Left ventricular longitudinal systolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a long-term follow-up study focused on speckle tracking echocardiography.

AIMS To examine left ventricular (LV) longitudinal systolic myocardial function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH). METHODS AND RESULTS Twenty-three of 39 consecutive patients with HOCM had serial two-dimensional (2D) echocardiograms available for speckle tracking analyses before and up to 36 months after TASH. Before TASH, overall LV myocardial longitudinal systolic 2D strain was decreased despite normal LV ejection fraction (EF). A significant reduction of LV mass and left ventricular outflow tract (LVOT) gradients occurred during long-term follow-up after TASH, but this was not accompanied by improvement of average LV longitudinal systolic strain. However, in the basal LV segments remote to the site of alcohol injection longitudinal systolic strain increased [baseline: -13.1 ± 5.4%; 1 month: -16.0 ± 5.5% (NS); 12 months: -16.5 ± 4.9% (P < 0.05 vs. baseline); 36 months: -17.4 ± 4.2% (P < 0.01 vs. baseline)]. In contrast, the alcohol-treated basal segments of the septum and adjacent myocardium showed unchanged strain over time. CONCLUSION Average LV longitudinal myocardial systolic function is depressed in HOCM despite normal LV EF. TASH-induced reduction of the LVOT obstruction does not improve average LV longitudinal systolic 2D strain. This is in contrast to global improvement of longitudinal systolic function after valve replacement in aortic valve stenosis. The discrepancy may be caused by the fact that HOCM is a primary myocardial disease.