CardiomyopathyEffects of Percutaneous Transluminal Septal Myocardial Ablation for Obstructive Hypertrophic Cardiomyopathy on Systolic and Diastolic Left Ventricular Function Assessed by Pressure–Volume Loops
Section snippets
Methods
The study population consisted of 10 consecutive patients with symptomatic obstructive HC despite optimal medical treatment who were referred for PTSMA at our center. The HC diagnosis was based on typical clinical, echocardiographic, and angiocardiographic findings. Inclusion criteria were New York Heart Association functional classes II to IV, LV outflow tract gradient >50 mm Hg at rest or >100 mm Hg at provocation (after extrasystole, isoproterenol, or Valsalva maneuver), septal thickness >15
Results
Baseline and 6-month follow-up clinical characteristics and hemodynamic measurements are presented in Table 1. Mean age at the time of the procedure was 61 ± 11 years. Angina was the principal manifestation in 3 patients (30%), syncope in 2 (20%), and dyspnea in 5 (50%). Despite optimal medical treatment, 4 patients (40%) were in New York Heart Association class III and 6 (60%) were in New York Heart Association class II. Mean gradient at rest was 88 ± 29 mm Hg and mean postextrasystolic
Discussion
Results of the present study indicated that, at 6-month follow-up, (1) LV outflow tract gradient remained low at rest and at provocation, (2) general hemodynamics and intrinsic myocardial systolic properties were not affected, and (3) diastolic function was significantly improved.
Short- and mid-term results of PTSMA are excellent for the decrease of LV outflow tract gradient obstruction. Previous studies have reported that, at 3 months, mean pressure gradients at rest and at provocation
References (28)
- et al.
Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up
J Am Coll Cardiol
(2000) - et al.
Early remodelling of left ventricle and improvement of myocardial performance in patients after percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy
Int J Cardiol
(2003) - et al.
Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy
Am J Cardiol
(2003) - et al.
Early remodelling of left ventricle and improvement of performance in patients after percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy
Int J Cardiol
(2003) - et al.
Usefulness of early diastolic flow propagation velocity measured by color M-mode Doppler technique for the assessment of left ventricular diastolic function in patients with hypertrophic cardiomyopathy
J Am Soc Echocardiogr
(2000) - et al.
Percutaneous transluminal septal myocardial ablation in drug-resistant hypertrophic obstructive cardiomyopathy: 18-month follow-up results
J Invasive Cardiol
(2001) - et al.
Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and three-year noninvasive follow-up in 18 patients
Can J Cardiol
(2004) - et al.
Echocardiography-guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy
Circulation
(1998) - et al.
Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy
Circulation
(1999) - et al.
Continuous measurement of left ventricular volume in animals and humans by conductance catheter
Circulation
(1984)
Hypertonic saline method accurately determines parallel conductance for dual-field conductance catheter
Am J Physiol Heart Circ Physiol
Single-beat estimation of the slope of the end-systolic pressure–volume relation in the human left ventricle
Circulation
Single-beat estimation of end-diastolic pressure–volume relationship: a novel method with potential for noninvasive application
Am J Physiol Heart Circ Physiol
Assessment of systolic and diastolic ventricular properties via pressure–volume analysis: a guide for clinical, translational, and basic researchers
Am J Physiol Heart Circ Physiol
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