Article Text

Download PDFPDF
Original research
Myocardial mechanics of percutaneous intramyocardial septal radiofrequency ablation
  1. Jing Li1,
  2. Juan Zhang1,
  3. Yu Shi2,
  4. Horst Sievert3,
  5. Cynthia C Taub4,
  6. Stefan Bertog3,5,
  7. Shengjun Ta1,
  8. Lei Changhui1,
  9. Ethan Senser4,
  10. Jing Wang1,
  11. Rui Hu1,
  12. Junzhe Huang1,
  13. Fangqi Ruan1,
  14. Yupeng Han1,
  15. Xiaojuan Li1,
  16. Bo Wang1,
  17. Xueli Zhao1,
  18. Jiao Liu1,
  19. David H Hsi6,
  20. Liwen Liu1
  1. 1 Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
  2. 2 Department of Pharmacy, New Chang’an Maternity Hospital, Xian, Shaanxi, China
  3. 3 Department of Cardiology, Cardiovascular Center Frankfurt, Frankfurt, Germany
  4. 4 Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  5. 5 Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
  6. 6 Heart & Vascular Institute, Stamford Hospital, CT and Columbia University College of Physicians & Surgeons, New York, New York, USA
  1. Correspondence to Dr Liwen Liu, Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, 710032, China; liuliwen{at}; Professor David H Hsi, Heart & Vascular Institute, Stamford Hospital, CT and Columbia University College of Physicians & Surgeons, New York, NY, USA; dhsi{at}


Objective Echocardiography-guided Percutaneous IntraMyocardial Septal Radiofrequency Ablation (PIMSRA, Liwen procedure) is a novel treatment option for hypertrophic obstructive cardiomyopathy (HOCM). The impact of PIMSRA on myocardial mechanics is unknown.

Methods Between October 2016 and June 2019, PIMSRA and 3-dimentional speckle tracking echocardiography were performed in 82 patients. Echocardiographic imaging, qualitative and quantitative clinical assessment were completed at baseline, immediately postprocedure and 1-year follow-up.

Results There was a significant reduction in the peak left ventricular outflow tract (LVOT) gradients immediately following PIMSRA and at 1-year follow-up (resting gradients: from 83.50 (61.25) to 23.00 (41.75) mm Hg, p<0.001 and 13.50 (21.75) mm Hg, p<0.001, respectively; stress-induced gradients: from 118.25 (96.02) to 47.00 (74.50) mm Hg (1 year), p<0.001). There was an improvement in exercise time on stress echocardiography (p<0.001) and distance by 6 min walk test (p=0.034). Immediately after PIMSRA, there was a significant reduction in radial and circumferential strain in the ablated segments (p<0.001), with no change of longitudinal strain. At 1-year follow-up, the radial and circumferential strain recovered in the ablated segments. Meanwhile, left ventricular regional and global longitudinal strain had improved significantly (p<0.05).

Conclusions PIMSRA is an effective treatment for symptomatic HOCM that resulted in a sustained improvement in exercise capacity, a persistent decrease in LVOT gradient, and a measurable increase in myocardial contractile function.

Trial registration number NCT04777188.

  • echocardiography
  • cardiomyopathy, hypertrophic

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Contributors LL designed and guaranted the study. JLi, LL, JZ, ST, LC, RH, JH, FR, YH and XL performed the procedure. JLi, JZ, ST, JH, YH, BW, JW, XZ and JLiu performed data collection, analysis and interpretation. JLi, ST and ES drafted the manuscript. LL, DHH, HS, CCT and SB performed editing and final review.

  • Funding This study was supported by National Natural Science Foundation of China (grant no. 82071932, 82001831); Shaanxi Provincial Key Project (grant no. 2017ZDXM-SF-058); Clinical Research Funding Project of Fourth Military Medical University (grant no. 2021XD010) and Xijing Hospital Science and Technology Development Fund Project (grant no. YYKJFZJJ2018Y002).

  • Competing interests HS has received consulting fees, reimbursement for travel expenses or study honoraria from Abbott, Ablative Solutions, Ancona Heart, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Cibiem, CGuard, Comed, Contego, CVRx, Edwards Lifesciences, Gardia, Hemoteq, InspireMD, Kona Medical, Lifetech, Maquet Getinge Group, Medtronic, Occlutech, pfm Medical, Recor, St. Jude Medical, Terumo, Trivascular, Vascular Dynamics, Venus and Veryan.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.