Early and long-term results of non-surgical septal reduction in patients with hypertrophic cardiomyopathy.
BACKGROUND
Non-surgical septal reduction (NSMR) is a new method of treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). The long-term outcome of patients undergoing this procedure has not yet been well established.


OBJECTIVE
To assess the short- and long-term results of NSMR in HOCM.


METHODS
Early and late (3-year) outcome after NSMR was assessed in 59 and 44 consecutive patients with HOCM, respectively. Control out-patient visits were scheduled 3, 6, and 12 months after NSMR, and annually thereafter. All patients had repeated ECG, echocardiography, 24-hour ambulatory ECG monitoring and spiro-ergometric tests.


RESULTS
Left ventricular outflow tract (LVOT) gradient, measured invasively directly after the procedure, decreased from 79.5+/-29.6 to 26.2+/-18.5 mmHg (p<0.0001). A significant LVOT gradient reduction was achieved in 51 (86%) patients. A complete a-v block occurred in 17 (29%) patients, of whom 7 (12%) underwent dual-chamber pacemaker implantation. A significant decrease in exertional dyspnea and angina was observed three months after NSMR (NYHA class reduction from 2.9+/-0.2 to 1.4+/-0.7, p=0.001 and CCS class reduction from 2.3+/-0.3 to 0.5+/-0.7, p=0.001, respectively). Of the 45 patients who were followed for > or =3 years, one patient died due to lung disease whereas no sudden deaths or life-threatening ventricular arrhythmias were observed. LVOT gradient was further reduced, and three years after NMSR disappeared in 35 (59%) patients. A significant improvement in physical capacity was noted (peakVO(2) increased from 14.1+/-3.8 ml/kg/min before NSMR to 23.2+/-6.2 three years later, p=0.02). Favourable LV remodelling was observed, causing LVOT dilatation and an increase in LV diastolic volume.


CONCLUSIONS
Because NSMR causes a significant reduction of LVOT gradient, an increase in physical capacity in >80% of patients and the long-term follow-up is uneventful, it may be regarded as an alternative procedure to myectomy in the treatment of patients with HOCM.
Chojnowska
Lidia
L
National Institute of Cardiology, Warsaw, Poland.
Ruzyłło
Witold
W
Witkowski
Adam
A
Demkow
Marcin
M
Kuśmierczyk-Droszcz
Beata
B
Kepka
Cezary
C
Konka
Marek
M
Małecka
Longina
L
Karcz
Maciej
M
Stepińska
Janina
J
D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006346:Heart Septum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014694:Ventricular Outflow Obstruction / Q000628:therapy