Tirza Springeling, Presenter: Nothing to Disclose

Sharon W Kirschbaum, Abstract Co-Author: Nothing to Disclose

Folkert J Ten Cate MD, Abstract Co-Author: Nothing to Disclose

Adriaan Moelker MD, Abstract Co-Author: Nothing to Disclose

Pim De Feijter, Abstract Co-Author: Nothing to Disclose

Robert Jan van Geuns MD, Abstract Co-Author: Nothing to Disclose

Non surgical septal myocardial reduction by coil embolization (CE) has been proposed as a feasible option with less adverse events compared to alcohol septal ablation (ASA) in drug resistant symptomatic patients with hypertrophic obstructive cardiomyopathy. The aim of this study was to compare myocardial infarction induced by both techniques.

Nineteen patients underwent non-surgical myocardial septal reduction, 13 by ASA and 6 by CE. All patients underwent MRI before and 3 days after successful procedure. LVOT gradient reduction was measured during the procedure. Ejection fraction (EF), End-diastlioc volume (EDV), end systolic volume (ESV), Peak filling rate (PFR), Peak ejection rate (PER) and infarct size were quantified on cine and delayed enhancement images.   

The LVOT gradient was reduced in both groups (ASA 127 ± 50 to 45 ±34 mmHg, p=<.01; CE 120 ± 36 to 57 ± 48 mmHg, p=<.01) during the procedure. Infarct size was smaller in the CE compared to the patients who underwent ASA 8,6 ± 5,6 and 12,4 ± 3,4 gram, (p=.01) respectively. EF decreased significantly in ASA group from 58 ± 8 to 51 ± 11%, (p=<.01) in contrast with the CE group (51 ± 12 to 49 ± 10%, p=.49). EDV decreased in the ASA group (82 ± 13 to 72 ± 9 ml, p=<.01) but not in the CE group (92 ± 22 to 93 ± 23 ml, p=.08). There was no significant difference at follow up for the ESV in both groups (ASA 34 ± 7 to 35 ± 8 ml, p=.35; CE 46 ± 17 to 48 ± 20 ml, p=.37). PER and PFR did not change in both groups (ASA: 3.1 ± 0.9 to 3.6 ± 0.7 ml/s p=.08; 2.6 ± 0.7 to 2.3 ± 0.8 ml/s and CE: 2.9 ± 0.9 to 3.0 ± 0.9 ml/s, p=.74; 2.1± 0.6 2.2± 0.5 p=.76 respectively) The induced infarct mass correlates significantly with EF, EDV and PFR (r= 0.68; 0.83; 0.53, p=<.01; <.01; .04 respectively). There was no correlation with the reduction of LVOT gradient.  

Both techniques reduce the LVOT gradient sufficiently during the procedure. The infarct size is smaller in patients with CE. Infarct size correlates good with LVEF, EDV and PFR but not with the LVOT gradient reduction. It is unclear if the smaller infarct size will be sufficient in the long term after the effect of the stunning is diminished and remodelling will take place.

Cardiac MRI is a accurate clinical tool to evaluate the effect of different treatments in patients with hypertrophic obstructive cardiomyopathy

Springeling, T, Kirschbaum, S, Ten Cate, F, Moelker, A, De Feijter, P, van Geuns, R, The Acute Effects of Percutaneous Transluminal Septal Alcohol Myocardial Ablation Compared to Coil Embolization in Patients with Hyperthrophic Obstructive Cardiomyopathy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8011162.html