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Myocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy

Gil Moravsky1, Beata Bruchal-Garbicz, Michal Jamorski

  • 1Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|June 27, 2013
PubMed

Insights

Septal myectomy significantly improves symptoms and reduces obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients. Post-surgery, myocardial mechanics show reduced circumferential strain and normalized rotation, indicating improved cardiac function.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomedical Engineering

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents abnormal myocardial mechanics, including low longitudinal strain and high circumferential strain.
  • Septal myectomy is a standard procedure for symptomatic HOCM patients, aiming for symptomatic relief.

Purpose of the Study:

  • To investigate the association between functional improvement after septal myectomy and changes in myocardial mechanics in HOCM patients.
  • To assess alterations in longitudinal strain, circumferential strain, and rotation post-myectomy.

Main Methods:

  • Retrospective analysis of clinical data and echocardiographic studies from 66 HOCM patients before and after septal myectomy (6-18 months).
  • Assessment of myocardial mechanics, including strain and rotation, using two-dimensional strain software (Velocity Vector Imaging).

Main Results:

  • Significant symptomatic improvement (NYHA class) and reduction in left ventricular outflow tract gradient and left atrial volume index post-myectomy.
  • Global longitudinal strain remained unchanged, while circumferential strain decreased and left ventricular twist normalized.
  • Predictors of symptomatic response included younger age, thinner posterior wall, and higher lateral early diastolic velocity (e').

Conclusions:

  • Septal myectomy effectively alleviates symptoms, reduces obstruction, and improves cardiac mechanics in HOCM.
  • Observed changes in myocardial mechanics (decreased circumferential strain, normalized rotation) reflect adaptations to reduced afterload.
  • Factors like age, posterior wall thickness, and diastolic function influence the degree of symptomatic response to myectomy.
Abstract

Keywords:
2DASAortic stenosisCIConfidence intervalFEARRFraction of early apical reverse rotationHCMHOCMHypertrophic cardiomyopathyHypertrophic obstructive cardiomyopathyLVLV outflow obstructionLVOTLeft ventricularLeft ventricular outflow tractMyocardial strainSeptal myectomyTwo-dimensional

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