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Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy

Anita Nguyen1, Hartzell V Schaff1, Rick A Nishimura2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

The Annals of Thoracic Surgery
|April 22, 2018
PubMed

Insights

Septal myectomy significantly reduces left atrial volume in hypertrophic cardiomyopathy patients, indicating reverse remodeling. This reduction in left atrial enlargement may lower the risk of atrial fibrillation and heart failure.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Enlarged left atrium (LA) in hypertrophic cardiomyopathy (HCM) correlates with adverse outcomes like atrial fibrillation (AF), stroke, and heart failure.
  • Investigating LA reverse remodeling post-septal myectomy is crucial for understanding HCM management.

Purpose of the Study:

  • To determine if septal myectomy leads to reverse remodeling of the left atrium in HCM patients.
  • To assess changes in left atrial volume index (LAVI) before and after surgery.

Main Methods:

  • Retrospective review of 656 HCM patients who underwent septal myectomy between 2007 and 2015.
  • Preoperative and postoperative transthoracic echocardiograms (TTE) were analyzed for LAVI.
  • Comparison of LAVI measurements to assess changes over time and association with AF.

Main Results:

  • A significant decrease in LAVI was observed post-myectomy (early: 43 mL/m², late: 38 mL/m²; p < 0.001).
  • Preoperative LAVI was notably higher in patients with a history of AF (57 mL/m²) compared to those without (45 mL/m²; p < 0.001).
  • Higher preoperative LAVI was associated with the later development of AF (p = 0.002).

Conclusions:

  • Septal myectomy results in significant left atrial volume reduction, suggesting reverse remodeling.
  • Early LA volume decrease is attributed to relief of left ventricular outflow tract obstruction and mitral regurgitation.
  • Late reduction in LA volume indicates sustained reverse remodeling, potentially improving clinical outcomes.
Abstract

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