Cardiomyopathy
Effects of Percutaneous Transluminal Septal Myocardial Ablation for Obstructive Hypertrophic Cardiomyopathy on Systolic and Diastolic Left Ventricular Function Assessed by Pressure–Volume Loops

https://doi.org/10.1016/j.amjcard.2007.12.016Get rights and content

The aim of the present study was to determine the long-term effects of percutaneous transluminal septal myocardial ablation (PTSMA) on systolic and diastolic left ventricular (LV) functions in patients with obstructive hypertrophic cardiomyopathy (HC). Ten consecutive patients with symptomatic HC despite optimal medical treatment were referred for PTSMA at our center. LV systolic and diastolic functions were assessed by online LV pressure–volume loops obtained by conductance catheter at baseline and at 6 months after the procedure. At follow-up, the mean gradients at rest and after extrasystole were significantly decreased compared with baseline (88 ± 29 to 21 ± 11 mm Hg and 130 ± 50 to 35 ± 22 mm Hg, respectively, p <0.01 for the 2 comparisons). End-systolic and end-diastolic pressures significantly decreased (p <0.01), whereas end-systolic and end-diastolic LV volumes significantly increased (p <0.01 for the 2 comparisons). Cardiac output and stroke volume were unchanged, as were ejection fraction (p = 0.25) and maximum dP/dt (p = 0.13). The slope of the end-systolic pressure–volume relation was not decreased, indicating a preserved contractility. The relaxation constant time, end-diastolic stiffness, projected volume of the end-diastolic pressure–volume relation at 30 mm Hg, and diastolic stiffness constant showed a significant improvement of active and passive myocardial diastolic properties. In conclusion, PTSMA is an effective method in the treatment of symptomatic patients with HC. At 6-month follow-up, the LV–aortic gradient was decreased and active and passive LV diastolic properties were increased. Myocardial contractility was not decreased and general hemodynamics was maintained.

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

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