Document Detail

Time to significant gradient reduction following septal balloon occlusion predicts the magnitude of final gradient response during alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy.
MedLine Citation:
PMID:  21939945     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to investigate whether a relationship exists between an acute reduction in resting left ventricular outflow tract (LVOT) gradient with balloon occlusion and the final invasive gradient response following alcohol septal ablation (ASA).
BACKGROUND: ASA is an alternative therapy to myectomy surgery to reduce the basal septal thickness and decrease the resting and/or provocable LVOT gradient in patients with hypertrophic cardiomyopathy. Patients have a variable gradient response to occlusion of the septal perforator artery before ethanol infusion for ASA.
METHODS: From November 1998 to November 2008, 120 patients (mean age 60 years [range 16 to 87 years], 50% women) with hypertrophic cardiomyopathy underwent ASA at our institution. The resting LVOT gradient (peak systolic left ventricle [LV] pressure - peak systolic aortic pressure) was measured continuously during the ASA procedure. The time to significant LVOT gradient decrease (defined as >50% decrease from baseline) was recorded following balloon occlusion of the dominant septal perforator coronary artery, which was found to perfuse the basal septum based on contrast echocardiographic studies.
RESULTS: The mean baseline resting LVOT gradient was 86 ± 43 mm Hg, and it decreased to 17 ± 11 mm Hg following ASA (-80.2%). The mean time to significant gradient reduction was 3.6 ± 2 min (range 25 s to 11 min). The time to significant LVOT gradient reduction strongly correlated with the final magnitude of gradient reduction following ASA (r = -0.81, p < 0.001).
CONCLUSIONS: This study demonstrates a correlation between the time to significant LVOT gradient reduction following septal perforator balloon occlusion and the magnitude of final gradient response after ASA.
Ali Almasood; Patrick Garceau; Anna Woo; Harry Rakowski; Leonard Schwartz; Christopher B Overgaard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  4     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-23     Completed Date:  2012-01-20     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1030-4     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Ablation Techniques*
Aged, 80 and over
Aorta / physiopathology
Balloon Occlusion*
Blood Pressure
Cardiomyopathy, Hypertrophic / complications,  physiopathology,  therapy*
Ethanol / administration & dosage*
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Outflow Obstruction / etiology,  physiopathology,  therapy*
Ventricular Pressure
Young Adult
Reg. No./Substance:
Comment In:
JACC Cardiovasc Interv. 2011 Sep;4(9):1035-6   [PMID:  21939946 ]

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