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1 Department of Cardiology, Barnes Jewish Hospital, St. Louis, Missouri, USA
2 Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
* To whom correspondence should be addressed. E-mail: garciam{at}ccf.org.
Objective: We sought to validate measurement of IVPG and analyze their change in patients with hypertrophic obstructive cardiomyopathy (HOCM) after septal reduction with ethanol (ESR).
Background: Quantitative analysis of color M-mode Doppler (CMM) images may be used to estimate diastolic intraventricular pressure gradients (IVPG) non-invasively. Methods: Non-invasive IVPG measurement was validated in 10 patients undergoing surgical myectomy. Echocardiograms were then analyzed in 19 patients at baseline and after ESR. Pulsed Doppler data through the mitral valve and pulmonary venous flow were obtained. CMM was used to obtain the flow propagation velocity (Vp) and to calculate IVPG off-line. LA pressure was estimated (eLAP) using previously validated Doppler equations. Data were compared before and after ESR.
Results: CMM-derived IVPG correlated well with invasive measurements obtained before and after surgical myectomy (r = 0.8, p<0.01, 
(CMM - invasive IVPG) = 0.09 ± 0.45 mmHg). ESR resulted in a decrease of resting LVOT systolic gradient from 62 ± 10 to 29 ± 5 mmHg (p<0.001). There was significant increase in the Vp and IVPG (from 48 ± 5 to 74 ± 7 cm/s and from 1.5 ± 0.2 to 2.6 ± 0.3 mmHg, respectively, p<0.001 for both). eLAP decreased from 16.2 ± 1.1 to 11.5 ± 0.9 mmHg (p<0.001). The increase in IVPG correlated with the reduction in the LVOT gradient (r = 0.6, p<0.01).
Conclusion: Reduction of LVOT obstruction after ESR is associated with an improvement in diastolic suction force. Non-invasive measurements of IVPG may be used as an indicator of diastolic function improvement in HOCM.
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