Desai Milind Y, Szpakowski Natalie, Tower-Rader Albree, Bittel Barb, Fava Agostina, Ospina Susan, Xu Bo, Thamilarasan Maran, Mentias Amgad, Smedira Nicholas G, Popovic Zoran B
Hypertrophic Cardiomyopathy Center, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA.
Department of Cardiovascular Medicine Massachusetts General Hospital Boston MA USA.
J Am Heart Assoc. 2025 Jan 7;14(1):e037058. doi: 10.1161/JAHA.124.037058. Epub 2024 Dec 24.
In obstructive hypertrophic cardiomyopathy, myectomy improves symptoms, quality of life, and left ventricular (LV) outflow tract gradients. We prospectively evaluated the temporal changes in various echo parameters after myectomy.
In 173 adults with obstructive hypertrophic cardiomyopathy (53±10 years, 63% men) who underwent myectomy between March 2017 and June 2020, clinical and blinded echo assessment (before and at 12±6 months follow-up) was performed prospectively (SPIRIT-HCM [Quality of Life and Functional Capacity Following Septal Myectomy in Obstructive Patients With Hypertrophic Cardiomyopathy]). Changes in echocardiographic parameters (left atrial volume index, /', LV outflow tract gradients, along with average LV global longitudinal strain on apical 2-, 3-, and 4-chamber views and regional LV strain from apical 4-chamber view) were measured in 126 patients. There was significant improvement in left atrial volume index (-6.9 mL/m [95% CI, 4-9.7]), /' (-2.9 [95% CI, -2.7 to -4.1]) and peak LV outflow tract gradient (-94 mm Hg [95% CI -87 to -100]) from baseline to follow-up (both <0.001). There was no improvement in basal (0.91% [95% CI, -0.15 to 1.97], =0.09) and midseptal (-0.98% [95% CI, -1.93 to 0.02], =0.05) LV strain, worsening in apical septal strain (-4.5% [95% CI, -5.9 to -3.0], <0.001) and an improvement in LV free wall strain (2.3% [95% CI, 0.67-3.9], <0.001), with no change in overall LV-global longitudinal strain (0.47% [95% CI, -0.43 to 1.37], =0.30). There was no correlation between change in LV-global longitudinal strain and change in 6-minute walk time (r=0.12, =0.24) or Kansas City Cardiomyopathy Questionnaire summary score change (r=0.02, =0.85), whereas it was significantly associated with change in /' (r=0.29, =0.003).
In patients with obstructive hypertrophic cardiomyopathy, myectomy improved various echocardiography parameters at 1-year; however, LV-global longitudinal strain remained unchanged.
URL: https://clinicaltrials.gov; Unique identifier: NCT03092843.
在梗阻性肥厚型心肌病中，心肌切除术可改善症状、生活质量和左心室（LV）流出道梯度。我们前瞻性评估了心肌切除术后各种超声心动图参数的时间变化。
在2017年3月至2020年6月期间接受心肌切除术的173例梗阻性肥厚型心肌病成人患者（53±10岁，63%为男性）中，前瞻性地进行了临床和盲法超声心动图评估（术前和12±6个月随访时）（SPIRIT-HCM [梗阻性肥厚型心肌病患者间隔心肌切除术后的生活质量和功能能力]）。在126例患者中测量了超声心动图参数的变化（左心房容积指数、LV流出道梯度，以及心尖二腔、三腔和四腔视图上的平均LV整体纵向应变和心尖四腔视图上的局部LV应变）。从基线到随访，左心房容积指数（-6.9 mL/m [95% CI，4 - 9.7]）、LV流出道梯度（-2.9 [95% CI，-2.7至-4.1]）和LV流出道峰值梯度（-94 mmHg [95% CI -87至-100]）有显著改善（均<0.001）。基底室间隔（0.91% [95% CI，-0.15至1.97]，P = 0.09）和室间隔中部（-0.98% [95% CI，-1.93至0.02]，P = 0.05）的LV应变无改善，心尖室间隔应变恶化（-4.5% [95% CI，-5.9至-3.0]，<0.001），LV游离壁应变改善（2.3% [95% CI，0.67 - 3.9]，<0.001），而LV整体纵向应变无变化（0.47% [95% CI，-0.43至1.37]，P = 0.30）。LV整体纵向应变的变化与6分钟步行时间的变化（r = 0.12，P = 0.24）或堪萨斯城心肌病问卷总结评分的变化（r = 0.02，P = 0.85）无相关性，而与LV流出道梯度的变化显著相关（r = 0.29，P = 0.003）。
在梗阻性肥厚型心肌病患者中，心肌切除术在1年后改善了各种超声心动图参数；然而，LV整体纵向应变保持不变。
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