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Association between left ventricular reverse remodeling and long-term outcomes after alcohol septal ablation for hypertrophic obstructive cardiomyopathy

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Abstract

There is a paucity of data regarding the effect of left ventricular (LV) reverse remodeling (r-LVR) on diastolic function and outcomes after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to identify the impact of r-LVR on the outcome and the predictors of such changes after ASA. Eighty-seven patients (57.5% men) were enrolled and underwent both echocardiography and cardiovascular magnetic resonance (CMR) imaging at baseline and 27 months after the procedure. The study population was divided into two groups by the degree of r-LVR. Compared to the greater r-LVR group, the lesser r-LVR group had a significantly larger LV mass (LVM) and lower diastolic function parameters at baseline. The greater r-LVR group had significantly greater LVM regression and improvement of diastolic function after ASA. Kaplan‒Meier analysis showed significantly worse composite events in the lesser r-LVR group after ASA (P = 0.016). After adjusting for multiple clinical variables, r-LVR was associated with an improved E/e’ (β = 0.390, p < 0.001) and reduced events (hazard ratio: 0.795; 95% confidence interval (CI), 0.644–0.983; p = 0.034). Preablation LVM was associated with a decreased probability of r-LVR (β = -0.228, p = 0.021) and diastolic function improvement (β= -0.245, p = 0.006). r-LVR was associated with long-term outcome benefit in patients with HOCM. Preablation LVM prevented LV from favoring reverse remodeling and thus may be a potential parameter for risk stratification and prognosis after ASA treatment.

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Funding

agencies: The present study was supported by the National Natural Science Foundation of China (NO.81700330) Beijing Municipal Excellent Talents Foundation (2016000021469G176) and Beijing Jishuitan Hospital Nova Program XKXX2018 (XKXX201802).

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Authors and Affiliations

  1. Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Being, People’s Republic of China

    Fu-Jian Duan

  2. Department of Cardiology, Beijing Jishuitan Hosptial, No. 31 East Street, Xinjiekou, XiCheng District, 100035, Beijing, China

    You-Zhou Chen

  3. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, 100037, Beijing, China

    Jian-Song Yuan & Shu-Bin Qiao

  4. Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yan Zhang

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  1. Fu-Jian Duan
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Correspondence to Shu-Bin Qiao.

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Duan, FJ., Chen, YZ., Yuan, JS. et al. Association between left ventricular reverse remodeling and long-term outcomes after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Int J Cardiovasc Imaging 39, 423–432 (2023). https://doi.org/10.1007/s10554-022-02735-4

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