[Early postoperative changes in systolic and diastolic function at rest and during stress in patients with hypertrophic obstructive cardiomyopathy (HOCM) after myectomy].
BACKGROUND
In this study systolic and diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) and intractable complaints to medication were investigated before and after a mean of 7 months after myectomy.


METHODS
Investigations in 19 patients with HOCM included echocardiography, Swan-Ganz-thermodilution-catheter and radionuclide-angiography.


RESULTS
Myectomy resulted in a reduction of the intraventricular gradient at rest (40.1 +/- 43.3 versus 7.6 +/- 12.0 mm Hg, p < or = 0.005) and under provocation (92.4 +/- 67.1 versus 21.3 +/- 26.5 mm Hg, p < or = 0.001). Echocardiographically determined basal septal thickness was reduced (24.9 +/- 6.3 versus 20.1 +/- 6.8 mm; p < or = 0.05) and diastolic diameter increased (40.4 +/- 5.2 versus 44.8 +/- 7.1; p < or = 0.05). Exercise tolerance increased from the maximally achieved 64.5 +/- 19.2 to 89.5 +/- 24.0 W (p < or = 0.001). Symptomatic status (NYHA) improved (1.7 +/- 1.4 versus 2.8 +/- 0.3 (p < or = 0.001). Systolic parameters showed at rest an increase in isovolumetric contraction time (65 +/- 39 versus 112 +/- 50 ms, p < or = 0.01), in time to peak ejection (109 +/- 40 versus 188 +/- 42 ms, p < or = 0.001), and a reduced left ventricular ejection fraction (72 +/- 12 versus 64 +/- 11%, p < or = 0.01). Analysis of regional ejection fraction revealed a significant reduction of ejection fraction in the basal septal region (p < or = 0.05). Increase of global and regional ejection fraction under exercise was still preserved. Mean pulmonary capillary wedge pressure was significantly reduced at rest (11.8 +/- 3.8 versus 8.6 +/- 2.4 mm Hg, p < or = 0.05) as well as under exercise (27.0 +/- 7.1 versus 20.4 +/- 6.8 mm Hg, p < or = 0.01), whereas left ventricular enddiastolic volume index (63 +/- 19 versus 72 +/- 17 ml*m-2, p < or = 0.05) was significantly increased.


CONCLUSIONS
In patients with HOCM, myectomy reduces intraventricular gradient, increases exercise capacity, and is accompanied by improved diastolic function parameters, while systolic function parameters are generally reduced.
Schwartzkopff
B
B
Abteilung für Kardiologie, Angiologie und Pneumologie, Heinrich-Heine-Universität, Düsseldorf.
Stark
P
P
Schulte
H D
HD
Mundhenke
M
M
Klein
R M
RM
Lösse
B
B
Vester
E G
EG
Strauer
B E
BE
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000601:surgery*; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011875:Radionuclide Angiography; D013599:Systole / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology