{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T14:18:51Z","timestamp":1782224331528,"version":"3.54.5"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Alcohol septal ablation (ASA) is an established interventional therapy for patients with obstructive hypertrophic cardiomyopathy (OHCM) who remain symptomatic despite optimal medical treatment. Nevertheless, 10\u201320% of patients fail to achieve a satisfactory hemodynamic or clinical response, highlighting the need for improved patient selection. Given that mitral valve (MV) morphology plays a central role in left ventricular outflow tract (LVOT) obstruction, we aimed to evaluate the impact of MV anatomical parameters on ASA outcomes. Methods: We retrospectively analyzed 38 OHCM patients who underwent ASA and had complete echocardiographic data before and at 6-month follow-up. Patients were stratified into responders (n = 32, defined as &gt;50% reduction in LVOT pressure gradient and\/or residual LVOT gradient &lt; 50 mmHg) and non-responders (n = 6, &lt;50% reduction or persistent gradient \u2265 50 mmHg), consistent with criteria used in previous ASA outcome studies. MV parameters\u2014including redundant anterior mitral leaflet (AML) length, posterior mitral leaflet (PML) projection, and anterior displacement of the coaptation point (AML\/PML projection ratio)\u2014were compared between groups. Results: Non-responders demonstrated significantly greater AML redundancy (13.16 \u00b1 1.72 vs. 9.96 \u00b1 1.99 mm, p &lt; 0.001), larger PML projection (18.5 \u00b1 3.78 vs. 13.65 \u00b1 3.8 mm, p = 0.006), and lower AML\/PML projection ratio (0.80 \u00b1 0.15 vs. 1.34 \u00b1 0.45, p = 0.007). These parameters were associated with reduced post-procedural LVOT gradient reduction in univariate logistic regression (p = 0.01, p = 0.027, p = 0.015, respectively). Multivariate modeling was not pursued due to collinearity among MV parameters and the limited number of non-responder events, which precluded robust adjustment. Conclusions: Mitral valve morphological features\u2014particularly redundant AML, greater PML projection, and anterior displacement of the coaptation point\u2014were associated with suboptimal ASA outcomes in univariate analysis. These data emphasize the need for comprehensive MV imaging in pre-procedural assessment. Integrating MV morphology into current selection algorithms may refine ASA patient selection and improve long-term success rates.<\/jats:p>","DOI":"10.3390\/jcm15031031","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:48:04Z","timestamp":1769590084000},"page":"1031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mitral Valve Abnormalities as Predictors of Procedural Success in Alcohol Septal Ablation: A Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5998-2932","authenticated-orcid":false,"given":"Raluca","family":"Coifan","sequence":"first","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mircea","sequence":"additional","affiliation":[{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1697-311X","authenticated-orcid":false,"given":"Alexandru Silvius","family":"Pescariu","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2951-8010","authenticated-orcid":false,"given":"Oana","family":"Voinescu","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2806-9002","authenticated-orcid":false,"given":"Bogdan","family":"Enache","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurentiu","family":"Pascalau","sequence":"additional","affiliation":[{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai-Andrei","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionut","family":"Golet","sequence":"additional","affiliation":[{"name":"Department of Management and Entrepreneurship, Faculty of Economics and Business Administration, West University of Timi\u0219oara, J. H Pestalozzi No. 16, 300115 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Sturza","sequence":"additional","affiliation":[{"name":"Department III\u2014Pathophysiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Centre for Translational Research and Systems Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin Tudor","family":"Luca","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina","family":"Ionac","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-9601","authenticated-orcid":false,"given":"Cristian","family":"Mornos","sequence":"additional","affiliation":[{"name":"Department VI\u2014Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Research Centre of the Institute of Cardiovascular Diseases Timisoara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e009026","DOI":"10.1161\/CIRCIMAGING.119.009026","article-title":"Multimodality Imaging in Hypertrophic Cardiomyopathy for Risk Stratification","volume":"13","author":"Kramer","year":"2020","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1016\/j.jacc.2024.02.014","article-title":"2024 AHA\/ACC\/AMSSM\/HRS\/PACES\/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"83","author":"Ommen","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC Guidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2478\/rjc-2024-0021","article-title":"Impact of cardiac magnetic resonance on the diagnosis and management of patients with cardiomyopathies","volume":"34","author":"Popa","year":"2024","journal-title":"Rom. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"ehac544.1747","DOI":"10.1093\/eurheartj\/ehac544.1747","article-title":"Population estimates of obstructive and non-obstructive hypertrophic cardiomyopathy in the UK and Germany","volume":"43","author":"Schultze","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jchf.2018.02.010","article-title":"Hypertrophic Cardiomyopathy: Clinical Update","volume":"6","author":"Geske","year":"2018","journal-title":"JACC. Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1016\/j.jcmg.2019.09.020","article-title":"The Hypertrophic Cardiomyopathy Phenotype Viewed Through the Prism of Multimodality Imaging: Clinical and Etiologic Implications","volume":"13","author":"Rowin","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1093\/ehjci\/jey095","article-title":"Intrinsic mitral valve alterations in hypertrophic cardiomyopathy sarcomere mutation carriers","volume":"19","author":"Groarke","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/ehjci\/jey112","article-title":"Mitral valve abnormalities in hypertrophic cardiomyopathy: A primary expression of the disease? Getting closer to the answer","volume":"19","author":"Spirito","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_10","first-page":"29","article-title":"Mitral valve in hypertrophic cardiomyopathy: A three-dimensional transesophageal study","volume":"62","author":"Venieri","year":"2021","journal-title":"Hell. J. Cardiol."},{"key":"ref_11","first-page":"248","article-title":"Mitral Regurgitation in Hypertrophic Cardiomyopathy: A Narrative Review of Mechanism and Current Management","volume":"9","author":"Anwar","year":"2022","journal-title":"Int. J. Clin. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lebowitz, S., Kowalewski, M., Raffa, G.M., Chu, D., Greco, M., Gandolfo, C., Mignosa, C., Lorusso, R., Suwalski, P., and Pilato, M. (2022). Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123405"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jtcvs.2018.08.062","article-title":"Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity score-matched cohort","volume":"157","author":"Nguyen","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1111\/jocs.14815","article-title":"Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy","volume":"35","author":"Savarimuthu","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1002\/ehf2.14272","article-title":"Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?","volume":"10","author":"Achim","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"369","DOI":"10.21037\/acs.2017.05.09","article-title":"Alcohol septal ablation: In which patients and why?","volume":"6","author":"Spirito","year":"2017","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.amjcard.2022.06.007","article-title":"Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years of Practice): AJC Expert Panel","volume":"180","author":"Maron","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.repc.2019.08.003","article-title":"Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of a reference center","volume":"38","author":"Fiarresga","year":"2019","journal-title":"Rev. Port. Cardiol."},{"key":"ref_19","first-page":"30","article-title":"Alcohol septal ablation in hypertrophic cardiomyopathy","volume":"2018","author":"Mateo","year":"2018","journal-title":"Glob. Cardiol. Sci. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ar\u00e9valos, V., Rodr\u00edguez-Arias, J.J., Brugaletta, S., Micari, A., Costa, F., Freixa, X., Masotti, M., Sabat\u00e9, M., and Regueiro, A. (2021). Alcohol Septal Ablation: An Option on the Rise in Hypertrophic Obstructive Cardiomyopathy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112276"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e002675","DOI":"10.1161\/CIRCINTERVENTIONS.115.002675","article-title":"Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: An Echocardiography and Cardiovascular Magnetic Resonance Imaging Study","volume":"9","author":"Lu","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.echo.2020.03.002","article-title":"Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons","volume":"33","author":"Nicoara","year":"2020","journal-title":"J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Multi-modality imaging assessment of native valvular regurgitation: An EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1177\/0962280214558972","article-title":"Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models","volume":"26","author":"Austin","year":"2017","journal-title":"Stat. Methods Med. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"i313","DOI":"10.1093\/ehjci\/jeae333.200","article-title":"Aorto-mitral angle: An emerging indicator for successful alcohol septal ablation in hypertrophic obstructive cardiomyopathy\u2014A pilot study","volume":"26","author":"Sosdean","year":"2025","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102016","DOI":"10.1016\/j.jaccas.2023.102016","article-title":"3-Dimensional Multiplanar Reconstruction with Transesophageal Echocardiography for Alcohol Septal Ablation","volume":"24","author":"Voudris","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1053\/j.jvca.2022.11.011","article-title":"Real-time multiplanar reconstruction imaging using 3-dimensional transesophageal echocardiography in structural heart interventions","volume":"37","author":"Wollborn","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"P272","DOI":"10.1186\/1532-429X-18-S1-P272","article-title":"Mitral valve leaflet length as an important factor to differentiate hypertrophic cardiomyopathy from other causes of left ventricular hypertrophy","volume":"18","author":"Luo","year":"2016","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jtcvs.2020.12.143","article-title":"Is anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy?","volume":"165","author":"Schaff","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.echo.2017.11.016","article-title":"Intraoperative Two- and Three-Dimensional Transesophageal Echocardiography in Combined Myectomy-Mitral Operations for Hypertrophic Cardiomyopathy","volume":"31","author":"Nampiaparampil","year":"2018","journal-title":"J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijcard.2016.03.041","article-title":"Long mitral valve leaflets determine left ventricular outflow tract obstruction during exercise in hypertrophic cardiomyopathy","volume":"212","author":"Henein","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1536\/ihj.17-072","article-title":"Morphological Determinants of Obstructive Hypertrophic Cardiomyopathy Obtained Using Echocardiography","volume":"59","author":"Nara","year":"2018","journal-title":"Int. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/ehjci\/jex234","article-title":"Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: A 3D computed tomography analysis","volume":"19","author":"Song","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12947-019-0171-1","article-title":"Genetic relevance and determinants of mitral leaflet size in hypertrophic cardiomyopathy","volume":"17","author":"Chung","year":"2019","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e34727","DOI":"10.1016\/j.heliyon.2024.e34727","article-title":"MYH7 mutation is associated with mitral valve leaflet elongation in patients with obstructive hypertrophic cardiomyopathy","volume":"10","author":"Guo","year":"2024","journal-title":"Heliyon"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.hlc.2024.11.015","article-title":"Location of Left Ventricular Outflow Tract Measurements for Stroke Volume Estimation with Echocardiography","volume":"34","author":"Cowie","year":"2025","journal-title":"Heart Lung Circ."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1031\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:07:11Z","timestamp":1769591231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031031"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031031","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]}}}