Relation of immediate decrease in ventricular septal strain after alcohol septal ablation for obstructive hypertrophic cardiomyopathy to long-term reduction in left ventricular outflow tract pressure gradient.

Alcohol septal ablation (ASA) aims to decrease left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (HC). To date, no diagnostic variables at baseline are available to predict long-term success of the procedure. We hypothesized that an immediate decrease in septal longitudinal strain after ASA would be associated with sustained LVOT gradient decrease after 6 months. ASA was performed in 22 patients with HC and severe drug-refractory symptoms. Clinical evaluation and 2-dimensional echocardiography were performed before, 1 day after, and 6 months after ASA. During 6-month follow-up, New York Heart Association class improved (2.7 +/- 0.5 vs 1.4 +/- 0.6, p <0.01) and LVOT gradient decreased (68 +/- 31 vs 21 +/- 21 mm Hg, p <0.01). Strain evaluation showed considerable decreases in basal septal strain (-12 +/- 3% vs -8 +/- 2%, p <0.01) and midseptal strain (-13 +/- 4% vs -8 +/- 3%, p <0.01) 1 day after ASA. Decreases in basal septal and midseptal strain 1 day after ASA were strongly related to the decrease in LVOT gradient during 6-month follow-up (r = 0.70, p <0.01, and r = 0.65, p <0.01, respectively). In conclusion, in patients with HC and severe drug-refractory symptoms, immediate decrease in septal strain after ASA is strongly related to a decrease in LVOT gradient after 6 months and might therefore serve as an early determinant for long-term success of the ASA procedure.