CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging
Willem G. van Dockum, MD*,*,
Folkert J. ten Cate, MD, PhD ,
Jurrien M. ten Berg, MD, PhD||,
Aernout M. Beek, MD*,
Jos W. R. Twisk, PhD ,
Jeroen Vos, MD,
Mark B. M. Hofman, PhD ,
Cees A. Visser, MD, PhD* and
Albert C. van Rossum, MD, PhD*
* Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Department of Clinical Physics and Informatics, VU University Medical Center, Amsterdam, The Netherlands
Department of Cardiology, Thoraxcenter Erasmus Medical Center, Rotterdam, The Netherlands
|| Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
Manuscript received February 27, 2003;
revised manuscript received August 1, 2003,
accepted August 5, 2003.
* Reprint requests and correspondence: Dr. Willem G. van Dockum, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands.
wg.vandockum{at}vumc.nl
OBJECTIVES: The aim of this study was to evaluate myocardial infarction induced by percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy using contrast-enhanced (CE) magnetic resonance imaging (MRI).
BACKGROUND: Contrast-enhanced MRI delineates the extent of myocardial infarction in coronary artery disease, but its role in ethanol-induced infarction has not been established.
METHODS: Cine and CE MRI were performed before and one month after PTSMA in 24 patients. Size and location of the induced infarction were related to left ventricular (LV) mass reduction, enzyme release, volume of ethanol administered, LV outflow tract gradient reduction, and coronary ablation site.
RESULTS: One month after PTSMA, regional hyperenhancement was visualized in the basal interventricular septum in all patients. Mean infarction size was 20 ± 9 g, corresponding to 10 ± 5% and 31 ± 16% of total LV and septal mass, respectively. Total LV mass decreased from 219 ± 64 to 205 ± 64 g (p < 0.01), and septal mass from 76 ± 25 to 68 ± 22 g (p < 0.01). Total LV mass reduction exceeded septal mass reduction (p < 0.01). Infarction size correlated with peak creatine phosphokinase-MB (ß = 0.67, p < 0.01), volume of ethanol administered (ß = 0.47, p = 0.02), total LV and septal mass reduction (ß = 0.50, p = 0.02; ß = 0.73, p < 0.01), and gradient reduction (ß = 0.63, p < 0.01). Seven patients with exclusively right-sided septal infarction had smaller infarction size and less gradient reduction than remaining patients with left-sided or transmural infarction (p < 0.01). In five of these, PTSMA was performed distal in the target artery.
CONCLUSIONS: Contrast-enhanced MRI allowed detailed evaluation of size and location of septal myocardial infarction induced by PTSMA. Infarction size correlated well with clinical indexes of infarct size.
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Abbreviations and Acronyms
| | CE | = contrast-enhanced | | CK | = creatine phosphokinase | | HOCM | = hypertrophic obstructive cardiomyopathy | | IVS | = interventricular septum | | LV | = left ventricle/ventricular | | LVOT | = left ventricular outflow tract | | MRI | = magnetic resonance imaging | | NYHA | = New York Heart Association | | PTSMA | = percutaneous transluminal septal myocardial ablation |
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