Preoperative left ventricular longitudinal strain predicts outcome of septal myectomy for obstructive hypertrophic
Hao Cui1, Hartzell V Schaff1, Rick A Nishimura2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Insights
Reduced preoperative global longitudinal strain (GLS) in obstructive hypertrophic cardiomyopathy (HCM) predicts poorer survival after septal myectomy. Septal myectomy improves regional strain uniformity but does not affect overall GLS.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is characterized by impaired left ventricular function.
- Longitudinal strain (LS) assessment via echocardiography provides insights into myocardial mechanics.
Approach:
- Retrospective analysis of 857 patients with obstructive HCM undergoing septal myectomy.
- Strain echocardiography data pre- and post-myectomy were analyzed.
- Long-term survival outcomes were correlated with preoperative LS parameters.
Key Points:
- Preoperative global longitudinal strain (GLS) was reduced and nonuniform in obstructive HCM patients.
- GLS showed poor correlation with ejection fraction and outflow tract gradient.
- Septal myectomy improved regional strain uniformity without altering GLS.
- Reduced preoperative GLS was independently associated with increased all-cause mortality post-myectomy.
Conclusions:
- Left ventricular longitudinal strain is significantly reduced and nonuniform in obstructive HCM.
- Septal myectomy normalizes regional strain patterns but does not impact overall GLS.
- Preoperative GLS is a critical prognostic biomarker for survival following septal myectomy in obstructive HCM.
Objective:
The objective of this study was to determine the characteristics of longitudinal strain and its effect on outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM) who underwent septal myectomy.
Methods:
We reviewed patients with obstructive HCM who underwent septal myectomy at our clinic from 2007 to 2016. Data of those who had strain echocardiography within 6 months before isolated myectomy were analyzed.
Results:
The median age of the 857 patients studied was 55 (interquartile range [IQR], 44-63) years, and 451 (52.6%) were male. Left ventricular ejection fraction was 71% (IQR, 67%-74%), and the resting peak outflow tract gradient was 58 (IQR, 27-85) mm Hg. The median global longitudinal strain (GLS) was -14.6% (IQR, -12.0% to -17.3%). Regional longitudinal strain was nonuniform as reflected by more normal values in apical segments and more abnormal in basal segments. Moreover, GLS correlated poorly with ejection fraction and outflow tract gradient. In 64 patients who had postoperative strain echocardiography, GLS was comparable before and after septal myectomy, but regional strain was more uniform after myectomy. Over a follow-up of 8.3 (IQR, 6.5-10.3) years, when patients were equally stratified according to GLS (cutoff, -14.64%), the group with worse GLS had significantly poorer survival compared with the better GLS group (P = .002). Left ventricular ejection fraction had no association with survival.
Conclusions:
Left ventricular longitudinal strain is nonuniform and might be significantly reduced in patients with obstructive HCM. Septal myectomy does not impair GLS but is associated with more uniform regional strains. Most importantly, reduced GLS preoperatively is strongly and independently associated with increased all-cause mortality after septal myectomy for obstructive HCM.
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