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Peer-reviewedCC BY 4.0BMC Cardiovascular Disorders

Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study

  • Anna Damlin1,2
  • Andreas Rück2,3
  • Mesud Mustafic4
  • Rebecka Jandér5
  • Anette Rickenlund1,6
  • Maria J Eriksson1,6
  • Nawzad Saleh2,3
  • David Marlevi1,6,7
7 affiliations
  1. 1Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  3. 3Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Cardiology, Danderyds Hospital, Stockholm, Sweden
  5. 5Department of Clinical Physiology, Södersjukhuset, Stockholm, Sweden
  6. 6Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
  7. 7Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
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Abstract

Background: The primary mechanism of mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy is systolic anterior motion (SAM) of the mitral leaflets due to septal hypertrophy narrowing the left ventricular outflow tract (LVOT), influencing leaflet movement and closure. Among patients undergoing alcohol septal ablation (ASA), the impact on- and underlying mechanism of MR remains less studied. The aim was to determine the prevalence of MR and changes in MR severity after ASA and analyze echocardiographic (ECHO) parameters associated with MR changes.

Methods: All patients who underwent ASA at Karolinska University Hospital in Sweden, 2009–2021 (follow-up until 2025), were included in this retrospective cohort study. ECHO parameters were collected before ASA, at 1-year follow-up and at the latest follow-up registered. To evaluate differences in continuous values, Kruskal-Wallis test was used, and for categorical values, Fischer’s exact test was used.

Results: 154 patients were included (mean follow-up 4.0 ± 3.9 years). 14% (n = 21) had at least moderate MR at baseline, of which 90% (n = 19) improved to mild MR or less. The patients with improved (n = 19, 12%) or unchanged (n = 128, 83%) grade of MR showed greater reduction of LVOT peak pressure gradients (improved MR: 137.5 to 4.8 mmHg, unchanged MR: 57.0 to 25.0 mmHg) between baseline and last follow-up, compared with patients with increased MR grade (n = 7, 4.5%, 57.0 to 51.0 mmHg, p = 0.003).

Conclusions: Among patients with at least moderate MR before ASA, MR severity generally improved at follow-up, potentially due to septal reduction and LVOT enlargement, which may have reduced SAM.

Clinical trial number: Not applicable.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06952-w.

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Cite

BibTeXRIS
BibTeX
@article{damlin2026improvement,
  title = {{Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study}},
  author = {Anna Damlin and Andreas Rück and Mesud Mustafic and Rebecka Jandér and Anette Rickenlund and Maria J Eriksson and Nawzad Saleh and David Marlevi},
  journal = {BMC Cardiovascular Disorders},
  year = {2026},
  month = oct,
  doi = {10.1186/s12872-026-06952-w},
  url = {https://doi.org/10.1186/s12872-026-06952-w},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Improvement in mitral regurgitation after alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a retrospective cohort study
AU  - Anna Damlin
AU  - Andreas Rück
AU  - Mesud Mustafic
AU  - Rebecka Jandér
AU  - Anette Rickenlund
AU  - Maria J Eriksson
AU  - Nawzad Saleh
AU  - David Marlevi
PY  - 2026
DA  - 2026/10/31
JO  - BMC Cardiovascular Disorders
DO  - 10.1186/s12872-026-06952-w
UR  - https://doi.org/10.1186/s12872-026-06952-w
AB  - Background: The primary mechanism of mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy is systolic anterior motion (SAM) of the mitral leaflets due to septal hypertrophy narrowing the left ventricular outflow tract (LVOT), influencing leaflet movement and closure. Among patients undergoing alcohol septal ablation (ASA), the impact on- and underlying mechanism of MR remains less studied. The aim was to determine the prevalence of MR and changes in MR severity after ASA and analyze echocardiographic (ECHO) parameters associated with MR changes.  Methods: All patients who underwent ASA at Karolinska University Hospital in Sweden, 2009–2021 (follow-up until 2025), were included in this retrospective cohort study. ECHO parameters were collected before ASA, at 1-year follow-up and at the latest follow-up registered. To evaluate differences in continuous values, Kruskal-Wallis test was used, and for categorical values, Fischer’s exact test was used.  Results: 154 patients were included (mean follow-up 4.0 ± 3.9 years). 14% (n = 21) had at least moderate MR at baseline, of which 90% (n = 19) improved to mild MR or less. The patients with improved (n = 19, 12%) or unchanged (n = 128, 83%) grade of MR showed greater reduction of LVOT peak pressure gradients (improved MR: 137.5 to 4.8 mmHg, unchanged MR: 57.0 to 25.0 mmHg) between baseline and last follow-up, compared with patients with increased MR grade (n = 7, 4.5%, 57.0 to 51.0 mmHg, p = 0.003).  Conclusions: Among patients with at least moderate MR before ASA, MR severity generally improved at follow-up, potentially due to septal reduction and LVOT enlargement, which may have reduced SAM.  Clinical trial number: Not applicable.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06952-w.
SN  - 1471-2261
ER  -