Objectives: This study examined whether percutaneous alcohol septal ablation affects coronary flow reserve (CFR) in patients with hypertrophic cardiomyopathy (HCM).
Methods: CFR was measured immediately before and after septal ablation in patients with symptomatic obstructive HCM. CFR was also obtained in normals (NL) for comparison.
Results: HCM patients (n=11), compared to NL (n=22), had a lower baseline CFR (1.96 ± 0.5 vs 3.11 ± 0.8, p<0.0001), a lower coronary resistance (1.04 ± 0.45 vs 2.63 ± 2.2, p< 0.0001), a higher coronary diastolic/systolic velocity ratio (DSVR; 5.1 ± 5 vs 2 ± 0.5, p= 0.04), and a lower hyperemic coronary flow per LV mass (0.73 ± 0.4 vs 1.2 ± 0.6 ml/min/g, p= 0.007). Septal ablation in the HCM group (n=7) reduced the outflow tract gradient but not the left atrial or LV diastolic pressures. Ablation resulted in immediate normalization of CFR (to 3.1 ± 1, p= 0.01) and DSVR (to 1.9 ± 0.8, p= 0.09) and an increase in coronary resistance (to 1.20 ± 0.4, p= 0.02). This was likely related to an improvement in the systolic coronary flow.
Conclusions: The current study demonstrates for the first time that successful septal ablation in patients with symptomatic HCM results in immediate improvement in CFR, which is reduced in HCM partly because of the increased systolic contraction load.
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