Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy.
Both percutaneous transcoronary alcohol septal reduction (ASR) and surgical myectomy are effective treatments to relieve left ventricular (LV) outflow tract obstruction in obstructive hypertrophic cardiomyopathy (HC). LV diastolic function was assessed by echocardiography in 57 patients with obstructive HC at baseline and 5 +/- 4 months after ASR (n = 37) or surgical myectomy (n = 20). LV outflow tract pressure gradient decreased from 65 +/- 40 to 23 +/- 21 mm Hg (p <0.01) after treatment. The ratio of the early-to-late peak diastolic LV inflow velocities, and the ratio of the early peak diastolic LV inflow velocity to the lateral mitral annulus early diastolic velocity determined by tissue Doppler imaging significantly decreased after the procedures (1.6 +/- 1.7 vs 1.0 +/- 0.7 and 15 +/- 8 vs 11 +/- 5, respectively), whereas LV inflow propagation velocity significantly increased (60 +/- 24 vs 71 +/- 36 cm/s). Left atrial size decreased from 29 +/- 7 to 25 +/- 6 cm(2) (p <0.05). Patients had a significant improvement in New York Heart Association functional class and in exercise performance. When comparing ASR with myectomy, no difference was found in the degree of change in any parameter of diastolic function. Thus, diastolic function indexes obtained by echocardiography changed after septal reduction interventions in patients with obstructive HC; this change was similar to that after surgical myectomy and ASR.
Sitges
Marta
M
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Shiota
Takahiro
T
Lever
Harry M
HM
Qin
Jian Xin
JX
Bauer
Fabrice
F
Drinko
Jeannie K
JK
Agler
Deborah A
DA
Martin
Maureen G
MG
Greenberg
Neil L
NL
Smedira
Nicholas G
NG
Lytle
Bruce W
BW
Tuzcu
E Murat
EM
Garcia
Mario J
MJ
Thomas
James D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology* / Q000628:therapy*; D017115:Catheter Ablation; D000431:Ethanol / Q000627:therapeutic use*; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000628:therapy; D012086:Reoperation; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology / Q000628:therapy
D000431:Ethanol