Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in...

Area of Science:

• Cardiology
• Interventional Cardiology
• Heart Failure Management

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) presents a significant clinical challenge, characterized by left ventricular outflow tract (LVOT) obstruction.
• Symptomatic patients often experience debilitating dyspnea, angina, and syncope, necessitating effective treatment strategies.

Purpose of the Study:

• To evaluate the mid-term clinical outcomes of non-surgical myocardial reduction in patients diagnosed with HOCM.
• To assess the efficacy of this minimally invasive approach in alleviating LVOT obstruction and improving patient quality of life.

Main Methods:

• Twenty-five HOCM patients with significant LVOT obstruction (mean gradient 84.54±31.38 mmHg) underwent non-surgical myocardial reduction.
• Follow-up included clinical examinations, echocardiography every 3 months, and symptom-limited treadmill tests at 6 months.
• Respiratory gas analysis was performed in 18 patients.

Main Results:

• Persistent LVOT gradient reduction was observed in 23 out of 25 patients, with 17 achieving >50% reduction.
• Significant clinical improvement was noted, with NYHA class decreasing from 2.8±0.5 to 1.2±0.5 (P<0.001).
• Objective measures demonstrated enhanced exercise capacity: exercise time increased (571.9±192.2 to 703.5±175.4 s) and peak VO2 improved (14.6±5.2 to 20.5±8.6 ml·kg⁻¹·min⁻¹).

Conclusions:

• Non-surgical myocardial reduction is effective in achieving significant LVOT gradient reduction and improving exercise capacity in HOCM patients.
• This minimally invasive method represents a promising alternative to surgical intervention for symptomatic individuals with HOCM.