title: Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study.
abstract: Dyssynchrony from biventricular pacing (BiV) can reduce dynamic obstruction in hypertrophic obstructive cardiomyopathy (HOCM), but its consequences on the left ventricular (LV) systolic function are unknown. We evaluate changes in LV systolic function and assess the effectiveness of BiV in HOCM. Thirteen patients with HOCM (55 [33/75] years, five males) received a BiV device and underwent 2D transthoracic echocardiography before the implantation and at 12 months follow-up. Global longitudinal and radial strain, and the timing of segmental displacement curves were measured by commercial speckle-tracking software to assess LV systolic function and dyssynchrony. Peak gradient in the LV outflow tract (LVOT) significantly decreased from 80 [51/100] to 30 [5/66] mmHg (p = 0.005). LV global strain was preserved from baseline to follow-up: 35.1 [20.2/43.8] % vs. 32.6 [27.1/44.1] %, p = NS (radial), and -16.6 [-19.1/-14.4] % vs. -15.7 [-17.0/-14.2] %, p = NS (longitudinal). Dyssynchrony analysis using displacement curves showed inversion of wall motion timing with earlier displacement of the lateral wall at follow-up only in patients with reduction in LVOT gradient. BiV reduces LVOT obstruction in patients with HOCM when dyssynchronization of LV motion and inversion of the timing of LV wall activation are reached. Notably, this does not lead to further deterioration of LV systolic function at mid-term follow-up.
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Giraldeau
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.|Universitat Pompeu Fabra, c/ Roc Boronat 138, 08018, Barcelona, Spain.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Duchateau
authors.affiliation: Universitat Pompeu Fabra, c/ Roc Boronat 138, 08018, Barcelona, Spain.|Institució Catalana de Recerca i Estudis Avançats, Pg/ Lluís Companys 23, 08010, Barcelona, Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.|División de Enfermedades Cardiovasculares, Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, Marcoleta 367, 22354 3000, Santiago, Chile.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Penela
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Reinder
authors.initials: R
authors.lastname: Evertz
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain. msitges@clinic.ub.es.|Institut d'investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain. msitges@clinic.ub.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012984:Software; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Biventricular pacing; Hypertrophic obstructive cardiomyopathy; Myocardial strain; Speckle-tracking