Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy

Objective： To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods： We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair （anterior mitral leaflet plication）; 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall＇s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge, Results： One patient died of post-operative heart failure. The mean follow-up time was 4.3 years, There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association （NYHA） Classes Ⅰ-Ⅱ due to associated valvular lesions, Conclusion： Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion （SAM） of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.

Uric acid is associated with cardiac death in patients with hypertrophic obstructive cardiomyopathy

BACKGROUND The role of uric acid(UA) in survival of patients with hypertrophic obstructive cardiomyopathy(HOCM) has not been fully evaluated. This study aimed to determine whether UA could be an independent risk factor of cardiac death in patients with HOCM.METHODS A total of 317 patients with HOCM, who were receiving conservative treatment in Fuwai Hospital from October2009 to December 2014, all of them completed UA evaluations, were analyzed. Patients were divided into three groups according to the UA levels: Tertile 1(≤ 318 μmol/L, n = 106), Tertile 2(319 to 397 μmol/L, n = 105), and Tertile 3(≥ 398 μmol/L, n = 106).RESULTS During a median follow-up of 45 months, 29 cardiac deaths(9.1%) occurred, including 6 sudden cardiac deaths and23 heart failure-related deaths. Cardiac death in Tertile 3(n = 16, 55.2%) was significantly higher than in Tertile 1(n = 6, 20.7%)and Tertile 2(n = 7, 24.1%). In univariate model, UA level(continuous value) showed predictive value of cardiac death [hazard ratio(HR) = 1.006, 95% CI: 1.003-1.009, P = 0.009]. Univariate Cox survival analysis had shown a significant higher property of cardiac death in patients of Tertile 3 when compared with those of Tertile 1, but cardiac death in patients of Tertile 2 did not show significant prognositic value compared with those of Tertile 1(HR = 3.927, 95% CI: 0.666-23.162, P = 0.131). UA was found to be an independent risk factor(HR = 1.005, 95% CI: 1.001-1.009, P = 0.009) of cardiac death in the multivariate regression analysis after the adjustment for age, body mass index, atrial fibrillation, hemoglobin, creatinine, high-sensitivity C-reactive protein, interventricular septum/left ventricular posterior wall ratio, left ventricular outflow tract and left ventricular ejection fraction.CONCLUSIONS UA concentration was found to be independently associated with cardiac death in HOCM patients receiving conservative treatment. Randomized trials of UA-lowering agents for HOCM patients are warranted.

Percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6±3.8 (6-20) months.Results Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93±22?mm?Hg vs 14.8±15?mm?Hg, P【0.0001) after the procedure with a mean decrease of 5.75±2.87?mm?Hg of left ventricular end diastolic pressure (P【0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4±0.5 vs 1.1±0.4, P【0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up. Conclusions LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and re-opening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.

Successful treatment with biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy

We report the effects of biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy （HOCM） refractory to medical therapy. A 58-year-old man with HOCM had suffered from dyspnea, chest pain and palpitation for 5 years. Cardiac catheterization showed a left ventricular outflow tract （LVOT） gradient of 80 mmHg. He refused septal myomectomy and the septal ablation was not available. Based on intraoperative pressure measurements, he was implanted with biventricular pacing and LVOT gradient decreased to 10 mmHg. During the follow-up period of 6 months, the patient＇s symptoms were markedly improved. Biventricular pacing may be an alternative therapy for patients with HOCM.

Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication

Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.

Myocardial condition after transcoronary ablation predicts the curative effect in patients with hypertrophic obstructive cardiomyopathy

Transcoronary ablation of septal hypertrophy （TASH） has been recommended as an option forpatients with drug-refractory hypertrophic obstructive cardiomyopathy （HOCM）. However, its outcome is varied, and some factors are attributed to the diversity results.1 Up to now, there is no study on the influence of the ablated myocardium＇s condition on the outcome. We retrospectively analyzed the myocardial perfusion imaging （MPI） obtained before and early after TASH in our patients to explore the relationship between the ablated myocardium＇s condition and the clinical outcome.

Cardiac electromechanical mapping in analyzing the mechanism of left ventricular remodeling immediately after percutaneous transluminal septal ablation in patients with hypertrophic obstructive cardiomyopathy

Background Effect of percutaneous transluminal septal ablation （PTSA） with ethanol injection on electromechanical remodeling of left ventricule still remains unknown. This study was conducted to assess the potential significance of cardiac electromechanical mapping （CEMM） in analyzing the left ventricular remodeling before and immediately after percutaneous transseptal myocardial ablation （PTSMA） in patients with hypertrophic obstructive cardiomyopathy （HOCM）.Methods Eight patients with drug-refractory HOCM and 6 patients with hypertrophic cardiopathy （HM） without increased left ventricular outtract gradien （LVOTG） were enrolled into the present study. CEMM was undergone in patients with HOCM before and immediately after PTSA procedure, and in patients with HM.Results PTSA was successful in all patients with HOCM, LVOTG significantly decreased from （62.87±21.16） mmHg to （ 12. 73± 3.05 ） mmHg immediately after ablation procedure. Value of UVP in septal-base segment in HM group was higher than that in HOCM group [ （22.79 ± 2. 34） mV vs （ 18.54 ± 1.76） mV ]. In patients with HOCM, lateral-middle and -base segments had lowest value of UVP [ （ 15.93±1.11 ） mV and （15.83 ±1.07）mV] before PTSA. Value of UVP at posterior-middle segment decreased from （23.58 ±2. 21 ） mV pre-PTSA to （18.89 ±1.91 ）mV post-procedure, PTSA led to significant increase of UVP at lateral-middle segment. Septal region in patients with HM and septal-middle, septal-base, posterior-base segments in HOCM had lower value of local linear shortening （LLS） among all patients in both HOCM and HM groups. PTSA resulted in significant reduction of LLS in anterior region and at septal-apex segment. Anterior-base and septal- middle segments in patients with HM had lowest value of local active time （ LAT）, and significantly differentiated from that in patients with HOCM [ （ -8.57 ±0. 68）ms vs （ - 18.61 ± 1.02）ms, （ -6. 75 ±0. 37）ms vs （ - 21.90 ± 0. 96）ms, respectively ]. LAT at septal-middle and -base segments in patients with HOCM was decreased significantly [ （ -21.90 ±0. 96）ms vs （ - 13.80 ±1.04）ms, P 〈0. 002; and （ - 15.20 ± 1.06）ms vs （ - 6. 33 ±0. 52） ms, respectively ] immediately after PTSA.Conclusions Posterior-lateral and anterior region probably played important roles in electromechanical remodeling. Significant electromechanical remodeling disassociation （uncoupling） was detected in most left ventricular regions, which would be important in differentiating of HOCM from HM, and in predicting the prognosis in patients with HOCM after PTSA procedure.

Left ventricular endocardial pacing predicts the reduction of left ventricular outflow tract pressure gradient immediately after percutaneous transseptal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medicatio

Background Hypertrophic obstructive cardiomyopathy （HOCM） carries an increased risk for sudden cardiac death. No data regarding the percutaneous transseptal myocardial ablation （PTSMA） and epicardial left ventricular pacing （LVP） were reported. Methods Seven patients with recurrent symptoms and increased resting left ventricular outflow tract pressure gradient （LVOTG） after PTSMA and another 14 patients with HOCM without history of PTSMA were studied. Both resting and dobutamine stress echocardiography, PTSMA and LVP were routinely performed. Results In patients without previous PTSMA procedure, mild reduction of resting LVOTG was detected at 5 minutes after left ventricular pacing, and this reduction became significant at 10 minutes. All patients were divided into successful and unsuccessful groups according to their response to LVP. In contrary to patients in unsuccessful group, resting and R-S2 stimuli-induced LVOTG during PTSMA procedure were decreased dramatically （（9±5） mmHg vs （58±12） mmHg, （12±2） mmHg vs （113±27） mmHg, P〈0.001）. Analysis of Logistic regression demonstrated that only LVOTG level dudng left ventdcular pacing was an independent factor predicting the reduction of LVOTG immediately after PTSMA （odds ratio （OR）, 0.59; 95% CI 2.67 to 5.82; P=0.0002）. Conclusion Left ventricular endocardial temporary pacing plays a critical role in predicting acute effect on the reduction of LVOTG immediately after PTSMA procedure.

Prevalence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy: a case-control study

Objective To explore the clinical characteristics and risk factors of pulmonary hypertension(PH)in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study.Incidence rate and severity of PH were depicted.

Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To compare the effects of septal ablation(SA)versus conservative medication(CM)on the hemodynamic,clinical status and survival in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods This retrospective study included 350 consecutive patients with HOCM(mean age(51.3±13.5)years old)hospitalized in Anzhen Hospital between