Hypertrophic cardiomyopathy phenotype is associated with postmyectomy change in diastolic function measured by...

Diastolic dysfunction may persist after septal myectomy for obstructive hypertrophic cardiomyopathy, contributing to residual or recurrent symptoms. To better understand postoperative diastolic function, we assessed the association between preoperative obstructive hypertrophic cardiomyopathy phenotypic characteristics and change in artificial intelligence-enabled electrocardiogram determined diastolic function, previously shown to quantify diastolic function.

We analyzed 166 consecutive patients with obstructive hypertrophic cardiomyopathy undergoing septal myectomy with prospective artificial intelligence-enabled electrocardiogram diastolic function data. Participants were classified as improved diastolic function (improved grade or persistently normal filling pressure) or persistent diastolic dysfunction (worsened grade or persistently high filling pressure).

The study population was 41% female with a median age of 59 years. There was no significant difference in baseline clinical characteristics between patients with improved diastolic function or persistent artificial intelligence-enabled electrocardiogram diastolic dysfunction. Patients with worsened postoperative diastolic dysfunction by artificial intelligence-enabled electrocardiogram had a greater left atrial volume index (P < .01), a greater left ventricular mass index (P < .01), a higher medial E/e' ratio (P < .01), and increased posterior wall thickness (P < .01) compared with those with improved or normal filling pressure grades by artificial intelligence-enabled electrocardiogram. All-cause mortality was low with no significant difference between artificial intelligence-enabled electrocardiogram diastolic function groups (adjusted hazard ratio, 0.84; 95% CI, 0.14-2.06).

Change in artificial intelligence-enabled electrocardiogram diastolic function is associated with echocardiographic predictors of diastolic dysfunction in obstructive hypertrophic cardiomyopathy patients undergoing septal myectomy. Patients with an advanced obstructive hypertrophic cardiomyopathy phenotype preoperatively may be less likely to experience improvement in diastolic function after septal myectomy based on artificial intelligence-enabled electrocardiogram diastolic grade changes.