Published Online
on May 2, 2005

A more recent version of this article appeared on May 17, 2005

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Submitted on July 22, 2004
Revised on January 16, 2005
Accepted on January 26, 2005

Early Onset and Progression of Left Ventricular Remodeling After Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Willem G. van Dockum MD^*, Aernout M. Beek MD, Folkert J. ten Cate MD, PhD, Jurrien M. ten Berg MD, PhD, Olga Bondarenko MD, Marco J.W. Götte MD, PhD, Jos W.R. Twisk PhD, Mark B.M. Hofman PhD, Cees A. Visser MD, PhD, and Albert C. van Rossum MD, PhD

From the Departments of Cardiology (W.G.v.D., A.M.B., O.B., M.J.W.G., C.A.V., A.C.v.R.), Clinical Epidemiology and Biostatistics (J.W.R.T.), and Clinical Physics and Informatics (M.B.M.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology (F.J.t.C.), Thoraxcenter Erasmus Medical Center, Rotterdam, the Netherlands; and Department of Cardiology (J.M.t.B.), St Antonius Hospital, Nieuwegein, the Netherlands.

^* To whom correspondence should be addressed. E-mail: wg.vandockum{at}vumc.nl.

Background--Alcohol septal ablation (ASA) reduces left ventricular outflow tract (LVOT) pressure gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM), which leads to left ventricular remodeling. We sought to describe the early to midterm changes and modulating factors of the remodeling process using cardiac MRI (CMR).

Methods and Results--CMR was performed at baseline and 1 and 6 months after ASA in 29 patients with HOCM (age 52±16 years). Contrast-enhanced CMR showed no infarct-related hyperenhancement outside the target septal area. Septal mass decreased from 75±23 g at baseline to 68±22 and 58±19 g (P<0.001) at 1- and 6-month follow-up, respectively. Remote, nonseptal mass decreased from 141±41 to 132±40 and 111±27 g (P<0.001), respectively. Analysis of temporal trends revealed that septal mass reduction was positively associated with contrast-enhanced infarct size and transmural or left-sided septal infarct location at both 1 and 6 months. Remote mass reduction was associated with infarct location at 6 months but not with contrast-enhanced infarct size. By linear regression analysis, percentage remote mass reduction correlated significantly with LVOT gradient reduction at 6-month follow-up (P=0.03).

Conclusions--Left ventricular remodeling after ASA occurs early and progresses on midterm follow-up, modulated by CMR infarct size and location. Remote mass reduction is associated with infarct location and correlates with reduction of the LVOT pressure gradient. Thus, myocardial hypertrophy in HOCM is, at least in part, afterload dependent and reversible and is not exclusively caused by the genetic disorder.

Key words: hypertrophy • cardiomyopathy • ablation • remodeling • magnetic resonance imaging

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