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Isolation and Functional Characterization of Human Ventricular Cardiomyocytes from Fresh Surgical Samples
Published on: April 21, 2014
Surgical outcome for hypertrophic cardiomyopathy patients with extreme interventricular septal thickness: a
Changwei Ren1, Shengwei Wang1, Jianbo Yu1
1Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China.
Insights
Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) impacts survival. Septal myectomy in these patients showed a poor surgical outcome, with higher mortality and NYHA class III or IV incidence.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Research
Background:
- Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) is linked to adverse cardiovascular events.
- Outcomes for HCM patients with IVST ≥30 mm undergoing septal myectomy require clarification.
Purpose of the Study:
- To evaluate the surgical outcomes of septal myectomy in hypertrophic cardiomyopathy patients with extreme interventricular septal thickness (IVST ≥30 mm).
Main Methods:
- A cohort of 47 HCM patients with IVST ≥30 mm undergoing septal myectomy was studied.
- Propensity score matching (2:1) created a comparison group of 94 patients with IVST <30 mm.
- Follow-up averaged 34.0±21.3 months.
Main Results:
- Patients with IVST ≥30 mm presented with more severe symptoms, including syncope and palpitations, and higher rates of moderate-to-severe mitral regurgitation.
- Despite a higher incidence of mortality (5 deaths in the IVST ≥30 mm group vs. 1 in the <30 mm group), 5-year survival free of all-cause mortality was significantly higher in the IVST ≥30 mm group (98.9% vs. 85.7%, P=0.03).
- IVST ≥30 mm was an independent risk factor for all-cause mortality (HR: 1.12, P=0.028), alongside left ventricular end-diastole diameter and age. The incidence of NYHA class III or IV was also significantly higher in the IVST ≥30 mm group.
Conclusions:
- Septal myectomy in HCM patients with extreme IVST (≥30 mm) is associated with a poor surgical outcome.
- Higher mortality and increased incidence of severe heart failure symptoms (NYHA class III or IV) characterize the outcomes in this patient subgroup.
Background:
Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) is associated with a higher incidence of adverse cardiovascular events. However, the results of these patients who underwent septal myectomy are unclear.
Methods:
We studied 47 HCM patients with IVST ≥30 mm who underwent septal myectomy between 2011 and 2018 in Anzhen Hospital. After a 2:1 propensity score matching, the study cohort included 141 patients and 94 patients with IVST <30 mm.
Results:
Patients with IVST ≥30 mm had a longer clinical course of disease, high incidence of syncope, palpitation, and moderate or severe mitral regurgitation. After a mean follow-up of 34.0±21.3 months, 6 patients died, including 5 with IVST ≥30 mm and 1 with IVST <30 mm. The 5-year survival free of all-cause mortality was significantly higher in patients with IVST ≥30 mm than in those with IVST <30 mm (98.9% vs. 85.7%, P=0.03). Multivariable Cox analysis revealed that IVST ≥30 mm (HR: 1.12, 95% CI: 1.01-1.25, P=0.028) was an independent risk factor for all-cause mortality. Meanwhile, left ventricular end diastole diameter (HR: 0.72, 95% CI: 0.54-0.97, P=0.031) and age (HR: 0.91, 95% CI: 0.83-0.99, P=0.025) were also independent risk factors for all-cause mortality in this special cohort. Furthermore, the incidence of NYHA class III or IV was significantly higher in patients with IVST ≥30 mm.
Conclusions:
The surgical outcome was poor in a matched cohort of HCM patients with IVST ≥30 mm, which was mainly reflected by mortality and the incidence of NYHA class III or IV.
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