Preoperative pulmonary hypertension did not significantly influence outcomes, with 92% of exposed and 95% of unexposed patients being asymptomatic or mildly symptomatic post-procedure.
Observational (n=162)
Does preoperative pulmonary hypertension influence clinical and surgical outcomes after septal reduction therapy in patients with obstructive hypertrophic cardiomyopathy?
Tasa de eventos absoluta: 92% vs 95%
BACKGROUND: There are limited data on the prevalence, pathophysiology, and management implications of pulmonary hypertension in patients with obstructive hypertrophic cardiomyopathy and advanced heart failure. METHODS AND RESULTS: To assess the clinical significance of measured cardiopulmonary hemodynamics in hypertrophic cardiomyopathy patients with heart failure, we retrospectively assessed right heart catheterization data in 162 consecutive patients with outflow tract gradients (median interquartile range, 90 mm Hg 70-110 mm Hg), 59±11 years old, and 49% men, predominately New York Heart Association class III/IV status. Pulmonary hypertension (mean pulmonary artery pressure, ≥25 mm Hg) was present in 82 patients (51%), including 29 (18%) regarded as moderate-severe (mean pulmonary artery pressure, ≥35 mm Hg) and 28 (34%) also had increased pulmonary vascular resistance >3.0 WU. The pulmonary artery wedge pressure was ≤15 mm Hg in 54%, indicating that left atrial hypertension was absent in a majority of patients. Notably, 9 patients (11%) met hemodynamic criteria for precapillary pulmonary hypertension (mean pulmonary artery pressure, ≥25 mm Hg; pulmonary vascular resistance, >3.0 WU; pulmonary artery wedge pressure, ≤15 mm Hg). Over a median follow-up of 327 days (90-743 days) after surgical myectomy (or alcohol septal ablation), 92% and 95% of patients with or without preoperative pulmonary hypertension, respectively, were asymptomatic or mildly symptomatic. One postoperative death occurred in a 59-year-old woman with acute respiratory failure and mean pulmonary artery pressure of 65 mm Hg. CONCLUSIONS: Pulmonary hypertension was common in obstructive hypertrophic cardiomyopathy patients with advanced heart failure. Although possibly a contributor to preoperative heart failure, pulmonary hypertension did not significantly influence clinical and surgical outcome. Notably, a novel patient subgroup was identified with resting invasive hemodynamics consistent with pulmonary vascular disease.
Covella et al. (Sat,) conducted a observational in obstructive hypertrophic cardiomyopathy and advanced heart failure (n=162). Preoperative pulmonary hypertension vs. No preoperative pulmonary hypertension was evaluated on Asymptomatic or mildly symptomatic status after surgical myectomy or alcohol septal ablation. Preoperative pulmonary hypertension did not significantly influence outcomes, with 92% of exposed and 95% of unexposed patients being asymptomatic or mildly symptomatic post-procedure.
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