Transcatheter Mitral Intervention Relieves Dynamic Outflow Obstruction and Reduces Cardiac Workload in Hypertrophic Cardiomyopathy

Kimmelstiel, Carey; Everett, Kay; Jain, Pankaj; Miyashita, Satoshi; Botto, Richard; Resor, Charles D.; Rowin, Ethan J.; Maron, Martin S.; Kapur, Navin K.

doi:10.1161/circheartfailure.121.009171

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…This suggests that additional treatment options could be considered when moderate or severe MR is confirmed after the procedure. Transcatheter mitral intervention (MitraClip) is a potential therapeutic option for patients following unsuccessful procedures because it has been shown to reduce outflow obstruction and eventuate in symptomatic improvement by eliminating SAM and MR. 23, 24 Previous studies have reported the association between septum wall thickness before ASA and subsequent CV mortality events. 20, 25 Although in these reports there was no mention of a relationship with postprocedural MR, our study found preprocedural anteroseptal wall thickness to be a potential underlying factor of moderate or severe MR after the procedure.…”

Section: Discussionmentioning

confidence: 97%

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―

Sawayama,

Kubo,

Ohya

et al. 2023

Circ J

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Background: Evidence is limited regarding long-term clinical outcomes after alcohol septal ablation (ASA) for patients with hypertrophic obstructive cardiomyopathy and its periprocedural predictive factors in Japan. Methods and Results:This retrospective observational study included 44 patients who underwent ASA between 1998 and 2022 in a single center. We evaluated the periprocedural change in variables and long-term clinical outcomes after the procedure. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. The secondary outcome was all-cause death. Using multivariable Poisson regression with robust error variance, we predicted underlying periprocedural factors related to primary outcome development. ASA decreased the median pressure gradient at the left ventricular outflow tract from 88 to 33 mmHg and reduced moderate or severe mitral regurgitation (MR), present in 53% of patients before ASA, to 16%. Over a median 6-year follow-up, the cumulative incidence of the primary outcome at 5 and 10 years was 16.5% and 25.6%, respectively. After multivariable analysis, moderate or severe MR after ASA was significantly associated with the primary outcome (relative risk 8.78; 95% confidence interval 1.34-57.3; P=0.024). All-cause mortality after ASA was 15.1% and 28.9% at 5 and 10 years, respectively. Conclusions:This study presents long-term clinical outcomes after ASA in Japan. Moderate or severe MR after ASA was significantly associated with the composite of cardiovascular death or hospitalization for heart failure.

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Section: Discussionmentioning

confidence: 97%

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―

Sawayama,

Kubo,

Ohya

et al. 2023

Circ J

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“…Nonsurgical, transcatheter mitral interventions have been proposed for both obstructive [52] and nonobstructive [53] phenotypes with significant mitral regurgitation. In patients with LVOTO who are not candidates for SRT via myectomy or ASA, transcatheter mitral interventions have been performed with success in small numbers [54].…”

Section: Future Directionsmentioning

confidence: 99%

The mitral valve in hypertrophic cardiomyopathy

Malcolmson

Shipolini

Mohiddin

et al. 2023

Current Opinion in Cardiology

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Purpose of review Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities. Recent findings The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options. Summary Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.

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TEER for SAM of the Mitral Valve and Flail Posterior Mitral Leaflet

Ravindra,

Anderson,

Morford

et al. 2025

JACC: Case Reports

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Transcatheter Mitral Intervention Relieves Dynamic Outflow Obstruction and Reduces Cardiac Workload in Hypertrophic Cardiomyopathy

Cited by 3 publications

References 3 publications

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―

The mitral valve in hypertrophic cardiomyopathy

TEER for SAM of the Mitral Valve and Flail Posterior Mitral Leaflet

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Transcatheter Mitral Intervention Relieves Dynamic Outflow Obstruction and Reduces Cardiac Workload in Hypertrophic Cardiomyopathy

Cited by 3 publications

References 3 publications

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan ― A Retrospective Observational Study ―

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan ― A Retrospective Observational Study ―

The mitral valve in hypertrophic cardiomyopathy

TEER for SAM of the Mitral Valve and Flail Posterior Mitral Leaflet

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Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―

Long-Term Clinical Outcome After Alcohol Septal Ablation and Its Periprocedural Predictive Factors in Japan　― A Retrospective Observational Study ―