Kim J J, Lee C W, Park S W, Hong M K, Lim H Y, Song J K, Jin Y S, Park S J
Department of Medicine, University of Ulsan, and the Sports Medicine Center, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 1999 Apr 15;83(8):1220-3. doi: 10.1016/s0002-9149(99)00063-6.
Transcoronary alcohol ablation (TAA) therapy of septal hypertrophy was recently proposed as a therapeutic modality for obstructive hypertrophic cardiomyopathy (HC). However, questions remain about the effect of TAA on exercise performance. We performed a time-course analysis of exercise capacity and exercise hemodynamics in 20 patients with symptomatic obstructive HC after TAA. Symptom-limited bicycle exercise testing was performed before and 3 and 12 months after TAA, and cardiac catheterization at 3-month follow-up. The pressure gradient of the left ventricular outflow tract immediately decreased from 58 +/- 8 to 4 +/- 1 mm Hg at rest (p <0.01) and from 143 +/- 11 to 30 +/- 6 mm Hg after extrasystole (p <0.01), but partially recovered at 3-month follow-up (14 +/- 4 and 40 +/- 9 mm Hg, respectively). Left ventricular end-diastolic pressure was not changed after TAA. Peak oxygen consumption increased from 19 +/- 2 to 23 +/- 1 ml/kg/min (p < 0.01) and exercise duration from 573 +/- 47 to 742 +/- 46 seconds (p <0.01) at 3-month follow-up, but thereafter reached a plateau. Abnormal patterns of exercise blood pressure response were shown in 9 patients but normalized after TAA. Major complications occurred in 4 patients: no reflow to the left anterior descending coronary artery in 2 patients and ventricular tachycardia requiring cardioversion in 2 patients. During the follow-up period, all patients survived with symptomatic improvement in 17 patients. Thus, TAA is a promising therapeutic modality with improvement in exercise capacity and abnormal exercise blood pressure response in obstructive HC. However, potential serious complications should be considered in the application of TAA.
经冠状动脉酒精消融术（TAA）治疗室间隔肥厚最近被提议作为梗阻性肥厚型心肌病（HC）的一种治疗方式。然而，TAA对运动能力的影响仍存在疑问。我们对20例有症状的梗阻性HC患者在TAA术后进行了运动能力和运动血流动力学的时间进程分析。在TAA术前、术后3个月和12个月进行了症状限制的自行车运动试验，并在3个月随访时进行了心导管检查。左心室流出道压力阶差在静息时立即从58±8降至4±1 mmHg（p<0.01），早搏后从143±11降至30±6 mmHg（p<0.01），但在3个月随访时部分恢复（分别为14±4和40±9 mmHg）。TAA术后左心室舒张末期压力未改变。在3个月随访时，峰值耗氧量从19±2增加到23±1 ml/kg/min（p<0.01），运动持续时间从573±47增加到742±46秒（p<0.01），但此后达到平台期。9例患者出现异常的运动血压反应模式，但TAA术后恢复正常。4例患者发生主要并发症：2例患者左前降支冠状动脉无复流，2例患者发生需要心脏复律的室性心动过速。在随访期间，所有患者均存活，17例患者症状改善。因此，TAA是一种有前景的治疗方式，可改善梗阻性HC患者的运动能力和异常的运动血压反应。然而，在应用TAA时应考虑潜在的严重并发症。
