Latent outflow tract obstruction in hypertrophic cardiomyopathy: Clinical characteristics and outcomes of septal myectomy.

Published on Dec 10, 2020in The Journal of Thoracic and Cardiovascular Surgery4.451
· DOI :10.1016/J.JTCVS.2020.12.016
Hao Cui4
Estimated H-index: 4
(Mayo Clinic),
Hartzell V. Schaff131
Estimated H-index: 131
(Mayo Clinic)
+ 3 AuthorsSteve R. Ommen78
Estimated H-index: 78
(Mayo Clinic)
Sources
Abstract
Abstract Objective This investigation analyzed clinical characteristics of patients with hypertrophic cardiomyopathy (HCM) and latent left ventricular outflow tract (LVOT) and outcomes following septal myectomy. Methods We reviewed patients with HCM and LVOT obstruction undergoing septal myectomy from 2001 to 2016 at our center. Follow-up data on functional status were obtained through mailed survey questionnaires. Results There were 629 (31.8%) patients with latent obstruction (resting LVOT gradient 30 mm Hg) among 1981 patients undergoing septal myectomy. Patients with latent obstruction were more likely to be male (65.7% vs 51.8%, P  Conclusions Patients with HCM and latent LVOT obstruction generally have milder left ventricular hypertrophy but similarly impaired functional capacity compared to those with resting obstruction. Septal myectomy improves functional capacity and symptoms.
References18
Newest
#1Hao Cui (Mayo Clinic)H-Index: 4
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 128
view all 7 authors...
Abstract Objective There has been debate on the importance and pathophysiologic effects of the dynamic subaortic pressure gradient in hypertrophic obstructive cardiomyopathy. The study was conducted to elucidate the hemodynamic abnormalities associated with the dynamic pressure gradient in hypertrophic obstructive cardiomyopathy. Methods Eight patients with hypertrophic obstructive cardiomyopathy and 7 patients with valvular aortic stenosis underwent a detailed hemodynamic study of pressure flow...
7 CitationsSource
#1Hao Cui (Mayo Clinic)H-Index: 4
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Abstract Background Conduction abnormalities including bundle branch block are recognized sequelae following septal myectomy in patients with hypertrophic cardiomyopathy, but their incidence and effect on long-term mortality have not been well studied. Objectives This study was conducted to determine the impact of conduction abnormalities on mortality in patients with obstructive hypertrophic cardiomyopathy following myectomy. Methods The outcomes of 2,482 patients with obstructive hypertrophic ...
21 CitationsSource
#1Zahara Meghji (Mayo Clinic)H-Index: 4
#2Anita Nguyen (Mayo Clinic)H-Index: 10
Last. Hartzell V. Schaff (Mayo Clinic)H-Index: 131
view all 9 authors...
Importance Recent data indicate that women with hypertrophic cardiomyopathy (HCM) are older and more symptomatic at presentation and have worse clinical outcomes than men. However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. Objective To analyze preoperative characteristics and overall survival of women and men undergoing septal myectomy for obstructive HCM. Design, Setting, and Participants This retrospective, single-cent...
24 CitationsSource
#1Anita Nguyen (Mayo Clinic)H-Index: 10
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Background In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of L...
15 CitationsSource
#1Dai-Yin Lu (NYMU: National Yang-Ming University)H-Index: 11
#2Iraklis Pozios (Johns Hopkins University)H-Index: 13
Last. Theodore P. Abraham (Johns Hopkins University)H-Index: 66
view all 10 authors...
Background Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterized by varying degrees of left ventricular outflow tract obstruction. In a large cohort, we compare the outcomes among 3 different hemodynamic groups. Methods and Results We prospectively enrolled patients fulfilling standard diagnostic criteria for HCM from January 2005 to June 2015. Detailed phenotypic characterization, including peak left ventricular outflow tract pressure gradients at rest and after ...
17 CitationsSource
#1Chadi Ayoub (Mayo Clinic)H-Index: 6
#2Jeffrey B. Geske (Mayo Clinic)H-Index: 25
Last. Patricia A. Pellikka (Mayo Clinic)H-Index: 101
view all 6 authors...
Guidelines recommend exercise stress echocardiogram (ESE) for patients with hypertrophic cardiomyopathy (HC) if a 50 mm Hg gradient is not present at rest or provoked with Valsalva or amyl nitrite, to direct medical and surgical management. However, no study has directly compared all 3 methods. We sought to evaluate efficacy and degree of provocation of left ventricular outflow gradients by ESE, and compare with Valsalva and amyl nitrite. In patients with HC between 2002 and 2015, resting echoca...
17 CitationsSource
#1Jeffrey B. Geske (Mayo Clinic)H-Index: 25
#2Kevin C. Ong (Mayo Clinic)H-Index: 5
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 12 authors...
Abstract Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were old...
73 CitationsSource
#1Rick A. Nishimura (Mayo Clinic)H-Index: 128
#2Hubert Seggewiss (Mayo Clinic)H-Index: 1
Last. Hartzell V. Schaff (Mayo Clinic)H-Index: 131
view all 3 authors...
Hypertrophic cardiomyopathy is a genetic disorder characterized by marked hypertrophy of the myocardium. It is frequently accompanied by dynamic left ventricular outflow tract obstruction and symptoms of dyspnea, angina, and syncope. The initial therapy for symptomatic patients with obstruction is medical therapy with β-blockers and calcium antagonists. However, there remain a subset of patients who have continued severe symptoms, which are unresponsive to medical therapy. These patients can be ...
58 CitationsSource
#1Dai-Yin Lu (NYMU: National Yang-Ming University)H-Index: 11
#2Bereketeab Hailesealassie (Johns Hopkins University)H-Index: 1
Last. Theodore P. Abraham (Johns Hopkins University)H-Index: 66
view all 12 authors...
Abstract Background Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30mmHg at rest or with provocation. There are no data on whether 30mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes. Methods Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite c...
11 CitationsSource
#1Joon Hwa Hong (Mayo Clinic)H-Index: 3
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Abstract Background Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. Objectives This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM. Methods A total of 2,107 septal myectomy operations performed in adults from January 1993 to May 2014 at Mayo Clinic in Rochester, Minnesota, were retrospectively revie...
91 CitationsSource
Cited By5
Newest
#1Qiang Ji (Fudan University)H-Index: 44
#2Yulin Wang (Fudan University)H-Index: 7
Last. Chunsheng WangH-Index: 21
view all 8 authors...
Abstract null null Background null The role of mitral subvalvular anomalies in the etiology of latent left ventricular outflow tract (LVOT) obstruction has rarely been reported; and the results of surgical treatment for latent LVOT obstruction have been infrequently reported as a separate group by other medical centers other than Mayo clinic. null null null Methods null Among 292 eligible patients, 45 with resting gradients null null null null Results null Comparatively, patients with latent obs...
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#1Juliano Lentz Carvalho (Mayo Clinic)H-Index: 3
#2Elena Ashikhmina (Mayo Clinic)H-Index: 8
Last. Hartzell V. Schaff (Mayo Clinic)H-Index: 131
view all 7 authors...
OBJECTIVES It is not uncommon to observe some discrepancy in hemodynamic values characterizing left ventricular outflow tract (LVOT) obstruction preoperatively and in the operating room in patients with hypertrophic obstructive cardiomyopathy. Interpretation of this discrepancy can be challenging. To clarify the extent of the discrepancy, the authors compared hemodynamic variables in patients undergoing septal myectomy at the time of preoperative and intraoperative evaluation. DESIGN Retrospecti...
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#1Stephanie Nguyen (CUMC: Columbia University Medical Center)H-Index: 5
#2Shepard D. Weiner (CUMC: Columbia University Medical Center)H-Index: 7
Last. Hiroo TakayamaH-Index: 58
view all 4 authors...
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