scholarly journals Right Ventricular Mechanical Changes after Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy: Vector Velocity Imaging Study

2019 ◽  
Vol 09 (07) ◽  
pp. 467-488
Author(s):  
Hala Mahfouz Badran ◽  
Ghada Soltan ◽  
Naglaa Faheem ◽  
Mohamed Ezzat Enait ◽  
Magdi H. Yacoub
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Right Ventricular ◽  
Imaging Study ◽  
Septal Myectomy ◽  
Velocity Imaging ◽  
Vector Velocity ◽  
Obstructive Hypertrophic Cardiomyopathy

P1771Right ventricular mechanical changes after septal myectomy for obstructive hypertrophic cardiomyopathy. Vector velocity imaging study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Badran ◽  
G Soltan ◽  
N Faheem ◽  
M Ezzat ◽  
M H Yacoub
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Nyha Class ◽  
Imaging Study ◽  
Functional Class ◽  
Class Iii ◽  
Septal Myectomy ◽  
Cardiac Phenotype ◽  
Velocity Imaging ◽  
Vector Velocity ◽  
Surgical Myectomy

Abstract Objectives The impairment of right ventricular (RV) myocardial mechanics is evident in hypertrophic cardiomyopathy (HCM). It is independently influenced by LV mechanics and correlated to the severity of LV phenotype. We investigated the changes in RV global and regional deformation following surgical septal myectomy using vector velocity imaging (VVI). Methods 25 HCM patients, 68% males with mean age (34.5±12 years) were examined before and within two months after surgical myectomy using VVI. In addition to conventional echocardiographic parameters, peak systolic strain (εsys), strain rate (SR) and time to peak εsys (TTP) of regional RV free wall (RVFW) & septal walls were analyzed in longitudinal (long) directions from apical four chamber view and their (Δ)changes were calculated. Similar parameters were quantified in LV from apical 2 & 4 CH views. Intra-V-delay was defined as SD of TTP and inter-V dyssynchrony was estimated from TTP difference between the most delayed LV segment & RVFW. Results All study patients showed improvement of their functional class from NYHA class III to class I and reduction of LVOT gradient to below 20 mmHg except one patient who had 30 mmHg gradients at rest. There was significant reduction of septal thickness, left atrial diameter& volume, LVOT gradient, LVMI, severity of mitral regurgitation, tricuspid annular velocities (P<0.0001), RV diameter (P<0.02) and increase in LV internal dimensions (P<0.001) post myectomy. However, there was significant reduction of RV and LV systolic mechanics; RV global εsys % (from −16.1±4.4 to −12.9±2.9, P<0.0001) and LV global εsys %: from −11.6±2.8 to −9.4±2.2%, P<0.0001) respectively. The magnitude of reduction of RV strain (Δ RV εsys%, Δ SRsys) was directly correlated LV maximal wall thickness (r=0.46, P<0.01) and ΔRV dyssynchrony (TTP-SD), (r=0.4, P<0.05) and negatively correlated to age (r=−0.46, P<0.02), pre-op RV SRsys (r=−0.52, P<0.01) and pre-op LV EF% (r=−0.43, P<0.03). Meanwhile the reduction in RV diastolic mechanics: Δ RV SRe & SRa were directly correlated to PAP and LVOT gradient before surgery (r=0.62, P<0.002). Conclusion Despite improvement of patient functional status and reduction LVOT gradient, RV mechanics shows further deterioration after surgical myectomy. The magnitude of reduction is modestly related to cardiac phenotype and pre-op mechanical function.

RF42 LONG TERM RESULTS OF SEPTAL MYECTOMY IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY

2018 ◽  
Vol 19 ◽  
pp. e76-00
Author(s):  
G. Saitto ◽  
F. Grimaldi ◽  
A. Varrica ◽  
A. Biondi ◽  
A. Garatti ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Long Term Results ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy

Abstract 14301: Effects of Septal Reduction Therapy on Acute Cardiovascular Events and All-cause Mortality in Patients With Obstructive Hypertrophic Cardiomyopathy: Propensity Score-matched Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sae Morita ◽  
Yanling Zhao ◽  
Kohei Hasegawa ◽  
Muredach P Reilly ◽  
Mathew S Maurer ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Propensity Score ◽  
New York State ◽  
Control Group ◽  
Short Term ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy ◽  
All Cause Mortality ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Matched Study

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

scholarly journals Short-term outcomes of surgical atrial ablation and septal myectomy

2021 ◽  
Vol 25 (3) ◽  
pp. 51
Author(s):  
A. S. Zalesov ◽  
A. V. Bogachev-Prokophiev ◽  
A. V. Afanasyev ◽  
R. M. Sharifulin ◽  
A. V. Sapegin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Sinus Node ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Radiofrequency Energy ◽  
Short Term ◽  
Surgical Ablation ◽  
Septal Myectomy ◽  
Atrial Ablation ◽  
Obstructive Hypertrophic Cardiomyopathy

<p><strong>Background.</strong> Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited.<br /><strong>Aim.</strong> This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation.<br /><strong>Methods.</strong> Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%).<br /><strong>Results.</strong> Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge.<br /><strong>Conclusion.</strong> Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.</p><p>Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.S. Zalesov, A.V. Bogachev-Prokophiev<br />Data collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. Sapegin<br />Statistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. Sharifulin<br />Drafting the article: A.S. Zalesov<br />Critical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. Demin<br />Final approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin</p>

Abstract 13590: Demographic and Clinical Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in a Large, Nationwide Us Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Butzner ◽  
Phil Sarocco ◽  
Ethan J Rowin ◽  
Martin S Maron ◽  
Laura A Robertson
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Clinical Characteristics ◽  
National Sample ◽  
Centers Of Excellence ◽  
Septal Myectomy ◽  
Level Data ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Integrated Delivery ◽  
Comorbidity Index ◽  
Delivery Networks

Background: Obstructive hypertrophic cardiomyopathy (oHCM) has mostly been studied in patients treated in advanced comprehensive Centers of Excellence (COE). Understanding the true prevalence of patients with oHCM in the general US population may improve the screening, identification, and treatment outside of COEs. Objectives: To describe the demographics and clinical characteristics of patients with oHCM. Methods: This is a retrospective cohort study to assess patient-level data from the IBM Explorys database (observational period: January 1, 2010 to December 31, 2018). The Explorys database amassed electronic medical records from 39 Integrated Delivery Networks (IDN) from ~12,982,704 patients. We identified adult patients (>18 years old) with oHCM and report their demographics and clinical characteristics from index date to the end of study period. Results: Of 8,792 patients, 53.0% were female, and 81.2% Caucasian (mean index age: 61.8 years). Primary insurance type was private (58.9%); 54.9% of patients lived in the Midwest. Mean BMI at index was 30.4; 30.9% were nondrinkers. The mean Quan-Charlson Comorbidity Index was 6.35% with the most common comorbidities being congestive heart failure (31.9%), chronic pulmonary disease (20.1%), and diabetes without chronic complications (16.9%). CV drug rates included β-blockers (80.5%), CCBs (46.0%), ACE inhibitors (27.7%), ARBs (18.8%), disopyramide (2.4%) and amiodarone (13.0%). Surgical procedure rates included septal myectomy (22%), ablation (19.8%), implantable cardioverter defibrillator (11.2%), and heart transplantation (0.3%). Major residual side effects subsequent to surgical procedures included atrial fibrillation (31.4%) and reintervention (15.6%). Common reintervention procedures included ablation and septal myectomy. Conclusions: This is the first study to examine a national sample of oHCM patients using clinical data from more than 39 IDNs. Leveraging the Explorys database allowed us to analyze a larger, more diverse cohort of oHCM patients across the entire broader US. The results from this analysis may be used to compare the characteristics of patients with oHCM in the general population with those treated in COE.

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