.
Retrospective cohort study of 154 patients who underwent alcohol septal ablation at Karolinska University Hospital in Sweden from 2009 to 2021, with a mean follow-up of 4.0 ± 3.9 years.
Echocardiographic parameters were assessed pre-procedure, at 1-year follow-up, and at the latest registered follow-up.
At baseline, 14% (n = 21) had at least moderate mitral regurgitation, of which 90% (n = 19) improved to mild regurgitation or less at the last follow-up, while 10% (n = 2) remained moderate.
Overall, 83% (n = 128) had an unchanged grade and 4.5% (n = 7) experienced increased regurgitation from mild or none to moderate; no patients had severe mitral regurgitation at follow-up.
Patients with improved (137.5 to 4.8 mmHg) or unchanged (57.0 to 25.0 mmHg) regurgitation achieved significantly greater left ventricular outflow tract peak gradient reductions than patients with increased regurgitation (57.0 to 51.0 mmHg, p = 0.003).

Study Design

Type

Cohort (n=154)

Multicenter

No

Structured PICO

Does alcohol septal ablation improve mitral regurgitation severity in patients with hypertrophic obstructive cardiomyopathy?

P

Population

154 adults (median age 63 years, 50% female) with hypertrophic obstructive cardiomyopathy unsuitable for surgical myectomy undergoing alcohol septal ablation, followed for a mean of 4.0 years.

E

Exposure

Alcohol septal ablation (ASA) performed on clinical indication alongside optimal medical therapy

O

Outcome

Prevalence of mitral regurgitation (MR) and changes in MR severity (improved, unchanged, or increased MR grade) assessed by transthoracic echocardiography at 1-year follow-up and latest follow-up (mean 4.0 ± 3.9 years)surrogate

Main Result

p-value: p=0.003

In patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation, 90% of those with at least moderate baseline SAM-mediated mitral regurgitation improved to mild or no regurgitation, associated with significant reductions in LVOT gradients.

Limitations

Single-center retrospective design potentially limiting generalizability
Low absolute number of events (only 21 patients with at least moderate MR at baseline and 7 with increased MR)
Limited statistical power precluding multivariable analysis, leaving univariate associations susceptible to confounding
Single-center design, possibly limiting generalizability
Low absolute number of events (i.e., MR of at least moderate grade), limiting statistical power and precluding a robust multivariable analysis
Reported associations are based on univariate analyses and may be susceptible to confounding by baseline clinical characteristics and other factors
Relatively small number of events limits the precision and robustness of the observed associations

Implication

Alcohol septal ablation may reduce moderate MR in HOCM; leaves open randomized confirmation of net clinical benefit.

Abstract

Background The primary mechanism of mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy is systolic anterior motion (SAM) of the mitral leaflets due to septal hypertrophy narrowing the left ventricular outflow tract (LVOT), influencing leaflet movement and closure. Among patients undergoing alcohol septal ablation (ASA), the impact on- and underlying mechanism of MR remains less studied. The aim was to determine the prevalence of MR and changes in MR severity after ASA and analyze echocardiographic (ECHO) parameters associated with MR changes. Methods All patients who underwent ASA at Karolinska University Hospital in Sweden, 2009–2021 (follow-up until 2025), were included in this retrospective cohort study. ECHO parameters were collected before ASA, at 1-year follow-up and at the latest follow-up registered. To evaluate differences in continuous values, Kruskal-Wallis test was used, and for categorical values, Fischer’s exact test was used. Results 154 patients were included (mean follow-up 4.0 ± 3.9 years). 14% ( n = 21) had at least moderate MR at baseline, of which 90% ( n = 19) improved to mild MR or less. The patients with improved ( n = 19, 12%) or unchanged ( n = 128, 83%) grade of MR showed greater reduction of LVOT peak pressure gradients (improved MR: 137.5 to 4.8 mmHg, unchanged MR: 57.0 to 25.0 mmHg) between baseline and last follow-up, compared with patients with increased MR grade ( n = 7, 4.5%, 57.0 to 51.0 mmHg, p = 0.003). Conclusions Among patients with at least moderate MR before ASA, MR severity generally improved at follow-up, potentially due to septal reduction and LVOT enlargement, which may have reduced SAM. Clinical trial number Not applicable.

Discussion

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Cite This Study

Damlin et al. (2026) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) (n=154). Alcohol septal ablation (ASA) vs. Pre-procedural baseline status / MR change subgroups (improved vs unchanged vs increased MR) was evaluated on Improvement in mitral regurgitation (MR) severity to mild or less among patients with at least moderate MR at baseline (p=0.003). Alcohol septal ablation improved mitral regurgitation to mild or less in 90% (19/21) of HOCM patients with at least moderate baseline MR over a mean 4.0-year follow-up.

synapsesocial.com/papers/6ae7d421edffb4962941048d https://doi.org/10.1186/s12872-026-06952-w

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Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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