Effects of Alcohol Septal Ablation on Exercise Hemodynamics, Symptoms, and Quality of Life in Obstructive Hypertrophic Cardiomyopathy.

BACKGROUND

The impact of alcohol septal ablation (ASA) on exercise hemodynamics, symptoms, and quality of life in patients with obstructive hypertrophic cardiomyopathy is poorly described according to contemporary standards. This study aimed to evaluate the effect of ASA on filling pressures at rest and during exercise, left ventricular outflow tract obstruction, symptoms, and quality of life in patients with obstructive hypertrophic cardiomyopathy.

METHODS

This prospective study enrolled 24 patients with obstructive hypertrophic cardiomyopathy referred for ASA. Right-heart catheterization and echocardiography were performed at rest and during exercise, before and ≈7 months after ASA. The primary outcome was the difference in pulmonary artery wedge pressure at 75 W. Secondary outcomes assessed left ventricular outflow tract gradients, New York Heart Association functional class, and the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score.

RESULTS

ASA significantly reduced pulmonary artery wedge pressure at 75 W (33±9 mm Hg versus 24±10 mm Hg; P<0.001), decreased left ventricular outflow tract gradients at rest (49 [interquartile range (IQR), 24-90] mm Hg versus 17 [IQR, 14-27] mm Hg; P<0.01), at peak exercise (45 [IQR, 29-90] mm Hg versus 32 [IQR, 21-61] mm Hg; P = 0.02), and after exercise (96 [IQR, 34-161] mm Hg versus 28 [IQR, 21-62] mm Hg; P<0.01). The Kansas City Cardiomyopathy Questionnaire Clinical Summary Score was significantly increased (65.4±16 versus 76.7±16; P<0.01). ASA improved New York Heart Association functional class, with 54% in class III before treatment, compared with 13% after treatment (P<0.001).

CONCLUSIONS

ASA significantly reduced exercise-induced filling pressures and LVOT obstruction, leading to improved symptoms and quality of life in patients with obstructive hypertrophic cardiomyopathy.