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Published on: April 8, 2013
Regression of left ventricular hypertrophy after nonsurgical septal reduction therapy for hypertrophic obstructive
W Mazur1, S F Nagueh, N M Lakkis
1Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
Insights
Nonsurgical septal reduction therapy (NSRT) significantly reduces outflow tract gradients and left ventricular hypertrophy (LVH) in hypertrophic obstructive cardiomyopathy (HOCM) patients. This therapy promotes beneficial LV remodeling, increasing chamber size while decreasing LVH over two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is defined by left ventricular hypertrophy (LVH) without external load.
- Nonsurgical septal reduction therapy (NSRT) using intracoronary ethanol is a new treatment for symptomatic HOCM.
- Long-term effects of NSRT on left ventricular (LV) mass remain unclear.
Purpose of the Study:
- To evaluate the long-term effects of NSRT on LV mass and dimensions in HOCM patients.
- To assess the impact of NSRT on outflow tract obstruction and LV remodeling.
Main Methods:
- Echocardiography was used to assess 26 HOCM patients at baseline, 1 year, and 2 years post-NSRT.
- LVH was quantified by wall thickness, myocardial area, and LV mass.
- Outflow tract gradient, LV dimensions, and function were measured.
Main Results:
- Outflow gradient decreased from 36 mmHg to 0 mmHg at 2 years (P<0.001), with symptomatic improvement.
- LV end-diastolic and end-systolic dimensions significantly increased at 1 and 2 years (P<0.001).
- LV mass regressed significantly, decreasing from 301g to 190g at 2 years (P<0.01).
Conclusions:
- NSRT induces significant LV remodeling in HOCM patients.
- This remodeling involves an increase in LV chamber size and a reduction in LVH.
- NSRT offers a potential therapeutic strategy for managing HOCM.
Background:
Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by left ventricular hypertrophy (LVH) in the absence of increased external load. Recently, nonsurgical septal reduction therapy (NSRT) with intracoronary ethanol has been introduced to treat severely symptomatic patients with outflow tract obstruction. Its long-term effects on LV mass, however, are unknown.
Methods And Results:
The LV size, function, and outflow tract gradient of 26 HOCM patients (53+/-15 years old) who underwent NSRT were assessed by echocardiography at baseline and 1 and 2 years after the procedure. LVH was evaluated by wall thickness of individual myocardial segments, planimetered myocardial area, and mass. The outflow gradient decreased from 36+/-6 mm Hg before NSRT to 0+/-3 mm Hg at 2 years (P<0.001), with patients experiencing symptomatic improvement (P<0.05). LV end-diastolic and end-systolic dimensions increased significantly at both 1 and 2 years (P<0.001). All parameters of LVH showed evidence of regression. LV mass decreased (301+/-78 g at baseline, 223+/-5 g at 1 year, and 190+/-58 g at 2 years; P<0.01), with the 2-year reduction in mass related to infarct size and the acute reduction in outflow tract gradient (r=0.48, P<0.05 and r=0.63, P<0.01, respectively).
Conclusions:
NSRT results in LV remodeling that is characterized by an increase in LV size and a decrease in the extent of LVH.
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