Ha Kyung Eun, Choi Kang-Un, Lee Hee-Jung, Gwak Seo-Yeon, Kim Kyu, Cho Iksung, Hong Geu-Ru, Ha Jong-Won, Shim Chi Young
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Division of Cardiology, Yeoungnam University College of Medicine, Daegu, Korea.
ESC Heart Fail. 2023 Oct;10(5):2939-2947. doi: 10.1002/ehf2.14481. Epub 2023 Jul 22.
Mechanical function of the left atrium (LA) and the left ventricle (LV) has been demonstrated to be a prognostic factor in patients with hypertrophic cardiomyopathy (HCM). We explore whether myocardial mechanical function can be improved by septal reduction therapy in symptomatic obstructive HCM.
Among 65 patients who underwent septal myectomy for symptomatic obstructive HCM from 2006 to 2022, 44 were analysed after excluding those who underwent simultaneous valve repair or replacement or maze operation. LA and LV functional variables including LA strain and LV global longitudinal strain were evaluated by two-dimensional and speckle-tracking echocardiography and compared before and 1 year after surgery. After septal myectomy, LA volume index (58.1 ± 18.3 vs. 45.3 ± 14.6 mL/m , P = 0.001) decreased significantly. As LV end-systolic dimension increased after surgery, the LV ejection fraction decreased (73.8 ± 6.7 vs. 62.9 ± 8.3%, P < 0.001). LA strain (24.4 ± 9.3 vs. 30.5 ± 13.6%, P = 0.004) improved after septal myectomy, but LV global longitudinal strain deteriorated (-12.6 ± 3.6 vs. -11.6 ± 4.3%, P = 0.033), mainly related to worsening non-septal longitudinal strain (-14.4 ± 4.3 vs. -10.9 ± 8.4%, P = 0.005).
As haemodynamic loads due to LV outflow tract obstruction was relieved through surgical septal reduction therapy in patients with symptomatic obstructive HCM, there was a significant reduction in LA volume and restoration of LA mechanical dysfunction. However, LV mechanical dysfunction deteriorated even after surgical septal reduction therapy.
左心房（LA）和左心室（LV）的机械功能已被证明是肥厚型心肌病（HCM）患者的一个预后因素。我们探讨在有症状的梗阻性HCM患者中，间隔减容治疗是否能改善心肌机械功能。
在2006年至2022年期间因有症状的梗阻性HCM接受间隔心肌切除术的65例患者中，排除那些同时进行瓣膜修复或置换或迷宫手术的患者后，对44例进行了分析。通过二维和斑点追踪超声心动图评估包括LA应变和LV整体纵向应变在内的LA和LV功能变量，并在手术前和手术后1年进行比较。间隔心肌切除术后，LA容积指数（58.1±18.3 vs. 45.3±14.6 mL/m²，P = 0.001）显著降低。由于手术后LV收缩末期内径增加，LV射血分数降低（73.8±6.7 vs. 62.9±8.3%，P < 0.001）。间隔心肌切除术后LA应变（24.4±9.3 vs. 30.5±13.6%，P = 0.004）有所改善，但LV整体纵向应变恶化（-12.6±3.6 vs. -11.6±4.3%，P = 0.033），主要与非间隔纵向应变恶化有关（-14.4±4.3 vs. -10.9±8.4%，P = 0.005）。
在有症状的梗阻性HCM患者中，通过手术间隔减容治疗缓解了LV流出道梗阻引起的血流动力学负荷，LA容积显著减少，LA机械功能障碍得以恢复。然而，即使在手术间隔减容治疗后，LV机械功能障碍仍有所恶化。
