Related Experiment Videos
[Early postoperative changes in systolic and diastolic function at rest and during stress in patients with
B Schwartzkopff1, P Stark, H D Schulte
1Abteilung für Kardiologie, Angiologie und Pneumologie, Heinrich-Heine-Universität, Düsseldorf.
Insights
Myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients significantly reduces intraventricular gradients and improves exercise capacity. While diastolic function enhances, some systolic function parameters show a reduction post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Context:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents challenges for medication-refractory patients.
- Surgical intervention like myectomy is considered for severe cases.
- Evaluating the impact of myectomy on cardiac function is crucial.
Purpose:
- To investigate the effects of myectomy on systolic and diastolic function in HOCM patients.
- To assess changes in intraventricular gradient, exercise tolerance, and cardiac pressures before and after surgery.
Summary:
- Myectomy in 19 HOCM patients led to reduced intraventricular gradients (rest and stress) and improved basal septal thickness and diastolic diameter.
- Exercise tolerance and symptomatic status (NYHA) significantly improved post-myectomy.
- Systolic function showed some reductions (e.g., ejection fraction), but global and regional function under exercise was preserved. Diastolic function parameters and cardiac pressures improved.
Impact:
- Myectomy offers significant benefits for HOCM patients with intractable symptoms, improving exercise capacity and diastolic function.
- The procedure effectively reduces obstructive gradients, enhancing quality of life.
- Understanding the trade-offs in systolic function post-myectomy is important for patient management.
Introduction:
In this study systolic and diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) and intractable complaints to medication were investigated before and after a mean of 7 months after myectomy.
Methods:
Investigations in 19 patients with HOCM included echocardiography, Swan-Ganz-thermodilution-catheter and radionuclide-angiography.
Results:
Myectomy resulted in a reduction of the intraventricular gradient at rest (40.1 +/- 43.3 versus 7.6 +/- 12.0 mm Hg, p < or = 0.005) and under provocation (92.4 +/- 67.1 versus 21.3 +/- 26.5 mm Hg, p < or = 0.001). Echocardiographically determined basal septal thickness was reduced (24.9 +/- 6.3 versus 20.1 +/- 6.8 mm; p < or = 0.05) and diastolic diameter increased (40.4 +/- 5.2 versus 44.8 +/- 7.1; p < or = 0.05). Exercise tolerance increased from the maximally achieved 64.5 +/- 19.2 to 89.5 +/- 24.0 W (p < or = 0.001). Symptomatic status (NYHA) improved (1.7 +/- 1.4 versus 2.8 +/- 0.3 (p < or = 0.001). Systolic parameters showed at rest an increase in isovolumetric contraction time (65 +/- 39 versus 112 +/- 50 ms, p < or = 0.01), in time to peak ejection (109 +/- 40 versus 188 +/- 42 ms, p < or = 0.001), and a reduced left ventricular ejection fraction (72 +/- 12 versus 64 +/- 11%, p < or = 0.01). Analysis of regional ejection fraction revealed a significant reduction of ejection fraction in the basal septal region (p < or = 0.05). Increase of global and regional ejection fraction under exercise was still preserved. Mean pulmonary capillary wedge pressure was significantly reduced at rest (11.8 +/- 3.8 versus 8.6 +/- 2.4 mm Hg, p < or = 0.05) as well as under exercise (27.0 +/- 7.1 versus 20.4 +/- 6.8 mm Hg, p < or = 0.01), whereas left ventricular enddiastolic volume index (63 +/- 19 versus 72 +/- 17 ml*m-2, p < or = 0.05) was significantly increased.
Conclusions:
In patients with HOCM, myectomy reduces intraventricular gradient, increases exercise capacity, and is accompanied by improved diastolic function parameters, while systolic function parameters are generally reduced.