Angiographic and echocardiographic correlates of suitable septal perforators for alcohol septal ablation in hypertrophic obstructive cardiomyopathy.

Myocardial contrast echocardiography during angiography is critical in identifying appropriate septal perforator(s) for alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. We evaluated whether there were other angiographic and/or echocardiographic markers that might identify patients who are anatomically suitable for ASA. We performed quantitative coronary angiographic analysis and echocardiographic assessment on 74 patients referred for ASA from January 2004 to July 2012 at the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Patients who proceeded to ASA were compared with those in whom ASA was aborted. Of the 74 patients referred for ASA, 63 proceeded to ASA and in 11 patients ASA was aborted because of various anatomic and technical reasons. There were no clinically significant differences observed in quantitative angiographic and echocardiographic measurements between the 2 groups. The ratio of ostial left main (LM) to ablated septal distance on angiography vs the basal septum to the septum area where the mitral valve contacted the septum because of systolic anterior motion (SAM) was 1.53. In the whole cohort, a significant correlation was observed between the ostial LM to the target septal distance and the distance from basal septum to SAM-septal contact point on echocardiography (r = 0.39; P = 0.008). A stronger correlation was evident when analysis was restricted to patients undergoing ASA only (r = 0.44; P = 0.006). Echocardiographic and angiographic assessments of the distance between the basal septum to SAM-septal contact point and ostial LM to the target septal distance might be useful in preprocedural selection of the appropriate septal perforator for ASA.