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Echocardiographic Changes Following Surgical Myectomy in Severely Symptomatic Obstructive Hypertrophic
Milind Y Desai1, Natalie Szpakowski1, Albree Tower-Rader1,2
1Hypertrophic Cardiomyopathy Center, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA.
Insights
Septal myectomy significantly improves echocardiographic parameters in obstructive hypertrophic cardiomyopathy patients. However, overall left ventricular global longitudinal strain did not change one year post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is a condition where the heart muscle thickens, obstructing blood flow.
- Septal myectomy is a surgical procedure to remove excess heart muscle, aiming to alleviate symptoms and improve quality of life.
- Previous studies indicate myectomy improves symptoms and reduces left ventricular (LV) outflow tract gradients.
Purpose of the Study:
- To prospectively evaluate temporal changes in echocardiographic parameters following septal myectomy in patients with obstructive HCM.
- To assess the impact of myectomy on various LV strain parameters and their correlation with clinical outcomes.
Main Methods:
- A prospective study of 173 adults with obstructive HCM undergoing septal myectomy.
- Echocardiographic assessments, including LV outflow tract gradients and LV global longitudinal strain, were performed before and 12 months after surgery.
- Analysis included changes in left atrial volume index, E/e', and regional/global LV strain.
Main Results:
- Significant improvements were observed in left atrial volume index, E/e', and peak LV outflow tract gradients post-myectomy (P<0.001).
- While LV free wall strain improved, basal, midseptal, and apical septal strains showed no significant improvement or worsened.
- Overall LV global longitudinal strain remained unchanged, with no correlation to improvements in 6-minute walk time or quality of life scores.
Conclusions:
- Septal myectomy leads to significant improvements in key echocardiographic parameters in obstructive HCM patients at one year.
- Despite improvements in other measures, overall LV global longitudinal strain did not change, suggesting potential regional myocardial remodeling or limitations in strain assessment.
- The findings highlight the multifaceted impact of myectomy on cardiac structure and function.
Background:
In obstructive hypertrophic cardiomyopathy, myectomy improves symptoms, quality of life, and left ventricular (LV) outflow tract gradients. We prospectively evaluated the temporal changes in various echo parameters after myectomy.
Methods And Results:
In 173 adults with obstructive hypertrophic cardiomyopathy (53±10 years, 63% men) who underwent myectomy between March 2017 and June 2020, clinical and blinded echo assessment (before and at 12±6 months follow-up) was performed prospectively (SPIRIT-HCM [Quality of Life and Functional Capacity Following Septal Myectomy in Obstructive Patients With Hypertrophic Cardiomyopathy]). Changes in echocardiographic parameters (left atrial volume index, E/e', LV outflow tract gradients, along with average LV global longitudinal strain on apical 2-, 3-, and 4-chamber views and regional LV strain from apical 4-chamber view) were measured in 126 patients. There was significant improvement in left atrial volume index (-6.9 mL/m2 [95% CI, 4-9.7]), E/e' (-2.9 [95% CI, -2.7 to -4.1]) and peak LV outflow tract gradient (-94 mm Hg [95% CI -87 to -100]) from baseline to follow-up (both P<0.001). There was no improvement in basal (0.91% [95% CI, -0.15 to 1.97], P=0.09) and midseptal (-0.98% [95% CI, -1.93 to 0.02], P=0.05) LV strain, worsening in apical septal strain (-4.5% [95% CI, -5.9 to -3.0], P<0.001) and an improvement in LV free wall strain (2.3% [95% CI, 0.67-3.9], P<0.001), with no change in overall LV-global longitudinal strain (0.47% [95% CI, -0.43 to 1.37], P=0.30). There was no correlation between change in LV-global longitudinal strain and change in 6-minute walk time (r=0.12, P=0.24) or Kansas City Cardiomyopathy Questionnaire summary score change (r=0.02, P=0.85), whereas it was significantly associated with change in E/e' (r=0.29, P=0.003).
Conclusions:
In patients with obstructive hypertrophic cardiomyopathy, myectomy improved various echocardiography parameters at 1-year; however, LV-global longitudinal strain remained unchanged.
Registration:
URL: https://clinicaltrials.gov; Unique identifier: NCT03092843.
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