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Hypertrophic obstructive cardiomyopathy: preoperative echocardiographic predictors of outcome after septal myectomy
R B McCully1, R A Nishimura, K R Bailey
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
Preoperative echocardiography can predict outcomes for hypertrophic obstructive cardiomyopathy patients undergoing septal myectomy. Key indicators like asymmetric hypertrophy and mitral valve motion help identify those most likely to benefit from surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) often requires surgical intervention (septal myectomy) for symptomatic relief.
- A subset of HOCM patients remain symptomatic post-surgery, necessitating predictive tools for better outcomes.
- Two-dimensional and Doppler echocardiography offer detailed anatomical and physiological insights.
Purpose of the Study:
- To evaluate the predictive value of preoperative echocardiographic findings for clinical outcomes in HOCM patients after septal myectomy.
- To identify specific echocardiographic markers associated with residual symptoms post-surgery.
Main Methods:
- Analysis of clinical, ECG, and echocardiographic data from 47 HOCM patients undergoing isolated septal myectomy (1986-1992).
- Preoperative and 1-year postoperative symptom assessment (specifically dyspnea).
- Correlation of preoperative ECG and echocardiographic variables with residual symptoms.
Main Results:
- All 47 patients were NYHA functional class III or IV, with 70% experiencing severe dyspnea.
- 55% of patients had persistent dyspnea 1 year post-myectomy.
- Asymmetric hypertrophy, severe systolic anterior motion of the mitral leaflet(s), and prolonged isovolumetric relaxation time independently predicted milder residual dyspnea.
Conclusions:
- Preoperative echocardiographic variables can identify HOCM patients likely to benefit from septal myectomy.
- Asymmetric hypertrophy, systolic anterior motion, and isovolumetric relaxation time are key predictors of positive surgical response.
- Echocardiography plays a crucial role in patient selection and outcome prediction for HOCM surgery.
Objectives:
The purpose of this study was to determine whether two-dimensional and Doppler echocardiography are predictive of clinical outcome in patients with hypertrophic obstructive cardiomyopathy who undergo septal myectomy.
Background:
Surgical myectomy provides excellent relief of symptoms in most patients with hypertrophic obstructive cardiomyopathy who are severely symptomatic despite medical therapy. There is a subset of patients who will remain symptomatic even after operation. Because comprehensive two-dimensional and Doppler echocardiography can define the range of anatomic and associated pathophysiologic abnormalities, it was hypothesized that preoperative echocardiographic variables may be predictive of clinical outcome after septal myectomy.
Methods:
The clinical, electrocardiographic (ECG), echocardiographic and surgical data of 47 adult patients with hypertrophic cardiomyopathy who underwent isolated septal myectomy from 1986 to 1992 were analyzed. Specific symptoms were evaluated both preoperatively and at 1 year postoperatively. Electrocardiography and echocardiography were performed preoperatively and postoperatively. The ECG and echocardiographic variables were analyzed to determine whether any were predictive of residual symptoms 1 year postoperatively.
Results:
The mean [+/-SD] age of the patients was 47 +/- 15 years. All were New York Heart Association functional class III or IV. Dyspnea was present in all 47 patients and was severe in 70%. Most patients experienced symptomatic improvement at 1 year; dyspnea persisted in 26 patients (55%). The preoperative echocardiographic variables of asymmetric hypertrophy, severe systolic anterior motion of the mitral leaflet(s) and prolonged isovolumetric relaxation time were independent predictors of mild or no residual dyspnea postoperatively.
Conclusions:
This initial study shows that the preoperative echocardiographic variables of asymmetric hypertrophy, severe systolic anterior motion of the mitral leaflet(s) and prolonged isovolumetric relaxation time can identify patients who are most likely to benefit from septal myectomy.