Preoperative left ventricular longitudinal strain predicts outcome of septal myectomy for obstructive hypertrophic cardiomyopathy.

Published on Oct 6, 2021in The Journal of Thoracic and Cardiovascular Surgery5.209
· DOI :10.1016/J.JTCVS.2021.09.058
Hao Cui7
Estimated H-index: 7
(Mayo Clinic),
Hartzell V. Schaff132
Estimated H-index: 132
(Mayo Clinic)
+ 4 AuthorsSteve R. Ommen80
Estimated H-index: 80
(Mayo Clinic)
Sources
Abstract
Abstract null null Objective null The objective of this study was to determine the characteristics of longitudinal strain and its effect on outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM) who underwent septal myectomy. null null null Methods null We reviewed patients with obstructive HCM who underwent septal myectomy at our clinic from 2007 to 2016. Data of those who had strain echocardiography within 6 months before isolated myectomy were analyzed. null null null Results null The median age of the 857 patients studied was 55 (interquartile range [IQR], 44-63) years, and 451 (52.6%) were male. Left ventricular ejection fraction was 71% (IQR, 67%-74%), and the resting peak outflow tract gradient was 58 (IQR, 27-85) mm Hg. The median global longitudinal strain (GLS) was −14.6% (IQR, −12.0% to −17.3%). Regional longitudinal strain was nonuniform as reflected by more normal values in apical segments and more abnormal in basal segments. Moreover, GLS correlated poorly with ejection fraction and outflow tract gradient. In 64 patients who had postoperative strain echocardiography, GLS was comparable before and after septal myectomy, but regional strain was more uniform after myectomy. Over a follow-up of 8.3 (IQR, 6.5-10.3) years, when patients were equally stratified according to GLS (cutoff, −14.64%), the group with worse GLS had significantly poorer survival compared with the better GLS group (P = .002). Left ventricular ejection fraction had no association with survival. null null null Conclusions null Left ventricular longitudinal strain is nonuniform and might be significantly reduced in patients with obstructive HCM. Septal myectomy does not impair GLS but is associated with more uniform regional strains. Most importantly, reduced GLS preoperatively is strongly and independently associated with increased all-cause mortality after septal myectomy for obstructive HCM.
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References32
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#1Sven-Oliver Tröbs (University of Mainz)H-Index: 3
#2Jürgen H. Prochaska (University of Mainz)H-Index: 14
Last. Philipp S. Wild (University of Mainz)H-Index: 66
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Importance Global longitudinal strain (GLS) is an emerging echocardiographic biomarker of cardiac function in heart failure (HF). Evidence from large-scale studies comprehensively investigating GLS for its association with clinical phenotypes and mortality in asymptomatic and symptomatic chronic HF is limited. Objective To assess the factors associated with GLS and its prognostic value in patients with chronic HF. Design, Setting, and Participants The observational, prospective MyoVasc cohort st...
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#1Brian P. Halliday (Imperial College London)H-Index: 10
#2Roxy Senior (Imperial College London)H-Index: 72
Last. Dudley J. Pennell (Imperial College London)H-Index: 115
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The measurement of left ventricular ejection fraction (LVEF) is a ubiquitous component of imaging studies used to evaluate patients with cardiac conditions and acts as an arbiter for many management decisions. This follows early trials investigating heart failure therapies which used a binary LVEF cut-off to select patients with the worst prognosis, who may gain the most benefit. Forty years on, the cardiac disease landscape has changed. Left ventricular ejection fraction is now a poor indicator...
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#1Paaladinesh Thavendiranathan (UHN: University Health Network)H-Index: 42
#2Tomoko Negishi (Menzies Research Institute)H-Index: 1
Last. Succour investigatorsH-Index: 3
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ABSTRACT Background In patients at risk of cancer therapy-related cardiac dysfunction (CTRCD), initiation of cardio-protective therapy (CPT) is constrained by the low sensitivity of EF for minor changes in LV function. Global longitudinal strain (GLS) is a robust and sensitive marker of LV dysfunction, but existing observational data have been insufficient to support a routine GLS-guided strategy for CPT. Objective To identify whether GLS-guided CPT prevents reduction in LVEF in patients undergo...
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#1Hao Cui (Mayo Clinic)H-Index: 7
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Steve R. Ommen (Mayo Clinic)H-Index: 80
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Abstract Objective This study was conducted to determine the influence of early septal reduction therapy (SRT) after referral on survival in patients with obstructive hypertrophic cardiomyopathy. Methods We reviewed the patients with obstructive hypertrophic cardiomyopathy (resting pressure gradient ≥30 mm Hg or provoked pressure gradient ≥50 mm Hg) who were evaluated at our clinic from 2000 to 2012. Early SRT was defined as undergoing septal myectomy or alcohol septal ablation during the 6 mont...
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#1Efstathios D. Pagourelias (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 20
#2Oana Mirea (CUA: The Catholic University of America)H-Index: 13
Last. Jens-Uwe Voigt (CUA: The Catholic University of America)H-Index: 56
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AIMS: We aimed at directly comparing three-dimensional (3D) and two-dimensional (2D) deformation parameters in hypertrophic hearts and depict which may best reflect underlying fibrosis in hypertrophic cardiomyopathy (HCM), defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). METHODS AND RESULTS: We included 40 HCM [54.1 +/- 14.3 years, 82.5% male, maximum wall thickness (MWT) 19.3 +/- 4.8 mm] and 15 hypertensive (HTN) patients showing myocardial hypertrophy (58.1 +/-...
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Last. Martin S. Maron (Tufts Medical Center)H-Index: 73
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Abstract Background End-stage (ES) hypertrophic cardiomyopathy (HCM) has been considered a particularly grim and unfavorable disease complication, associated with substantial morbidity and mortality, frequently requiring heart transplant. Previous reports have included small numbers of patients with relatively short follow-up, predominantly in prior treatment eras. Objectives The purpose of this study was to re-evaluate clinical profile and prognosis for end-stage heart failure in a large HCM co...
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#1Dan Zhu (PKU: Peking University)H-Index: 1
#2Saki Ito (Mayo Clinic)H-Index: 5
Last. Jae K. Oh (Mayo Clinic)H-Index: 119
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BACKGROUND: Left ventricular global longitudinal strain (GLS) is associated with long-term outcomes of patients with severe aortic stenosis. However, its prognostic value in patients with moderate aortic stenosis remains unknown. METHODS: Patients diagnosed with moderate aortic stenosis (1.0 /=50% were identified. GLS was assessed by 2-dimensional strain imaging using speckle-tracking method. All-cause mortality was assessed according to the median GLS value. RESULTS: Two hundred eighty-seven pa...
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#1Hao Cui (Mayo Clinic)H-Index: 7
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 103
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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...
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#1Farnaz Namazi (LUMC: Leiden University Medical Center)H-Index: 3
#2Pieter van der Bijl (LUMC: Leiden University Medical Center)H-Index: 13
Last. Jeroen J. Bax (LUMC: Leiden University Medical Center)H-Index: 152
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Abstract Background Left ventricular (LV) systolic function may be overestimated in patients with secondary mitral regurgitation (MR) when using LV ejection fraction (EF). LV global longitudinal strain (GLS) is a less load-dependent measure of LV function. However, the prognostic value of LV GLS in secondary MR has not been evaluated. Objectives This study sought to demonstrate the prognostic value of LV GLS over LVEF in patients with secondary MR. Methods A total of 650 patients (mean 66 ± 11 y...
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#1Albree Tower-Rader (Cleveland Clinic)H-Index: 7
#2Divyanshu Mohananey (Cleveland Clinic)H-Index: 16
Last. Milind Y. Desai (Cleveland Clinic)H-Index: 69
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Abstract Objectives The association of left ventricular global longitudinal strain (LV-GLS) with clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has been examined in multiple studies. The authors conducted a systematic review aimed at summarizing and critically appraising the current evidence. Background HCM is a common genetic cardiovascular disease with an estimated prevalence of 1 in 500 patients. LV-GLS derived from speckle tracking echocardiography is a sensitive noninv...
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#1Charles M. Wojnarski (Virginia Mason Medical Center)
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