An observational cohort study of serial blood sampling to measure the levels of biomarkers expressed prior to and after transcoronary ablation of septal hypertrophy (TASH).

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The principle hypothesis of this study proposal is that the clinical procedure of septal ablation (TASH) offers the most accurate and controlled circumstance of acute cardiac injury, mimicking a myocardial infarction. As the precise time of myocardial cell death can be documented, this then allows precise temporal profiling of novel markers that could be used to make further improvements in the diagnosis and management of heart attacks, as they present in "real world" clinical experience. This study will identify rapidly responding biomarkers that are specific to myocardial infarction. Knowledge of these markers and their temporal profile can then be applied to future clinical studies directly assessing their potential to be applied in an emergency department setting to assist in the rapid, accurate identification of patients suffering acute coronary syndromes. Consecutive patients (up to n=50) with hypertrophic obstructive cardiomyopathy (HOCM) undergoing septal ablation will be included. As per usual clinical care and procedure, septal ablation occurs via temporary septal artery branch occlusion and injection of 1ml 100% ethanol after heparin administration (bolus, 5000 IU heparin). Postprocedural management included monitoring at the intensive care unit for 48 hours. All patients will be provided with complete study information before being asked to provide consent. Blood samples (10ml serum and 10ml EDTA) will be taken at each time point given, ie. 20ml per time point. Samples will be taken at 10 minutes, +15, +30, +45, +60, +120, +240 and +1440 minutes after ethanol administration. Samples will be drawn at each time point from a forearm antecubital vein. Cardiac coronary sinus samples will be taken at 10 and +15 minutes only.

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